Impact of a Clinical Documentation Integrity Program on Severity of Illness of Expired Patients

BACKGROUND: As payment models continue to move toward value-driven care, the quality of documentation has become more important than ever. Clinical Documentation Integrity (CDI) programs can aid in the documentation of diagnoses that are specific and consistent throughout the medical record, which leads to accurate code assignment, better understanding of patient complexity, and improved facility reimbursement.

METHODS: An interrupted time series analysis was conducted by using a segmented regression model to estimate the impact of our hospital’s CDI program on perceived patient complexity using severity of illness stratification, observed to expected mortality ratio and case-mix index. Patients who died during the admission were chosen to limit our analysis to patients with the highest severity of illness.

RESULTS: A total of 206 patients who had died while inpatient at our 400 bed children’s hospital were included. There was a 15.7% increase in patients who were final coded with the highest level of severity of illness after our CDI program launched compared with those patients admitted before program inception. The hospital case-mix index for inpatient cases increased 25% from 2011 to 2017. There was a 44% decrease in the observed to expected mortality ratio.

DISCUSSION: A CDI program can have a significant impact, as evidenced by our ability to show complexity gains on some of the sickest patients by supporting documentation of precise, accurate diagnoses. In turn, this may allow for better understanding of the complexity of our patient population and support appropriate reimbursement and payer contract negotiations.