Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
World Neurosurg. 2020 Jan;133:e819-e827. doi: 10.1016/j.wneu.2019.10.022. Epub 2019 Oct 10.
The mortality index, or the ratio of observed to expected mortality, is a reported quality metric that has been assumed to directly reflect patient care. However, documentation and coding that does not use knowledge of how a reported mortality index is derived could reflect poorly on a hospital or service line. We present our effort at reducing the reported mortality index of neurosurgery and neurology patients within a neurocritical care unit through documentation and coding accuracy with direct incorporation of mortality modeling.
Using a reported method from Vizient Inc., we generated a spreadsheet tool to enable direct manipulation of the data to identify documentation and coding issues that influenced the reported mortality index in a retrospective set of patients. Subsequently, we implemented the prospective changes to documentation and coding and compared our calculated mortality index to the reported Vizient mortality index.
Prospective implementation of the documentation and coding issues identified through our spreadsheet tool resulted in a drastic reduction of both our calculated and the reported Vizient mortality index.
Incorporating knowledge of mortality index modeling into the documentation and coding resulted in impressive reductions in the reported mortality index for our patients, serving as a both an internal benchmark and a method of comparison with other institutions.
死亡率指数，即观察死亡率与预期死亡率之比，是一种已被认为可直接反映患者护理质量的报告指标。然而，如果报告的死亡率指数的文档记录和编码没有利用死亡率模型的相关知识，这可能会对医院或服务线产生不利影响。我们通过直接纳入死亡率模型，展示了在神经重症监护病房中通过文档记录和编码准确性来降低神经外科和神经科患者报告死亡率指数的努力。
我们使用 Vizient Inc. 报告的方法，生成了一个电子表格工具，以实现对数据的直接操作，从而确定影响报告死亡率指数的文档记录和编码问题。随后，我们实施了前瞻性的文档记录和编码更改，并将我们计算的死亡率指数与报告的 Vizient 死亡率指数进行了比较。
通过我们的电子表格工具确定的文档记录和编码问题的前瞻性实施，导致我们计算的和报告的 Vizient 死亡率指数都大幅降低。
将死亡率指数建模的知识纳入文档记录和编码中，使我们的患者报告死亡率指数显著降低，这不仅为我们内部提供了基准，也为与其他机构进行比较提供了方法。
