"Borgess Health was working to decrease observed mortality through quality care initiatives, but had overlooked another critical point: improving documentation to improve the SOI expected mortality part of the ratio," says Oliva, who adds that the healthcare industry has traditionally viewed mortality as a quality problem, largely ignoring the role documentation plays in outcome metrics.
Having gone through the process of assessing and correcting clinical documentation at Bayhealth, Oliva was intrigued at how changing Borgess Health's documentation approach might influence the organization's metrics. Borgess Health, part of the Ascension Health network, includes more than 120 care sites in 15 southern Michigan cities, as well as five owned or affiliated hospitals, a nursing home, ambulatory care facilities, home health care, physician practices, a cancer center, and an air ambulance service.
Implementing a new clinical documentation improvement program had to be done carefully to ensure that changes didn't negatively affect the system's overall quality of care. Once the J.A. Thomas clinical documentation program was in place, Oliva carefully monitored SOI and mortality for changes.
"If you're moving the severity number and increasing the expected level of severity of patients and your observation indicators, such as mortality, don't move, then you're not having an impact. But if it does move, then you know you're impacting your denominator and not doing anything to impact your quality," he explains. "The first measurements I took after J.A. Thomas was added, there was dramatic move in CC [complications or comorbidities] pairs, and our mortality dropped 30%. That told me the program was working."