Q&A: CDI dashboard

Q: Is anyone using or creating dashboards for CDI to share information to senior leadership and to providers?

Response #1: We create an enterprisewide CDI dashboard that is shared with the chief financial officers, chief medical officers, chief nursing officers, and CDI leaders across the organization. At the site level, the CDI dashboard is shared with the CDI team, coding, and physician leaders.

We track:

• Review rate
• Query rate
• Agree rate
• Response rate
• Average hours to first CDI review
• Query response time in hours
• Query impact rate
• CDI specialist/coder DRG match rate
• Average reviews per visit

Response #2: We also have a dashboard we share with executive leadership. We track:

• Number of reviews per staff member
• Number of queries to providers
• Physician response rate
• Physician agree rate
• Case mix index (CMI) by month
• Financial impact (when the query increased payment by changing the principal diagnosis, the PCS code, or adding a CC/MCC)
• Number of accounts with a quality impact (i.e., added severity of illness/risk of mortality score, patient safety indicator [PSI]/hospital-acquired condition [HAC], or impacted a readmission or mortality index case)

We also have an outpatient team that works on hierarchical condition category (HCC) queries or evaluation and management and CPT. The dashboard for that is similar but I wish we could get numbers related to risk adjustment factor score and HCC capture over time. We can measure the CMI or DRGs on inpatient accounts but our data on the outpatient side is not as robust.

Response #3: The dashboard I created is fairly high level for all the executive team for all 10 hospitals. It contains the following on a monthly basis in the EPIC dashboard which was created for me by our business intelligence department:

• Total cases for the respective insurance (actual) 
• The budgeted CMI for this particular Medicare and non-Medicare  
• Actual CMI for a particular month   
• Total psych patients
• Total orthopedic and cardiac surgical cases 
• Total tracheostomy 3 and 4
• Total cases with higher relative weight (e.g., left ventricular assist devices, Impella heart pumps, CART T-cell therapy, and bone marrow transplants)
• Total cases with a relative weight higher than 3.5 
• Percent of medical versus surgical cases  
• The query rate 
• The percentage of cases reviewed by the CDI team   

Response #4: Our process is the same as others have mentioned. In addition, we have a dashboard from a contracted third party that compares our facilities and physicians to a regional group in comparing CC/MCC capture rate, physician by query answer rate, total charges by DRG, and length of stay. Each physician group receives a copy of their metrics.  

Response #5: We’ve created multiple dashboards to share with leadership. Our dashboards include:

• Actual review hours
• Number of initial reviews
• Number of concurrent reviews
• Number of subsequent reviews
• Number of concurrent queries
• Number of subsequent queries
• Query response time
• Individual provider response rate, type, and time
• Query impact rate 
• PSI rate, review, and outcome
• HAC rate, review, and outcome
• Mortality rate, review, and outcome
• Targeted DRG reviews such as an unspecified principal diagnosis rate, review, and outcome
• Query rate with compliance
• Provider education per CDI to service lines and individual 
• Just-in-time communication with the provider
• CMI
• Financial impact

Response #6: The CDI team here is a system position that includes work done at nine different facilities across the system.

The general key performance indicators (KPI) we share at each facility are as follows:

• Number and percentage of inpatient charts reviewed per facility (excluding obstetrics, neonates, rehab, and psychiatric stays)
• Number of encounters with a query as well as number of queries overall, understanding there is often more than one query/chart
• Concurrent versus retrospective queries
  • Note: We are working on a new reporting structure for “prospective queries” which are defined as queries written 1-4 business days after discharge but prior to coding. The CDI team write all queries on encounters, coders do not write queries but do request us to write them retrospectively. 
• Top five query types per facility
• Query response time, agree, disagree, and unable to determine

There are some facilities that request specific info on certain conditions such as:

• Number of queries placed for acute myocardial infarction etiology/specificity
• Number of queries placed for heart failure acuity, specificity, and etiology with response of unable to determine
• Number of queries placed for malnutrition

These are aligned with current best practice alerts we have built-in Epic to prevent the need for a CDI query or for specific facility goals.

Response #7: We have worked closely with our data and analytics team to build out a Tableau dashboard for CDI that is physician-facing for our adult patients. We have had it for over one year now. The dashboard is updated monthly and includes a benchmarking tool as a separate report as well. These have been great for physician leaders and section administrators to see the progress of their programs/service line without us having to send them their data/performance. There are various filters available for them to drill down into the data and you can even get down to the patient data if you want to look further, say at deaths that were attributed to your service or a provider during a given time period. Some of the filters include: 

• Discharge date
• Service line
• Financial class
• Provider name
• Vizient service line. 

The following metrics are on this dashboard:

• Total discharges
• Mortality observed to expected rate
• CMI
• CC/MCC capture rate

They are also able to see their performance for the last four quarters and, as you hover over the various metrics graphs, it will display to show trends over time as well.

We are working with our data and analytics team to create a CDI process metric dashboard which will include the following:

• CDI reviews
• Percentage of cases with CDI review
• Query rate
• Query response time

We are also working to tie in reporting related to U.S. News & World Report cases.   

Response #8: Our CDI dashboard consists of:

• Monthly discharges
• Financial impact
• Severity impact
• KPIs per service line (agreed, not agreed, as well as chart impact rate)

We compare to pre-established benchmarks. Per service line, we report out specific physician metrics to chiefs quarterly so trends can be addressed. We have just begun to develop a CDI system-level program directed by a physician as well. 

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly newsletter for members of the Leadership Council. For the purposes of this article, all Council member answers have been deidentified.