Resident-Led Clinical Documentation Improvement in Cardiology: Early Effects on Risk-Adjusted Quality Metrics.

BACKGROUND

Risk-adjusted quality metrics, including the mortality index and length of stay index, are central to evaluating cardiovascular care, yet documentation gaps can misrepresent institutional performance.

PROJECT RATIONALE: At our rural academic medical center, the Cardiology service line demonstrated a baseline mortality index of 1.40, indicating 40% higher-than-expected mortality. We identified documentation gaps in common cardiology diagnoses as contributing factors.

PROJECT SUMMARY: This quality improvement study, with a retrospective preintervention comparison, analyzed 2,143 Cardiology encounters over 18 months (July 2024-December 2025). A resident-led intervention including resident training, peer review, and clinical documentation improvement specialist collaboration was associated with mortality index improvement from 1.40 to 0.97 (30.7% relative improvement) and length of stay index improvement from 0.91 to 0.85 (6.6%).

TAKE-HOME MESSAGES: A resident-led clinical documentation improvement initiative improved documentation accuracy of patient risk, increasing expected values and correcting artificially elevated quality indices without changing clinical care or actual patient outcomes.