Query percentage goals

massenab

 I have a question that I am looking for some thoughts on from the group. As a CDI Director are working on increasing our query volume and have questions on how we should report our goal percentage.

We have set a goal of 20% for query volume (which we were told by a consulting firm that is a national average) but are trying to decide if that is 20% of total reviews or 20% of unique patients reviewed?

Obviously our query percentage will be much higher if we base it on unique accounts but is that how others report?

For example if I review a pt. record 2 times and only query once, my query percentage is 50% if I use total reviews but it is 100% if I use unique accts as my denominator.

I hope this makes sense. Let me know if you are confused or if you report this data in a different manner. We are open to ideas! 

Thank you!

lprescott1

I call these 'query quotas" and although I do understand the need to monitor to get a snapshot of your programs activities, i do encourage people not to put too much weight or expectation on such numbers. The better data is a review or audit that captures missed opportunities- versus a flat number of how many queries are asked. This of course takes more time. But this allows you to better understand your staffs level of functioning and target educational need.

Also the nature of the organization will influence query rates so a national average or expectation as a benchmark can be concerning. if you experience high provider turnover related to the use of locums, or resident training etc. your rate is going to be higher than a hospital in which the provider staffing is more stable. Specific service lines will demonstrate different rates of query. The identified mission or focus of your department will impact query frequency, etc.

As to your question above- i would measure queries per encounter. If you do it by the number of reviews that might lead to pressure upon the staff to query when it is not appropriate because there is an expectation that they must do so "X" amount times.

massenab

Thank you! I think your response gives us a different way to look at our metrics! I appreciate your input.

ebraun

I agree with the above comment to audit and ensure query opportunities are not missed.  We do have a "query rate target" of 35% and typically exceed that (query rate is based on number of individual cases - not total reviews).  However, we also audit each CDIS monthly to ensure their queries are appropriate when solicited and that there aren't missed query opportunities.  I think the query rate gives you an idea so you know your staff is sending queries, but the true story will be found in auditing. 

amanda.flores

I thought your question was interesting and wanted to weigh in. My CDI team happened to be on a webinar where the presenter talked about changing a long drawn out mission statement to one word "query" our team chooses to adopt this one-word mission statement about 13 months ago. We have seen a dramatic increase in the number of queries that our department is doing now. in the past we were hanging out at about a 20% query rate we are now at a 30% query rate. With the increase in query activity, we were wanting to make sure that our queries were not just activity for our staff to check a box. We made the queries easier to use by adding them to auto text (we use Cerner EMR) and making them where they have all formatted the same style and where the bottom line is up front for the physician to understand what the query is about. We are also sending queries that do not always have a financial impact due to some quality focus work around APR DRG's and have seen dramatic improvement rate in the risk of mortality and severity of illness not only for mortality cases but also in survivors. I have found that when the team wants to ask if they should query the answer is always yes (of course they must be compliant queries and they must have clinical indicators present).

cynthia.mead@nahealth.com

We count number of queries over number of charts reviewed and are averaging a 16-18% query rate with a response rate of 90%+. (ie: 3 queries on one chart is a 300% query rate). Our opinion is that it takes just as much time and effort to write the third query on a chart as it did to write the first query, if not more!

We are an established program with a relatively stable physician base. We have provided a lot of education over the years to our physicians and have seen our query rate decrease as they learn what is needed for complete documentation. IMHO, a higher query rate would indicate failure in our education processes.

We query for clinical validation/denial prevention, PSI's, quality measures, all of the normal stuff. We have had a couple of outside audits that have found very limited missed opportunities for queries. We also review queries for appropriateness on a monthly.

 Every week we total number of queries by topic and provide education on the top 2 query topics. If I could get my physicians to consistently document malnutrition I think our query rate would drop to 5%!

I don't really like number of queries as a metric. I would rather use audit based metrics such as missed opportunities or appropriateness of queries but realize those are more time intensive metrics.

Cynthia Mead RN CCDS

Flagstaff Medical Center

ccurhonda

We were just having a conversation about query percentages over time. If you have a stable Hospitalist team that has been well educated by the CDI team, wouldn't query percentages go down over time? Maybe with increases to account for new Providers or new coding rules? Our baseline goal has always be 20% "national average" but we have seen lower and higher averages over the years.