Performance metrics

kristie.perry@erlanger.org

Could someone give me an idea of the current performance metrics your facility has in place for CDI specialists?  Are there any current, new trends above and beyond number of reviews/re-reviews and % query response rate? Thanks for any information!

Kristie Perry

ccatlett1

We also monitor physician response rate, agreement rate, type of query (CHF) and number of queries.  This enables us to identify education priorities for a group or a particular physician.

Cheryl Catlett

nameher

I have a hard time with "agreement rate" as a metric because it is difficult to define 'agree'. 
When it is our job to achieve clarification, there is no specific response that = agree, rather a response the provides the appropriate clinical information to allow us to code a diagnosis that is supported by the clinical information in the record is the desired response.
How do you 'all' define 'agree'?

Thank you
Marie

whitneyarellano

nameher said:

I have a hard time with "agreement rate" as a metric because it is difficult to define 'agree'. 
When it is our job to achieve clarification, there is no specific response that = agree, rather a response the provides the appropriate clinical information to allow us to code a diagnosis that is supported by the clinical information in the record is the desired response.
How do you 'all' define 'agree'?

Thank you
Marie

Marie,

We define "agree" as - clinically, we agree with their response and it was one of the options that we gave in the query. The key word there is "clinically." However, for the reasons you have stated, we don't hold anyone (CDI staff or providers) to a specific agree rate. It's good data to track, but we don't have any specific number that we stick to for several reasons, some of the most important being 1) We don't want our CDI nurses to avoid going outside of the box for fear of getting a disagree, and 2) We don't want the providers to feel obligated to provide any certain responses - accuracy is the goal, not necessarily agree or disagree. Analyzing agree rates per CDI nurse may show a pattern of sending only easy queries (high percentage of agreement) or queries that may not be clinically competent or may be too far outside of the box (high percentage of disagreement). On the provider side, a high agree rate may be a provider who is too agreeable, or a low agree rate may indicate a provider being obstinate. All things that would need to be explored further, but we don't really think there is a magic number per se - more just monitoring of trends.

ldanhires

We monitor coverage rate, query rate, response rate and agreement rate. Although we have benchmarks for each, we don't strictly adhere to the benchmark. We have some CDS's who go above and beyond in educatng providers, making rounds, or going to meetings. They may not reach benchmarks, but they excel in their CDI role. We take all of this into consideration, however, the C-Suite wants to see black and white numbers. So we present them with these, always with an explanation if we fall short on any of them. So far, its worked well for everyone.

deborah.young.squatriglia@duke.edu

WE monitor Initial reviews, re-reviews or follow ups, query rate, MD response rate, MD agree rate, financial impact, SOI/ROM changes, # PSI queries, #HAC queries, # of V izient beta  coefficient clarification and Chart impact rate.

Jessica.Landherr@mercy.net

How do you all calculate query rate?  Do you do it by if an account had a query or do you count each query on the chart. For example if a chart had 3 queries, do you just count that as 1 because it had a query or 3 since there were three queries on it?

cari.coker-fritsch@saukprairiehealthcare.org

We count each individual query.

chinwealor

Same here, we count each individual query. At the end of the day, our queries are the most important part of the CDI work. If a CDI reviews five charts with four queries each (total of 20 queries), but asks only one query for each chart (5 out of 20 queries), the CDI's query rate is at 25%. Those 15 missed opportunities = missed metrics and reimbursement (75%). The review rate should be a factor but the query rate is the most important one. This determines the success or failure of any CDI program. After that, the response rate and then just as important, the agree rate.