CLINICAL DATA QUALITY REVIEW AUDITS
Data Quality is a fundamental building block to having useful and timely information that is used for planning, performance measurement, accountability scorecards, and funding. It is becoming increasingly important for hospitals to understand the relationship between Data Quality and health record coding practices, as well as, other factors that influence the quality of clinical data reporting, such as physician chart completion. For example, Ontario coded data has been used in a variety of important ways, such as The Ministry of Health and Long Term Care (MTHLTC) has used cost per weighted case to assess hospital efficiency and relative funding levels in funding policy.
As one of Salumatics Data Quality Review tools, we have developed the RIW-weighted Complexity Index (RCI) as an objective indicator of coding quality. It is an analytical methodology for identifying variations in coding practices. Specifically, the tool compares a facility's complexity distribution within CMG's to a cohort's average (or expected) distribution. After adjusting for Length of Stay (LOS) and age within CMG, the RCI identifies unusual coding patterns by identifying those CMG's where the hospital's actual distribution differs from the expected distribution. A comparison of observed/expected RIW's identifies "high leverage" cases. That is, those cases that would have the greatest potential to have been under or over coded.
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