CDI and Quality Metrics Flashcards
6 cards from real CCDS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CDI and Quality Metrics flashcards as text
Which quality program uses the Excess Days in Acute Care (EDAC) measure alongside readmissions?
Answer: Hospital Readmissions Reduction Program (HRRP)
The HRRP uses the EDAC measure, which captures not only 30-day readmissions but also observation stays and ED visits within 30 days of discharge.
What does a high CC and MCC capture rate indicate about a CDI program?
Answer: The CDI program is effectively identifying and documenting secondary diagnoses
A high CC/MCC capture rate reflects that the CDI program is successfully identifying and ensuring documentation of significant secondary diagnoses that affect patient severity and resource utilization.
Under the Hospital Value-Based Purchasing (HVBP) program, which domain carries the LARGEST percentage weight in the total performance score?
Answer: Clinical outcomes
Clinical outcomes (mortality and complications) carries the largest weight in the HVBP total performance score. CDI specialists contribute to this domain by ensuring documentation fully captures severity of illness.
Which statement BEST describes the relationship between Severity of Illness (SOI) and Risk of Mortality (ROM) scores in the APR-DRG system?
Answer: SOI measures resource use while ROM independently measures likelihood of death
In the APR-DRG system, SOI and ROM are separate, independently calculated measures. SOI reflects the extent of physiologic decompensation and resource intensity, while ROM reflects the likelihood that the patient will die.
A hospital's PSI-11 (postoperative respiratory failure) rate is elevated. Which CDI action is MOST appropriate?
Answer: Query physicians to document preoperative respiratory status and POA indicators
PSI-11 flags postoperative respiratory failure. The most appropriate CDI action is to ensure physicians document the patient's preoperative respiratory status and accurate POA indicators, because pre-existing respiratory conditions present on admission may exclude cases from the PSI calculation.
A hospital notices its observed mortality rate is significantly higher than the expected rate for pneumonia patients. The CDI manager suspects documentation deficiency. What is the MOST likely documentation gap?
Answer: Secondary diagnoses that capture patient complexity are not being documented
When observed mortality exceeds expected mortality, it often indicates that secondary diagnoses reflecting patient complexity such as MCCs are not being documented. Without these diagnoses, the risk-adjustment model underestimates expected mortality.