Managing Individual Cases in QDI

Review Case Details and Evidence

Navigate to an open case by clicking on its HAR number on one of the list views.

To review the details and evidence for a case, click on the HAR number of a case in the case management table. The individual case view appears on the screen.

At the top is the case HAR number and the MRN number that you can use to search for the patient’s record in the EHR.

You can view basic information about the case:

• Priority
• A hospitalized patient’s Admit Date and Discharge Date
• Their Provider
• The Case Age (how many days the case has been open)
• The patient’s Length of Stay in hospital
• Whether they are an Inpatient
• Coding Status
• The CDI specialist who is the Owner of the case
• When the case was Last Modified
• Who it was

Identifying Opportunities

The third tab is Opportunities.

Now that you have become familiar with the case by examining the data about it in the first two tabs and in the patient’s record in the EHR, you can identify opportunities to improve the accuracy of diagnoses and to identify missed conditions that are indicated by the patient data.

In this view, you can see a table with a list of the opportunities suggested by the patient data.

These are the columns in the table:

Opportunity - This is the name of a suggested patient condition.

Elixhauser Impact - A patient’s comorbidities are weighted using an Elixhauser score. The Elixhauser Comorbidity Index is a measure of overall severity of comorbidities, predicting hospital length of stay, hospital charges, and in-hospital mortality. The higher the score, the higher the predicted hospital resource use and mortality rate are. This weight is calculated based on evidence found in the patient data. 

Opportunity Status - This reflects the status of the opportunity.

Physician Documented - Whether the provider has documented the condition/opportunity.

Evidence - A summary of the evidence upon which this suggested opportunity is based.

Recommended Diagnosis - The diagnosis that the system recommends based on the patient data.

When you click on the name of one of the opportunities, additional details about the opportunity displays in a detail view. Here is a example:

Click on Edit to edit the fields.

You can include Evidence text that supports your conclusions in the Recommended Diagnosis field.

You can copy recommended Diagnoses, and paste the text into external systems such as your queries to use as evidence in a query to a provider.

Initiate Queries to Providers/Clinical Staff

After you have determined that a condition is present for the patient and there is an opportunity to add a condition diagnosis to the patient documentation, you can query the provider to ask for their acceptance through an external messaging system. You can track that the query was sent by updating the Status field to Query Sent in the detail view.

Handle Answers from Providers/Clinical Staff

When you have received an answer to your query from the provider, you can mark whether the query has been accepted by checking the Opportunity Verified option in the Status field.

When you have addressed all of your concerns, and the provider has responded to your query so that all issues are resolved select Completed for the status for that Opportunity.

A modal will appear in which you can edit some of the information.

• Opportunity Status - You can choose the following:
  • Open
  • Opportunity Verified - You will select this when you have accepted a provider’s answer to your query.
  • Query Sent - Select this status when you have sent a query to a provider asking them questions about a diagnosis.
  • Completed - When you have addressed all of your concerns with regard to this opportunity and a provider has responded to your query about it, and accepted it, change its status to Completed here.
• Recommended Diagnosis - you can type here to add or alter diagnoses.

Click Save.

Mark Opportunities and Cases as Complete When All Validations Are Done

When you have completed all necessary validations, updates, and queries for opportunities and for the case, you mark each opportunity as complete for each condition by updating the Opportunity Status field to Completed.

You can then move on to the next condition (opportunity) in the case. After all the opportunities on a case have been completed, you can close the case by:

1. Selecting the row and then the Close Case button at the top right hand corner of the case's detail view
2. Clicking on the … button at the end of the case row in the cases list view, and choosing Close.
3. Using the bulk Close Cases button after selecting a checkbox next to the case row in the case list view.