title: Pocket change: a simple educational intervention increases hospitalist documentation of comorbidities and improves hospital quality performance measures.
abstract: BACKGROUND
  Complete documentation of patient comorbidities in the medical record is important for clinical care, hospital reimbursement, and quality performance measures. We designed a pocket card reminder and brief educational intervention aimed at hospitalists with the goal of improving documentation of 6 common comorbidities present on admission: coagulation abnormalities, metastatic cancer, anemia, fluid and electrolyte abnormalities, malnutrition, and obesity.
  
  
  METHODS
  Two internal medicine inpatient teams led by 10 hospitalist physicians at an academic medical center received the educational intervention and pocket card reminder (n = 520 admissions). Two internal medicine teams led by nonhospitalist physicians served as a control group (n = 590 admissions). Levels of documentation of 6 common comorbidities, expected length of stay, and expected mortality were measured at baseline and during the 9-month study period.
  
  
  RESULTS
  The intervention was associated with increased documentation of anemia, fluid and electrolyte abnormalities, malnutrition, and obesity in the intervention group, both compared to baseline and compared to the control group during the study period. The expected length of stay increased in the intervention group during the study period.
  
  
  CONCLUSIONS
  A simple educational intervention and pocket card reminder were associated with improved documentation and hospital quality measures at an academic medical center.
authors.affiliation: Department of Medicine, University of Washington, Seattle (Drs Sparks, Salskov, Chang, Gupta, Staiger, and Anawalt); and Division of Endocrinology, University of California at San Francisco (Dr Wentworth).
authors.forename: Rachel
authors.initials: R
authors.lastname: Sparks
authors.forename: Alex H
authors.initials: AH
authors.lastname: Salskov
authors.forename: Anita S
authors.initials: AS
authors.lastname: Chang
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Wentworth
authors.forename: Pritha P
authors.initials: PP
authors.lastname: Gupta
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Staiger
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Anawalt
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000328:Adult; D015897:Comorbidity; D004282:Documentation / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D020445:Hospitalists / Q000193:education*; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000379:methods; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D011787:Quality of Health Care; D017010:Reminder Systems / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires