338 Getting Ahead of the Disparities Curve: Increasing Capture Rate of Comorbidities Which Would Exacerbate Socioeconomic Disparities in a Value-Based System

INTRODUCTION: Value-based systems will place financial risk on providers. If these payments are not adequately adjusted for comorbidity burden, systems will be disincentivized to treat marginalized socioeconomic groups who have disproportionately high comorbidity burden. METHODS: Comorbidity-focused note-writing templates were incorporated into the physicians’ workflow within Jefferson University Hospital’s Neurosurgery Department. A list of high-risk comorbidities was identified and incorporated into the top of each note. Emphasis was given to comorbidities which have high historical impact on mortality and which are commonly overlooked in the acute neurosurgical decisionmaking process (e.g. obesity). The selected comorbidities were populated into the top of every note which included treatment plans for each condition. The process measure included the percentage of notes in compliance with the template. The outcome measures were expected mortality (composite variable representing comorbidity burden) and the capture rate of major comorbidities within the coding process. Measures were compared between one full year pre and post-intervention. Coders were blinded to the presence of our intervention. RESULTS: There was 100% compliance after the second week post-intervention (as measured by full audit of all notes written). There was a 44% (3.4% to 4.9%) improvement in expected mortality for the department’s encounters. There was an increased capture rate for several major comorbidities which are disproportionately associated with marginalized socioeconomic groups. These included malnutrition (233% increase, from 3% to 10%), coagulopathies (71% increase from 7% to 12%), obesity (50% increase from 22% to 33%), congestive heart failure (43% increase from 7% to 10%), hypertension (31% increase from 13% to 17%), and deficiency anemias (31% increase from 16% to 21%). CONCLUSIONS: We present a low-cost framework to increase capture rate of high-risk comorbidities which traditionally contribute to socioeconomic disparities.