hospital room with empty beds and view of interior courtyard

Applying the 6 Aims to CDI

What is quality in healthcare? The Institute of Medicine (IOM) defines health care quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.“ After the 1999 landmark report, “To Err is Human: Building a Safer Health System” was published, the spotlight was on how tens of thousands of Americans die each year from medical errors. In 2001, the IOM followed up with the report, “Crossing the Quality Chasm.” From this report, six quality domains were identified.

While these are focused on direct patient care outcomes, CDI efforts align well with the IOM domains of quality care, or what the IOM titles the six “Aims for Improvement.”

  1. Effective. Healthcare must be effective, providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).
    • The CDI professional validates diagnoses in the record using best practices set forth by organizations using evidence based scientific research.  The CDI professional also seeks clarification when there is evidence of a diagnosis (management, signs and symptoms, objective or subjective accounts, etc) and no diagnosis documented.  From these two views of the record, the CDI professional assists in ensuring that health care is effective.
  2. Efficient. The healthcare system should be efficient, avoiding waste, including waste of equipment, supplies, ideas, and energy. By assisting the provider in complete and precise documentation of all conditions, documentation gaps that could translate into perceived waste are eliminated.
    • By assisting the provider in complete and precise documentation of all conditions, documentation gaps that could translate into perceived waste are eliminated.
  3. Equitable. Healthcare should be equitable, providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
    • All records should be reviewed impartially and to the fullest extent of quality, without regard to race, ethnicity, gender, income and payer.  No record should be left behind.
  4. Patient-centered. Healthcare should be patient-centered, providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
    • The CDI professional’s decisions and actions concerning a record evolve around the patient, and represent an ethical, respectful record review, and appropriate and compliant clarifications.
  5. Safe. Healthcare must be safe, avoiding injuries to patients from the care that is intended to help them.
    • Although the CDI profession isn’t involved in direct patient care, we are directly involved in the reflection of that care in the medical record documentation. While the CDI professional is not the only person who views the medical record, there is an ethical responsibility to the patient to report instances of documentation of perceived harm in the medical record.
  6. Timely. Care should be timely, reducing waits and sometimes harmful delays for both those who receive and those who give care.
    • The CDI professional identifies any gaps in timeliness of care and assists in ensuring documentation specifically addresses any harmful delays, should they occur.

It has been stated that we cannot hope to cross the chasm and achieve these aims until we make fundamental changes to the whole health care system. If everyone does their part with the patient at the center, we can meet these changes along the path as executives work toward changes at the system level. Donald M. Berwick, MD, MPP, former President and Chief Executive Officer of the Institute for Healthcare Improvement and one of the Chasm report’s architects, probably said it best, “No matter where you are, you can look at this list of aims and say that at the level of the system you house, the level you’re responsible for, you can organize improvements around those directions.” Let’s continue to make a difference in the life of the patient and expand our efforts to align our CDI programs with these 6 aims for quality healthcare.



Committee on Quality of Health Care in America.  Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century