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National Home and Community Based Waiver Conference. 2002 Massachusetts DMR Mortality Report: How are we doing in life? Sharon Oxx RN, CDDN. Who are we serving?. Why do we do a mortality report?. How do we compare to the general population and like populations? - PowerPoint PPT Presentation
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National Home and Community Based Waiver
Conference
2002 Massachusetts DMR Mortality Report: How are we doing in life?
Sharon Oxx RN, CDDN
Who are we serving?
AGE & GENDERPeople Served by DMR
2002
0
2000
4000
6000
8000
10000
12000
Men 2279 6144 4023 716 310 61
Women 1655 4880 3569 685 396 104
18-24 yrs 25-44 yrs 45-64 yrs 65-74 yrs 75-84 yrs 85+ yrs
9% are 65-yrs and older
75% between 25-64-yrs
Percent of Population 65+ yrs by Residential Setting
2002
51%
23%
16%
9%
4%
0%
10%
20%
30%
40%
50%
60%
Own Home DMRCommunity
Non-DMR DMRFacility
NusingHome
Per
cent
of P
opul
atio
n
StatewideAverage = 9%
Why do we do a mortality report?
• How do we compare to the general population and like populations?
• Are there any ‘preventable’ conditions that we need to address?
• What conditions are common in this population?
• How can we improve overall services?
Mortality Statistics
• Purpose: To make comparisons with prior years within the DMR population and between the DMR and general population in order to identify preventable deaths and risk factors that should to be addressed for the health, safety and well being of the DMR population.
Mortality Reporting Process
• The deaths of all adults (18 or older) served by DMR, who are listed in CRS, must be reported to DMR via the Death Reporting System
• If individuals meet certain criteria a comprehensive mortality review process is conducted
Clinical Mortality Review Process
Clinical reviews are conducted (usually by Area nurses) on the deaths of persons served by DMR who:
• are at least 18 years of age
• receive a minimum of 15 hours of residential support that is provided, funded, arranged, or certified by DMR
Clinical Mortality Review Process (cont.)
• died in a day support program funded or certified by DMR
• died in a day habilitation program
• died during transportation funded or arranged by DMR
Mortality Review Committee Process
Clinical mortality reviews are reviewed by a Regional Committee and either closed at the Regional level or referred to the Statewide Mortality Review Committee according to certain criteria
Criteria for Central Committee Review
• Sudden or unanticipated death
• Adverse drug event
• Sepsis
Criteria for Central Committee Review (cont.)
• Accidental choking
• Aspiration (with or without pneumonia), chronic obstructive pulmonary issues
• Bowel impaction
Criteria for Central Committee Review (cont.)
• Death involving restraint/ seclusion
• Accident or serious injury within 30 days of death
• Substance abuse related to death
Criteria for Central Committee Review (cont.)
• Suspected suicide
• Death that may be related to or involves a history of abuse, neglect, and/or omission
• Other
What We Track for Trends
• Age at death
• Gender
• Location
• Causes
Death Stats
• Regions with older populations have higher death rates and regions with younger populations have lower death rates.
• Lowest death rates among persons living in their own homes with a family member
• Highest death rates among persons in nursing homes
Death Stats (cont.)
• Findings are consistent with age distribution and medical condition of the population in types of residence.
• Average age at death for 2002 = 61.5 years (60.2 yrs. in 2000, 60.7 yrs. in 2001) Women 62 years, men 60.9 years
• Rate of death increased for people 65+ and decreased for those 25-64.
Distribution of Deaths by Type of Residence
2002
Residence TypePopulation No.
Deaths% of
DeathsDeath Rate
(n/1000)
Average Age at Death
Own Home 11,270 88 22% 7.8 50.5
DMR Community 10,506 152 38% 14.5 60.1
Non-DMR Residence 882 20 5% 22.7 47.0
DMR Facility 1,163 34 8% 29.2 70.8
Nursing Home 1,001 111 27% 110.9 71.8
Total (Statewide) 24,822 405 100% 16.3 61.5
Mortality Rate by Age GroupComparison Across 3 Years
2000 - 2002
0
20
40
60
80
100
120
140
160
180
200
220
18-24 25-44 45-64 65-74 75-84 85 +
No
. D
ea
ths
pe
r 1
00
0
2002 2001 2000
Increase in mortality over timefor persons older than65-yrs.
Top 10 Leading Causes of Death Rank U.S. 2002 MA 2001 DMR 1999 DMR 2000 DMR 2001 DMR 2002
1 Heart Disease Heart Disease Heart Disease Heart Disease Heart Disease Heart Disease
2 Cancer Cancer Pneumonia PneumoniaAspiration Pneumonia
Aspiration Pneumonia
3 Stroke StrokeChronic
Respiratory Disease
ChronicRespiratory
DiseaseCancer
Cancer & Septicemia[4]
4Chronic
Respiratory Disease
Chronic Respiratory
DiseaseCancer Cancer Septicemia
C-P Arrest/Seizure15
5 AccidentsInfluenza and Pneumonia
Septicemia Septicemia Alzheimer’s Alzheimer’s
6 Diabetes Alzheimer’s Gastro-Intestinal NephritisInfluenza and Pneumonia
Chronic Respiratory Disease
7Influenza and Pneumonia
Unintentional Injuries
NephritisC-P Arrest/
Seizure
ChronicRespiratory
Disease
Influenza and Pneumonia
8 Alzheimer’s Diabetes Alzheimer’s Alzheimer’sC-P Arrest/Seizure 15 Nephritis
9 Nephritis Nephritis Seizure-related Stroke Accidents Stroke
10 Septicemia Septicemia AccidentsGastro-
intestinalStroke
Congenital Defects
Cause of Death by Age Group for Massachusetts Population
2001
RankAge range (years)
15-24 25-44 45-64 65-74 75-84 85+
1 Unintentional Injuries
Cancer Cancer Cancer Heart Disease
Heart Disease
2 Injuries of undetermined
intent
Injuries of undetermined
intent
Heart Disease
Heart Disease
Cancer Cancer
3 Homicide Heart Disease CLRD* CLRD* Stroke Stroke
* CLRD = Chronic Lower Respiratory Disease
Cause of Death by Age Group for DMR 2002
RankAge range (years)
18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
1
Not enough data to rank
CLRD*Heart
DiseaseCancer Alzheimer’s Heart Disease
Heart Disease
Aspiration Pneumonia
2 Sepsis SepsisHeart
DiseaseCP Arrest /
SeizureCancer
Aspiration Pneumonia
Heart Disease
3Con-
genital defects
Aspiration Pneumonia
CP Arrest / Seizure
Heart Disease
Aspiration Pneumonia
Cancer CLRD*
* CLRD = Chronic Lower Respiratory Disease
Potentially Avoidable Deaths• Heart Disease - appropriate health screenings and
address risk factors• Aspiration - special risk of DMR population;
feeding and swallowing problems, GI reflux, medications, CP, oral health.
• Cancer - appropriate health screenings and address risk factors
• Sepsis - higher risk for DMR population; requires timely recognition, diagnosis and treatment of infection, management of bowel problems, etc.
Examples of DMR Quality Improvement Response
• Health alerts re: swallowing problems and aspiration pneumonia; bowel management and sepsis.
• Preventive health standards
• Observation of behaviors and symptoms
Examples of DMR Quality Improvement Response (cont.)
• DMR nursing supports
• Risk management
• Training of providers/direct care staff
• Advocacy in health care settings
Examples of DMR Quality Improvement Response (cont.)
• Living Well newsletter
• Assessment and protocol development
• Quarterly statewide trainings on common health issues
Next Steps….
1. CMS Real Choices / QA Grant– New England Collaborative– Common indicators re: reporting deaths to
allow for comparisons of data across states
• Close the loop: feedback to providers
Questions?????
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