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?????