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National Home and Community Based Waiver Conference

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?

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National Home and Community Based Waiver Conference

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  1. National Home and Community Based Waiver Conference 2002 Massachusetts DMR Mortality Report:How are we doing in life? Sharon Oxx RN, CDDN

  2. Who are we serving?

  3. 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?

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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

  9. Criteria for Central Committee Review • Sudden or unanticipated death • Adverse drug event • Sepsis

  10. Criteria for Central Committee Review (cont.) • Accidental choking • Aspiration (with or without pneumonia), chronic obstructive pulmonary issues • Bowel impaction

  11. Criteria for Central Committee Review (cont.) • Death involving restraint/ seclusion • Accident or serious injury within 30 days of death • Substance abuse related to death

  12. 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

  13. What We Track for Trends • Age at death • Gender • Location • Causes

  14. 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

  15. 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.

  16. Distribution of Deaths by Type of Residence 2002

  17. Top 10 Leading Causes of Death

  18. Cause of Death by Age Group for Massachusetts Population 2001 * CLRD = Chronic Lower Respiratory Disease

  19. Cause of Death by Age Group for DMR 2002 * CLRD = Chronic Lower Respiratory Disease

  20. 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.

  21. 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

  22. Examples of DMR Quality Improvement Response (cont.) • DMR nursing supports • Risk management • Training of providers/direct care staff • Advocacy in health care settings

  23. Examples of DMR Quality Improvement Response (cont.) • Living Well newsletter • Assessment and protocol development • Quarterly statewide trainings on common health issues

  24. 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

  25. Questions?????

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