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?

5. 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?

6. 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.

7. 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

8. 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

9. 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

10. 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

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

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

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

14. 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

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

16. 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

17. 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.

18. Distribution of Deaths by Type of Residence 2002 Residence Type PopulationNo. Deaths % of Deaths Death Rate (n/1000) Average Age at Death Own Home11,2708822%7.850.5 DMR Community10,50615238%14.560.1 Non-DMR Residence882205%22.747.0 DMR Facility1,163348%29.270.8 Nursing Home1,00111127%110.971.8 Total (Statewide)24,822405100%16.361.5

20. Top 10 Leading Causes of Death RankU.S. 2002MA 2001DMR 1999DMR 2000DMR 2001DMR 2002 1Heart Disease 2Cancer Pneumonia Aspiration Pneumonia 3Stroke Chronic Respiratory Disease Chronic Respiratory Disease Cancer Cancer & Septicemia[4][4] 4 Chronic Respiratory Disease Cancer Septicemia C-P Arrest/ Seizure 15 5Accidents Influenza and Pneumonia Septicemia Alzheimer’s 6DiabetesAlzheimer’sGastro-IntestinalNephritis Influenza and Pneumonia Chronic Respiratory Disease 7 Influenza and Pneumonia Unintentional Injuries Nephritis C-P Arrest/ Seizure Chronic Respiratory Disease Influenza and Pneumonia 8Alzheimer’sDiabetesAlzheimer’s C-P Arrest/ Seizure 15 Nephritis 9 Seizure-relatedStrokeAccidentsStroke 10Septicemia AccidentsGastro-intestinalStroke Congenital Defects

21. Cause of Death by Age Group for Massachusetts Population 2001 Rank Age range (years) 15-2425-4445-6465-7475-8485+ 1Unintentional Injuries Cancer Heart Disease 2Injuries of undetermined intent Heart Disease Cancer 3HomicideHeart DiseaseCLRD* Stroke * CLRD = Chronic Lower Respiratory Disease

22. Cause of Death by Age Group for DMR 2002 Rank Age range (years) 18-2425-3435-4445-5455-6465-7475-8485+ 1 Not enough data to rank CLRD* Heart Disease CancerAlzheimer’sHeart Disease Aspiration Pneumonia 2Sepsis Heart Disease CP Arrest / Seizure Cancer Aspiration Pneumonia Heart Disease 3 Con- genital defects Aspiration Pneumonia CP Arrest / Seizure Heart Disease Aspiration Pneumonia CancerCLRD* * CLRD = Chronic Lower Respiratory Disease

23. 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.

24. 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

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

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

27. 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

28. Questions?????