3/30/2015
Death Clearance – Is It
Worth It?
1
Karla Nead, CTR
Kyle Ziegler, CTR
NCRA 2015 Annual Educational Conference - San Antonio, Texas
2
May 23, 2015
Overview
What is Death Clearance
Death Clearance Process
Overview
California Statistical Overview
Conclusion
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
1
3/30/2015
3
What is Death Clearance
The process of linking mortality
records (death certificates) with the
ultimate goals of:
Updating follow up information (date of
death, vital status, and cause of death)
for statistical outcomes
Capturing incidence cases a CCR would
have otherwise missed
NCRA 2015 Annual Educational Conference - San Antonio, Texas
4
May 23, 2015
What is Death Clearance
National Standard
NAACCR Death Clearance Manual, section 2
The Death Clearance Process can
only be performed on diagnosis years
in which a CCR is at least 90%
complete
Example: In the year 2015, California is
performing DC on 2013 diagnosis year
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
2
3/30/2015
5
What is Death Clearance
A Step Back – What is a Linkage?
Linkage
The business definition of a linkage is: Relationships
and interactions between tasks, functions,
departments, and organizations, that promote flow
of information, ideas, and integration in
achievement of shared objectives. (Business Dictonary.com)
The registry definition is similar: A linkage is the
process a CCR does to enhance its data by “linking”
its data with another organizations data and sharing
the results.
 Two data bases are “matched” and missing or uncollected
information is identified and reconciled between the data bases
NCRA 2015 Annual Educational Conference - San Antonio, Texas
6
May 23, 2015
Death Clearance Process Overview
Step-by Step
Death Certificate (DC) Images are
Loaded to California’s Central
Cancer Registry’s Database
(Eureka)
ONLY DC’s with a Malignancy stated as
the Primary or Secondary Cause of Death
or noted in the Other Contributing Factors
section.
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
3
3/30/2015
7
Death Clearance Process Overview
Step-by Step
All Positive Matches are linked and set as
complete
 Nothing more is done with these
All Possible Matches are manually reviewed
 Possible second primaries
 Possible matches
 Sent to Follow Back processing (next step)
All Non-Matches are Sent for Follow Back
Processing
 Physicians, Convalescent facilities, Coroners, and
Hospitals
NCRA 2015 Annual Educational Conference - San Antonio, Texas
8
May 23, 2015
Death Clearance Process Overview
Step-by Step
Once all follow back is completed and
responses are received from follow back
sources each case is abstracted into Eureka
 Physician Only (MDO)
 Death Certificate Only (DCO)
 Abstract form Hospital
NOTE: Hospitals are given a grace period to
submit an abstract identified during the Death
Clearance process.
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
4
3/30/2015
9
Vol ~ 5%
Death
Clearance
Process –
Screening and
Classification
Condition
Reportable?
Death record
comes in as CFAQ
in Eureka
Hospital
Case?
NO
YES
Patient +
Tumor Match
exists in
Eureka?
NO
YES
Delete the
death certificate
No Further
Action Necessary
Physician Office/
Hospice?
NO
NO
Coroner?
YES
YES
YES
Hospital Follow-Back
Process
MD Follow-Back
Process
Generate patient listing
from Eureka and fax to
the Coroner’s Office
Assign type of
Follow-back
NO
YES
Is it a Death Clearance
Only (DCO)?
NO
Additional Follow-back
sources provided/
available?
YES
Abstract as
DCO
NO
Abstract the case in
Eureka
Receive autopsy
reports, investigative
reports from the
Coroner
Condition
Reportable?
YES
Abstract the case as
a Coroner case in
Eureka
NO
No Further Action
Necessary
10
May 23, 2015
Death Clearance – by the numbers
Very Laborious Process
Process begins in April and the last cases are
loaded in September
12 staff
Approximately 2,350 hours
1.2 FTE
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
5
3/30/2015
11
Death Clearance – by the numbers
California Data Base
3,681,635
Patients
4,188,646
Tumors
5,453,485
Admissions/Case Report
CRGC Sacramento
1,638,802 (44.5%)
Patients
1,856,928 (44.3%)
Tumors
2,456,679 (45%)
Admissions/Case Report
NCRA 2015 Annual Educational Conference - San Antonio, Texas
12
May 23, 2015
Death Clearance – by the numbers
CRGC Sacramento
2013 Death Clearance
1,856,928 Admissions
40,014 Statmaster Records Applied to DB
1,006 Admissions Added
0.8% of the Data Base
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
6
3/30/2015
13
May 23, 2015
14
CRGC - Sacramento
May 23, 2015
7
3/30/2015
15
Death Clearance – by the numbers
85,864 Statmaster Records Loaded
in 2013
40,947 (48%) processed by CRGC
Sacramento
Annual Average Yield
Total Number of cases identified and
added to data base: 1,176
NCRA 2015 Annual Educational Conference - San Antonio, Texas
16
May 23, 2015
Death Clearance – by the numbers
2013 Death Clearance Distribution
MDO
670
DCO
291
Hospital
155
Convalescent
46
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
8
3/30/2015
17
Death Clearance – by the numbers
May 23, 2015
18
Death Clearance – by the numbers
Cost
Processing Passive Follow Up
$13,136
Screening, Classifying, Performing FB
$12,378
Abstracting
$9,229
TOTAL
$34,743
Cost Per Case (minimum)
NCRA 2015 Annual Educational Conference - San Antonio, Texas
$34.74
May 23, 2015
9
3/30/2015
19
Conclusion
Is the Death Clearance Process Worth
the Labor to Capture ?
YES
Is the Death Clearance Process Worth
the Cost?
YES
NCRA 2015 Annual Educational Conference - San Antonio, Texas
20
May 23, 2015
Special Thank You!
Wendy Ringer, CTR
Marianne Schlecht, CTR
Scott Riddle
Valerie McRae, CTR
Stephanie Phipps, CTR
Marta Induni, PhD
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
10
3/30/2015
21
Questions?
NCRA 2015 Annual Educational Conference - San Antonio, Texas
May 23, 2015
11