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
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