Introducing The Death Clearance Manual

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IntroducingThe Death Clearance Manual

• Robin Otto, RHIA, CTR
• Manager, Pennsylvania Cancer Registry
• Co-Chair, Death Clearance Issues Workgroup
• NAACCR 2008 Conference
• Denver, Colorado

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Outline

• Background
• Content
• Completion Schedule
• Acknowledgements
• Public Comment

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Background

• Purpose of Death Clearance Manual establish
  minimum requirements, or least common
  denominator, for conducting death clearance in
  order to achieve consistency among central cancer
  registries (CCR).
• Do more, not less - CCRs can do more but may not
  do less than the minimum requirements.
• Gaining Concensus - try to gain concensus among
  CCRs and standard setters before releasing the
  manual.

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Background (continued)

• Manual includes
• Minimum requirements for conducting death
  clearance
• Example 3.1.1 Annual Death Clearance Match
  Death Clearance match must be completed at least
  annually for a specified year of deaths to update
  death and other information on cases in the CCR
  database.
• Guidelines and rationale to facilitate
  understanding the process
• Standard terms and definitions
• All aspects of death clearance in one resource

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Chapter 2 Understanding Death Clearance

• Origin of Death Clearance- Dr. John Young, Jr.
• The term death clearance originally arose from
  the End Results Group, one of the predecessors of
  the SEER Program. The term referred to the
  process of linking against mortality files for
  the purpose of clearing out all of the deaths
  before beginning the follow-up process and
  generating accurate survival statistics. The idea
  of following back on non-reported cancer deaths
  came much later when registries expanded to a
  population base and the emphasis was on complete
  and accurate incidence as well as survival data.

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Chapter 2 Understanding Death Clearance

• Definition
• Death Clearance is the process of matching
  registered deaths in a population against
  reportable conditions in the CCR database for two
  purposes 1) ascertainment of death information
  for persons in the CCR (death clearance match)
  and 2) identification of all deaths with a
  reportable condition mentioned as a cause of
  death which are not found in the CCR database
  (death clearance follow-back).

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Chapter 2 Understanding Death Clearance

• 2.1 Definition of death clearance
• 2.2 Purpose of death clearance
• 2.3 Death clearance process
• 2.4 Record linkage between CCR and Vital Records
• 2.5 Timing for conducting death clearance
• 2.6 Working with Vital Records
• 2.7 Vital Records cause of death section on
  Death Certificate

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Chapter 3 Death Clearance Match

• 3.1 Linkage with mortality files
• Contains minimum requirements and guidelines
  regarding how often, use of official mortality
  file, type of file (underlying or multiple cause)
• 3.2 Death Information Update
• Lists required death fields
• 3.3 Best Value Selection
• Guidelines for using death certificate to update
  CCR record

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Chapter 4 Death Clearance Follow-Back

• 4.1 Linkage with mortality file
• Contains minimum requirements and guidelines
  regarding how often, use of official mortality
  file, type of file (multiple cause)
• 4.1.3 Multiple Cause of Death File The Vital
  Records mortality file used to perform the death
  clearance follow-back process must include all
  causes of death the underlying cause and all
  contributing causes.

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Chapter 4 Death Clearance Follow-Back

• 4.2 Identification of Potential Incidence Case
• 4.2.1 Criteria to Identify Potential Incidence
  Cases All criteria listed below must be used to
  identify potential incidence cases from the
  mortality file.
• All causes of death not just underlying
• Patient and tumor non-matches
• More

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Chapter 4 Death Clearance Follow-Back

• 4.3 Death Certificate Review
• Not required but if done, must comply with
  minimum requirements
• 4.3.1 May be excluded based on death certificate
  review
• Coding Error
• Non-reportable condition
• Tumor or neoplasm (not brain/CNS)
• Non-reportable ambiguous terminology
• Diagnosed prior to being reportable
• Non-resident

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Chapter 4 Death Clearance Follow-Back

• 4.3 Death Certificate Review
• 4.3.2 Death Certificates Included for Follow-back
  Based on Death Certificate Review When death
  certificates are reviewed, the following types of
  cases must be followed back to obtain clinical
  information before a final determination can be
  made.
• Reportable condition
• Reportable ambiguous terminology
• History of
• When in doubt

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Chapter 4 Death Clearance Follow-Back

• 4.4 Follow-back on Potential Incidence Cases
• Basic information on conducting follow-back
• 4.4.2 Follow-back Source At least one
  follow-back source must be contacted to obtain
  clinical information for each potential incidence
  case.

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Chapter 4 Death Clearance Follow-Back

• 4.5 Interpreting Death Clearance Follow-back
  information
• 4.5.1 Sufficient Follow-back Information
  received from follow-back is considered
  sufficient to take a case out of DCO status when
  at a minimum the information provides both
  clinical confirmation of the diagnosis by a
  medical practitioner and the exact or estimated
  diagnosis date.

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Chapter 4 Death Clearance Follow-Back

• 4.5 Interpreting Death Clearance Follow-back
  information
• Non-physician coroner cannot provide confirmation
  of diagnosis.
• Detailed instructions provided to estimate
  diagnosis dates from vague information.
• Unknown diagnosis date cannot be entered on any
  case from death clearance follow-back process.

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Chapter 4 Death Clearance Follow-Back

• 4.6. Final Disposition of Potential incidence
  Cases
• MDO If the diagnosis cannot be clinically
  confirmed from follow-back but the diagnosis date
  can be estimated using information on the death
  certificate, the case must be abstracted as a
  DCO.
• DCO a case for which the death certificate is
  the only source of information.

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Chapter 4 Death Clearance Follow-Back

• 4.6. Final Disposition of Potential incidence
  Cases
• History of reportable when the cause of death
  prefaced with history of is the underlying
  cause
• Underlying cause means this condition was the
  disease which initiated the train of events
  leading directly to death.
• Underlying cause is used to calculate standard
  mortality statistics.

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Chapter 4 Death Clearance Follow-Back

• 4.7 Death Clearance Follow-Back Complete For
  the death clearance follow-back process to be
  complete for a specified year, both the following
  conditions must be met
• All potential incidence cases must be resolved as
  a missed incidence case, DCO, or excluded as
  non-reportable and
• All cases determined to be a missed incidence
  case or DCO must be entered.

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Chapter 4 Death Clearance Follow-Back

• 4.8 Abstracting Reportable Cases
• Provides guidelines for abstracting cases
  determined to be missed incidence cases.
• Provides detailed instructions for abstracting
  cases as DCOs.

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Chapter 4 Death Clearance Follow-Back

• 4.9 DCO Percentage
• Explains how to calculate DCO percentage for all
  standard setters.
• Documents DCO percentage standards for all
  standard setters.

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Chapter 4 Death Clearance Follow-Back

• 4.10 Analysis of Death Clearance Follow-Back
  Results
• Explains how to analyze results to get more out
  of the process than just a DCO percentage.

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Completion Schedule

• Final Review by Work Group
• Final Review by ROC
• Final Review by Cancer Registry Steering
  Committee
• NAACCR Webinar in September 2008
• Opportunity for public comment
• Submission to NAACCR Board

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Acknowledgements

• Carol Johnson
• Karen Knight
• Serena Kozie
• Helena Krakalovich
• Karen Ledford
• Nancy Lozon
• Kathleen McKeen
• Susan Strauss-Willson
• Heather Stuart
• Marilyn Wooton

• Susan Bolick-Aldrich, Co-Chair
• Wendy Aldinger
• Stacey Carson
• Gayle Clutter
• Lois Dickie
• Cate Ellis
• Kay Gephard
• Susan Gershman
• Martha Graves
• Jeannette Jackson-Thompson

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Comment/Questions

• Robin Otto
• rootto_at_state.pa.us
• 717-783-2548