The Part 2 of the MCCD is designed to indicate other significant diseases, conditions or events that contributed to the occurrence of the death, but were not in themselves part of the primary or main sequence leading to the death.
A retrospective review was conducted on a total of 173 counterfoils of MCCD issued for patients between the period January 2010 and January 2011.
The study of the MCCD counterfoils did not involve collection of the gender of the deceased, or details of the certifying doctor.
Where cases were discussed with the Procurator Fiscal's (PF) office and permission thereafter granted to the referring/reporting doctor to proceed with issuing the MCCD; then the MCCD was included in the data collation for this study.
In the latter scenario, the MCCD would usually be subsequently completed by a PF appointed Pathologist/Doctor with our service.
While the MCCD study does not shed light on the relative merits of these three designs, if it develops that some of the care coordination sites are cost neutral, and (as appears likely) none of the MHS sites are even close to cost neutrality, it would appear that moderate size units are more likely to be effective than large scale, externally based programs.
A few of the MCCD programs show promise of achieving cost neutrality, suggesting that further study of program features is necessary to develop an evidence base for what seems to work best for different types of patients and settings, and what features should qualify a program for Medicare reimbursement if evidence of cost savings is demonstrated over the longer followup period.
For the MCCD programs to be considered successful, CMS expects them to be cost neutral while improving clinical quality of care.
During the four-year operating period of the MCCD programs, members of both the treatment group and the control group continued to obtain their traditional Medicare-covered services from fee-for-service providers in the usual manner.
Covering more than 1,300 square miles and serving approximately 400,000 people in ten municipalities, MCCD
receives more than 21,000 calls a month.
Theoretically, MCCDs appear to provide many practical advantages, such as the mechanical devices deliver compressions at the same frequency and depth which are recommended in the guidelines, as opposed to the inter-rescuer variations and fatigue factors that affect the quality of chest compression; these devices allow the rescuers to perform other tasks (cannulation, airway, etc.
Table 3 presents the results of some studies that have reported on other MCCDs and techniques.