An Intervention to Improve Cause-of-Death Reporting in New York City Hospitals, 2009–2010

Abstract

IntroductionPoor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC’s health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting.MethodsFrom June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals.ResultsAt intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period.ConclusionThis NYC health department’s hospital-level intervention led to durable changes in COD reporting.

How Well Do Birth Records Serve Maternal and Child Health Programs? Birth Registration System Evaluation, New York City, 2008–2011

“…On the basis of these findings, BVS is developing an online training program to address registrars' knowledge gaps. Similar online trainings have effectively improved causeof-death reporting in NYC [18,19]. Analogous efforts are under way at the national level; recently, a Birth Data Quality Workgroup at NCHS was charged with developing a national model of training for birth registrars [20].…”

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Premature Mortality in North Carolina

“…The major limitations of this analysis are the definitions of race and ethnicity, the presence of populations that are too small to be analyzed, and the unreliability of the reported underlying cause of death. Death certificates may overreport heart disease as a cause of death [29], and specification of the underlying cause of death becomes more complicated as the number of comorbidities increases. Cause of death is also likely to be less accurate for older individuals with multiple chronic conditions [9].…”