Saving lives through certifying deaths: assessing the impact of two interventions to improve cause of death data in Perú

Miki, Janet; Rampatige, Rasika; Richards, Nicola; Adair, Tim; Cortez-Escalante, Juan José; Vargas-Herrera, Javier

doi:10.1186/s12889-018-6264-1

Cited by 48 publications

(50 citation statements)

References 26 publications

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“…We recommend that all house staff be required to participate in at least one interactive death certification educational workshop over the course of their training. 2,5,23,26 To ensure that basic death certification principals are reinforced and that all key medical diagnoses and findings are incorporated into the death, medical certifiers are strongly encouraged to take the opportunity to discuss death certificates with the clinical care team during rounds and at applicable conferences (eg., specialty-specific 'Morbidity and Mortality' conferences). 2 It is recommended that as with other institutional quality improvement initiatives, there likewise be a local quality improvement committee knowledgeable in death certification issues that reviews each certificate in conjunction with the medical history and-in cases of error-notifies the certifier of the issue and requested amendment.…”

Section: Discussionmentioning

confidence: 99%

Death Certification: Errors and Interventions

2019

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Death certificates are legal documents containing critical information. Despite the importance of accurate certification, errors remain common. Estimates of error prevalence vary between studies, and error classification systems are often unclear. Relatively few studies have assessed the frequency at which death certification errors occur in US hospitals, and even fewer have attempted a standardized classification of errors based on their severity. In the current study, our objective was to evaluate the frequency of death certification errors at an academic center, implement a standardized method of categorizing error severity, and analyze sources of error to better identify ways to improve death certification accuracy. Design: We retrospectively reviewed the accuracy of cause and manner of death certification at our regional academic institution for 179 cases in which autopsy was performed between 2013-2016. We compared non-pathologist physician completed death certificates with the cause and manner of death ultimately determined at autopsy. Methods: Errors were classified via a 5-point scale of increasing error severity. Grades I-IIc were considered minor errors, while III-V were considered severe. Sources of error were analyzed. Results: In the majority of cases (85%), death certificates contained ≥ one error, with multiple errors (51%) being more common than single (33%). The most frequent error type was Grade 1 (53%), followed by Grade III (30%), and Grade IIb (18%). The more severe Grade IV errors were seen in 23% of cases; no Grade V errors were found. No amendments were made to any death certificates following finalization of autopsy results during the study period. Conclusion: This study reaffirms the importance of autopsy and autopsy pathologists in ensuring accurate and complete death certification. It also suggests that death certification errors may be more frequent than previously reported. We propose a method by which death certification errors can be classified in terms of increasing severity. By understanding the types of errors occurring on death certificates, academic institutions can work to improve certification accuracy. Better clinician education, coordination with autopsy pathologists, and implementation of a systematic approach to ensuring concordance of death certificates with autopsy results is recommended.

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Section: Discussionmentioning

confidence: 99%

Death Certification: Errors and Interventions

2019

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“…The online SINADEF system introduced in Peru enabled an improvement in certification quality through several mechanisms: (1) eliminating the effect of illegible handwriting, (2) reducing the use of ill-defined conditions by having warning 'popups', and (3) not allowing for blank spaces to be left between the lines of events. SINADEF also greatly improved the timeliness of data, as online certificates became available immediately to the Ministry of Health [19]. Further improvements in the quality of certification were evident, particularly in reducing major errors, after the training of physicians in correct medical certification in addition to the use of the online system.…”

Section: Online System and Basic Training Strategymentioning

confidence: 99%

“…The final country strategy employed to improve quality of medical certification was implemented in Peru, where two specific interventions were introduced to improve the completeness of death registration and the quality of COD data [19]. This involved firstly, in August 2016, the introduction of an online death notification and certification system, Sistema Informático Nacional de Defunciones (SINADEF), into health facilities and morgues.…”

Section: Online System and Basic Training Strategymentioning

confidence: 99%

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Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative

Hart

Sorchik

et al. 2020

BMC Med

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Background: Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification. Methods: The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne. Results: The TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles. Conclusions: The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.

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“…For example, as of 2019, VAs have been conducted for over 20, 000 community deaths in Bangladesh and 50,000 in Myanmar; prior to the Initiative, there was no reliable information on the causes of community deaths in these countries. Additionally, benefits of the D4H medical certification of COD training in Peru have been demonstrated, with results being used to further strengthen the training [22].…”

Section: Training the Future Crvs Workforcementioning

confidence: 99%

Addressing critical knowledge and capacity gaps to sustain CRVS system development

Adair

Richards

Streatfield

et al. 2020

BMC Med

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Background: Improving civil registration and vital statistics (CRVS) systems requires strengthening the capacity of the CRVS workforce. The improvement of data collection and diagnostic practices must be accompanied by efforts to ensure that the workforce has the skills and knowledge to assess the quality of, and analyse, CRVS data using demographic and epidemiological techniques. While longer-term measures to improve data collection practices must continue to be implemented, it is important to build capacity in the cautious use of imperfect data. However, a lack of training programmes, guidelines and tools make capacity shortages a common issue in CRVS systems. As such, any strategy to build capacity should be underpinned by (1) a repository of knowledge and body of evidence on CRVS, and (2) targeted strategies to train the CRVS workforce. Main text: During the 4 years of the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne, an extensive repository of knowledge and practical tools to support CRVS system improvements was developed for use by various audiences and stakeholders (the 'CRVS Knowledge Gateway'). Complementing this has been a targeted strategy to build CRVS capacity in countries that comprised two approachesin-country or regional training and a visiting Fellowship Program. These approaches address the need to build competence in countries to collect, analyse and effectively use good quality birth and death data, and a longer-term need to ensure that local staff in countries possess the comprehensive knowledge of CRVS strategies and practices necessary to ensure sustainable CRVS development. Conclusion: The Knowledge Gateway is a dynamic, useful and long-lasting repository of CRVS knowledge for countries and development partners to use to formulate and evaluate CRVS development strategies. Capacitybuilding through in-country or regional training and the University of Melbourne D4H Fellowship Program will ensure that CRVS capacity and knowledge is developed and maintained, facilitating improvements in CRVS data systems that can be used by policymakers to support better decision-making in health.

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Saving lives through certifying deaths: assessing the impact of two interventions to improve cause of death data in Perú

Cited by 48 publications

References 26 publications

Death Certification: Errors and Interventions

Death Certification: Errors and Interventions

Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative

Addressing critical knowledge and capacity gaps to sustain CRVS system development

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