Improving the Accuracy of Death Certificates

Abstract

To the Editor. —Because of death certificate inaccuracies and other reasons, including the trend toward electronic document filing, the National Center for Health Statistics has called meetings of a steering committee to reengineer the death registration process. 1,2 The suggestion was made that the Uniform Hospital Discharge Data Set (UHDDS) might contain information that could improve or augment the death certificate because the UHDDS is often available quickly after death, it contains a list of diagnoses used for coding a patient's conditions, and it is a telegraphic distillation of the medical record. On the surface the idea sounds good, but an important problem needs to be addressed. The UHDDS captures the admitting diagnoses, principal diagnoses, and other diagnoses in the medical record. However, it is possible that major diagnoses that would serve as the underlying cause of death (for the death certificate) might escape capture in the UHDDS. For example,