Quality Of Death Certification Research Articles

Looking at the future of the medical certification of cause of death (MCCD) in England and Wales.

Internationally, the quality of death certification is poor although there are multiple efforts underway to improve the process. In England, a new medical certification system has been proposed to improve the quality of data. We surveyed general practitioners (n = 95) across the West Yorkshire area of England to appraise their views regarding whether further possible changes to the death certification system could promote their quality.

Evaluation of errors in death certification by medical officers in an acute hospital.

To identify the frequency and types of errors in the Medical Certificate Cause of Death (MCCD) completed by hospital medical officers for deceased older patients. Among 127 deaths in a tertiary hospital acute geriatric unit between 1 July 2021 and 30 June 2022, a cause of death was documented for 116 patients (mean age 87.8, SD 5.7 years, 47% female, 39% from a nursing home). The MCCD was evaluated for errors as compared to national guidelines based on five criteria: mechanism without underlying cause; competing causes; improper sequencing; incomplete data; and use of abbreviations. The level of training of the documenting medical officer and whether the MCCD was completed out of usual working hours was evaluated with respect to errors. At least one error was present in 60 (52%) of the MCCD evaluated, and there were two or more errors in 16 (14%). Most commonly, documenting competing causes of death was found in 45 (39%) of all MCCD, followed by missing data (10%) and improper sequencing (9%). MCCDs were mostly completed by postgraduate year (PGY) 1 or 2 medical officers (78%) and out-of-hours (in 72%). There was no significant difference in frequency of errors between junior and senior medical officers (p = 0.52) or if it was completed within or out-of-hours (p = 0.14). The MCCD for deceased hospital patients often contained an error. Major improvement in the quality of death certification is needed among all medical officers.

What are the effects of different places of death of old people?

HintergrundEine unzureichende Qualität der ärztlichen Leichenschau wird seit vielen Jahren in der rechtsmedizinischen Fachliteratur diskutiert. Es ist bekannt, dass bei älteren Verstorbenen im Vergleich zu jüngeren seltener eine nichtnatürliche Todesart attestiert wird und seltener Obduktionen durchgeführt werden.MethodeEs wurden die Todesbescheinigungen aller Sterbefälle analysiert, die in München im Sterbezeitraum vom 01.01.2013 bis zum 31.12.2014 mit einem Alter ≥ 75 Jahre verstarben. Es erfolgte eine standardisierte, anonymisierte Dateneingabe. Die erhobenen Daten wurden deskriptiv ausgewertet.ErgebnisseIm Untersuchungszeitraum verstarben insgesamt 26.303 Personen. Von diesen Sterbefällen waren 16.146 (60,7 %) ≥ 75 Jahre. Häufigste Sterbeorte der Betagten waren Krankenhaus (56,1 %), Privatadresse (21,8 %) und Altenheim (20,0 %). Eine natürliche Todesart wurde bei 88,5 %, eine ungeklärte bei 8,8 % und eine nichtnatürliche bei 2,7 % angegeben. Häufigste unmittelbare Todesursachen waren Krankheiten des Kreislaufsystems (23,5 %), ungenau bezeichnete bzw. unbekannte Todesursachen (20,0 %) und Krankheiten des Atmungssystems (16,3 %). Obduziert wurden 4,9 %, weit überwiegend gerichtlich. Die untersuchten Parameter zeigten bei den sterbeortabhängigen Analysen große Unterschiede.DiskussionDiese Untersuchung zeigt erneut erhebliche Qualitätsmängel bei der Ausfertigung von Todesbescheinigungen. Deren Qualität konnte in den letzten Jahren trotz des dualen Ansatzes der Münchner Gesundheitsbehörde (Kontrolle, Schulung) nicht nachhaltig verbessert werden. Todesarten und -ursachen zeigen teils erhebliche Unterschiede in Abhängigkeit von Sterbeort und leichenschauendem Arzt. Die festgestellten Defizite der unter der Rubrik „Todesursachen“ gemachten Angaben dürften auch auf die Todesursachenstatistik negative Auswirkungen haben.

Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

BackgroundThe majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.MethodWe conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.ResultsOf the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.ConclusionStandardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths.

Noninformative coding of causes of death in cardiovascular deaths: effects on the mortality rate for ischemic heart disease

The validity of mortality statistics is specific to causes of death and depends on the quality of death certificates. The proportion of noninformative underlying causes of death in all deaths is an indicator for the validity of amortality statistic. The most frequent noninformative cause of death involves cardiovascular diseases (ICD-10: I00-I99). Regional differences in the frequency and type of use of noninformative cardiovascular causes of death are investigated and their effect on the mortality rate of ischemic heart disease is presented. Mortality rates for cardiovascular causes of death by gender, age group, and federal state were extracted from the Information System of the Federal Health Monitoring (GBE) for 2000, 2010, 2015, and 2016. The proportion of noninformative causes of death in all cardiovascular deaths, as well as the mortality rate for ischemic heart disease after recoding noninformative causes of death, were calculated. The proportion of noninformative causes of death in all cardiovascular deaths is high and depends on age, sex, federal state, and year of death. Regional differences in frequency and type of use were found. After recoding selected noninformative causes of death, the mean increase in the mortality rate for ischemic heart disease in all federal states was 33%. Acomparison of cause-specific mortality rates between regions, sexes, and over time is affected by differences in the use of noninformative causes of death. Improving the quality of death certificates is aprerequisite for valid mortality statistics.

Mortality and quality of death certification in a cohort of patients with Parkinson’s disease and matched controls in North Wales, UK at 18 years: a community-based cohort study

ObjectiveThis investigation reports the cause and the quality of death certification in a community cohort of patients with Parkinson’s disease (PD) and controls at 18 years.SettingDenbighshire North Wales, UK.ParticipantsThe community-based...

Quality of death certification in Colombia.

Objective: To evaluate the quality of the certification of general death and cancer in Colombia.Methods: Validity indicators were described for each province and the cities of Bogotá, Cali, Manizales, Pasto and Bucaramanga. A factorial analysis of principal components was carried out in order to identify non-obvious relationships.Results: Were analyzed 984,159 deaths, among them there were 164,542 deaths due to cancer. 93.7% of the general mortality was well certified. The predominant errors were signs, symptoms and ill-defined conditions. 92.8% of cancer mortality was well certified. The predominant errors were due to poorly defined cancer sites.Conclusions: Certification of quality indicators in Colombia has improved. Given the good performance of the quality indicators for certificating general death and cancer, it is considered that this is a valid input for the estimation of cancer incidences.

P270 Motor neurone disease (MND); a survey of deaths in the era of non-invasive ventilation

BackgroundThe care of patients with MND has changed radically with greater uptake of non-invasive ventilation (NIV) and tube feeding (TF). Community colleagues in our region have expressed anxiety about how...

Underascertainment of child abuse fatalities in France: Retrospective analysis of judicial data to assess underreporting of infant homicides in mortality statistics

Objectives Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. Methods A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996–2000, with follow-up of their files until case closing (1996–2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics. Results We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome [SIDS] without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2–3.6 times higher than those in mortality statistics. Nearly 1/3 of “accidental” deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians’ inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department. Conclusions In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics. Practice implications This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician “training” section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification.

Cancer incidence estimates at the national and district levels in Colombia

To estimate national and district cancer incidence for 18 major cancer sites in Colombia. National and district incidence was estimated by applying a set of age, sex and site-specific incidence/mortality ratios, obtained from a population-based cancer registry, to national and regional mortality. The work was done in Bogotá (Colombia) and Lyon (France) between May 2003 and August 2004. The annual total number of cases expected (all cancers but skin) was 17 819 in men and 18 772 in women. Among males the most frequent cancers were those of the prostate (45.8 per 100 000), stomach (36.0), and lung (20.0). In females the most frequent were those of the cervix uteri (36.8 per 100 000), breast (30.0), and stomach (20.7). Districts with the lowest death certification coverage yielded the highest incidence rates. In the absence of national population-based cancer registry data, estimates of incidence provide valuable information at national and regional levels. As mortality data are an important source for the estimation,the quality of death certification should be considered as a possible cause of bias.

Co-existing conditions for deaths from infectious and parasitic diseases in Australia

Objective: To examine the frequency distribution of co-existing conditions for deaths where the underlying cause was infectious and parasitic diseases. Materials and methods: Besides the underlying cause of death, the distributions of co-existing conditions for deaths from infectious and parasitic diseases were examined in total and by various age and sex groups, at individual and chapter levels, using 1998 Australian mortality data. Results: In addition to the underlying cause of death, the average number of reported co-existing conditions for a single infectious and parasitic death was 1.62. The most common co-existing conditions were respiratory failure, acute renal failure – non-specific causes, ischaemic heart disease, pneumonia and diabetes. When studying the distribution of co-existing conditions at the ICD-9 chapter level, it was found that the circulatory system diseases were the most important. There was an increasing trend in the number of reported co-existing conditions from 60 years of age upwards. Gender differences existed in the frequency of some reported co-existing conditions. The most common organism types of co-existing conditions were other bacterial infection and other viruses. Conclusions: The study indicated that the quality of death certificates is less than satisfactory for the 1998 Australian mortality data. The findings may be helpful in clarifying the ICD coding rules and the development of disease prevention strategies.

Relative value of incidence and mortality data in cancer research.

Cancer surveillance has played an important role in programmes of cancer control, ranging from aiding formulation of current hypotheses regarding the nature of the causes of cancer to assessing the effectiveness of cancer treatment regimes and cancer prevention programmes. Central to this has been the contribution from routine data collection schemes, particularly cancer mortality data and cancer registration schemes, the latter providing cancer incidence statistics for a variety of international populations. Criticisms have been made of the quality of cancer incidence data and there have been suggestions that cancer surveillance may be better achieved by use of mortality data. From examination of the reliability and quality of mortality data, it would appear that international variation in the quality of death certification and in the application of internationally agreed rules for selecting the underlying cause of death may in themselves be enough to vitiate the argument that there is significant international variation in cancer levels or to indicate variation where none in reality may exist. Good cancer incidence data are vitally important to descriptive epidemiology as are good cancer mortality data. It is important to recognize that there are limitations to both types of data which vary both temporarily and internationally. Cancer surveillance and the assessment of the impact of cancer control programmes depend on the reliability of descriptive epidemiology and would best be achieved by maintaining current, population-based cancer registration schemes and, if and where possible, extending such schemes to other populations or population groups. Maximum benefit would be achieved by simultaneous improvement in the quality of mortality data.

Mortality from stroke among U.S. veterans in Georgia and 5 western states: II. Quality of death certification and clinical records

This is the second of a series of reports comparing 604 deaths from stroke among U.S. veterans over 12 months in 1967–1968 in Georgia with 560 stroke deaths in the states of Colorado, Idaho, Montana, Utah and Wyoming; 1210 and 1644 deaths randomly selected from all other deaths in 2 areas, respectively, in the same year are used as controls. An analysis is presented of indicators of the quality of the data contained on the death certificates and in the clinical records of these men. There is little difference between the areas in the proportion of stroke cases dying in hospital, but more stroke deaths occurred at home in Georgia relative to the West; and this is largely compensated for by a higher proportion of deaths in nursing homes in the West. Autopsies were performed more frequently among stroke cases in the West than in Georgia; and in both cases and controls, more frequently in young than in old men. Certificates were signed more often by a physician in the West than in Georgia, and it was more usual for him to be present during the last illness and to be younger. Clinical records showed that each of 4 common diagnostic procedures not specific to stroke (blood chemistry, urinalysis, blood count and diagnostic radiology) were performed more frequently in the West. Differences between Georgia and the West in reported mortality from stroke can reasonably be attributed neither to differences in standards of medical care nor to accuracy of death certification. They apparently are due to other factors.