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

Hart, John; Sorchik, Renee; Bo, Khin Sandar; Chowdhury, Hafizur Rahman; Gamage, Saman; Joshi, Rohina; Kwa, Viola; Li, Hang; Mahesh, Pasyodun Koralage Buddhika; McLaughlin, Deirdre; Mikkelsen, Lene; Miki, Janet; Napulan, Roderick; Rampatige, Rasika; Reeve, Matthew; Sarmiento, Carmina; War, Nang Su; Richards, Nicola; Riley, Ian; López, Alan D.

doi:10.1186/s12916-020-01519-8

Cited by 40 publications

(61 citation statements)

References 10 publications

(12 reference statements)

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“…Accordingly, the Data for Health Initiative has invested substantial effort to improve knowledge and skills among physicians who certify causes of death in hospitals, since this is often the only information available to governments about who dies of what. The impact of three different medical certification training strategies implemented as part of the Initiative is presented in this collectionpossibly the first ever multicountry assessment of medical certification improvement strategies [29]. These suggest that a reduction in incorrectly completed certificates of between 28 and 43% is possible, depending on the strategy.…”

Section: Quality Of Death Data Is Variable and Needs Improvementmentioning

confidence: 99%

Reducing ignorance about who dies of what: research and innovation to strengthen CRVS systems

López

McLaughlin

Richards

2020

BMC Med

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The Sustainable Development Goal (SDG) agenda offers a major impetus to consolidate and accelerate development in civil registration and vital statistics (CRVS) systems. Strengthening CRVS systems is an SDG outcome in itself. Moreover, CRVS systems are the bestif not essentialsource of data to monitor and guide health policy debates and to assess progress towards numerous SDG targets and indicators. They also provide the necessary documentation and proof of identity for service access and are critical for disaster preparedness and response. While there has been impressive global momentum to improve CRVS systems over the past decade, several challenges remain. This article collection provides an overview of recent innovations, progress, viewpoints and key areas in which action is still requirednotably around the need for better systems and procedures to notify the fact of death and to reliably diagnose its cause, both for deaths in hospital and elsewhere.

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Section: Quality Of Death Data Is Variable and Needs Improvementmentioning

confidence: 99%

Reducing ignorance about who dies of what: research and innovation to strengthen CRVS systems

López

McLaughlin

Richards

2020

BMC Med

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“…Within the 21 selected articles [13][14][15][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], there were 24 distinct interventions, with one article describing four interventions across four countries [30]. In another, findings were stratified under two study populations [27].…”

Section: Resultsmentioning

confidence: 99%

“…These ranged in duration from 45 min [13] to 5 h [27], and some interventions included subsequent sessions on additional days [36]. Other descriptions included 'training of trainers' (Philippines, Myanmar, Sri Lanka) [30], a video (UK) [35] and web-based or online training (USA, Fiji) [14,15,31]. In Peru, training was complementary to an online death certification system [32].…”

Section: Study Populations Interventions and Outcomesmentioning

confidence: 99%

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Effectiveness of training interventions to improve quality of medical certification of cause of death: systematic review and meta-analysis

Gamage

Mahesh

Schnall

et al. 2020

BMC Med

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Background Valid cause of death data are essential for health policy formation. The quality of medical certification of cause of death (MCCOD) by physicians directly affects the utility of cause of death data for public policy and hospital management. Whilst training in correct certification has been provided for physicians and medical students, the impact of training is often unknown. This study was conducted to systematically review and meta-analyse the effectiveness of training interventions to improve the quality of MCCOD. Methods This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration ID: CRD42020172547) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. CENTRAL, Ovid MEDLINE and Ovid EMBASE databases were searched using pre-defined search strategies covering the eligibility criteria. Studies were selected using four screening questions using the Distiller-SR software. Risk of bias assessments were conducted with GRADE recommendations and ROBINS-I criteria for randomised and non-randomised interventions, respectively. Study selection, data extraction and bias assessments were performed independently by two reviewers with a third reviewer to resolve conflicts. Clinical, methodological and statistical heterogeneity assessments were conducted. Meta-analyses were performed with Review Manager 5.4 software using the ‘generic inverse variance method’ with risk difference as the pooled estimate. A ‘summary of findings’ table was prepared using the ‘GRADEproGDT’ online tool. Sensitivity analyses and narrative synthesis of the findings were also performed. Results After de-duplication, 616 articles were identified and 21 subsequently selected for synthesis of findings; four underwent meta-analysis. The meta-analyses indicated that selected training interventions significantly reduced error rates among participants, with pooled risk differences of 15–33%. Robustness was identified with the sensitivity analyses. The findings of the narrative synthesis were similarly suggestive of favourable outcomes for both physicians and medical trainees. Conclusions Training physicians in correct certification improves the accuracy and policy utility of cause of death data. Investment in MCCOD training activities should be considered as a key component of strategies to improve vital registration systems given the potential of such training to substantially improve the quality of cause of death data.

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“…This can be achieved through training of doctors in standard death certification practices, which has proven to reduce the errors in other countries [26]. This can be supplemented with strategies such as hospital based committees that can oversee cause of death quality assessments [27].…”

Section: Discussion Conclusion and Recommendationsmentioning

confidence: 99%

Evaluation of civil registration and vital statistics system in the Maldives: Focus on mortality statistics

Usman

Moosa

2020

SJI

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An efficient Civil Registration and Vital Statistics (CRVS) system is a development imperative. Data on death registration and causes of death are important for measuring health outcomes. This paper evaluates the completeness and quality of data on death registration and causes of death (CoD) based on analysis of the registration records on death and causes of death for the period 2009–2018. Using established methods and approaches, we observed that CRVS system performed well on death registration completeness, quality of age and sex reporting. However, the quality of cause of death data was poor with 50% of the International Classification of Diseases (ICD) codes classified as “major garbage codes” and significant time lag was observed in the transmission and production of vital statistics. The CRVS system in Maldives is complete with all deaths occurring within its territory registered and causes of death recorded. The two areas that require attention are the time taken for publication of vital statistics and quality of cause of death reporting. Appropriate re-engineering of the existing business process can build real-time mortality data, and regular quality assessment of death certificates with feedback to health facilities can bring sustained improvements in quality of vital statistics.

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

Cited by 40 publications

References 10 publications

Reducing ignorance about who dies of what: research and innovation to strengthen CRVS systems

Reducing ignorance about who dies of what: research and innovation to strengthen CRVS systems

Effectiveness of training interventions to improve quality of medical certification of cause of death: systematic review and meta-analysis

Evaluation of civil registration and vital statistics system in the Maldives: Focus on mortality statistics

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