Death certification: issues and interventions

Dan Middleton, Robert Anderson, Tiffini Billingsly, N. Bande Mangaliso Virgil, Yolanda Wimberly, Robin Lee

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DOI: 10.4236/ojpm.2011.13022                

Abstract

A review of the literature suggests that errors in death certification are common. We reviewed the published literature to clarify what is known and what remains to be learned before evidence-based changes in medical education can be recommended. We searched the National Library of Medicine’s PubMed database for articles that addressed death certificate accuracy and identified 159 articles of interest published from 1996 to 2010. Among these 159 articles, we found 83 that were relevant to our goals and objectives. Cause of death certification has been shown to be problematic and several interventions have been shown to improve its accuracy, especially if the intervention is interactive. However these studies have focused on short term gains rather than on long term retention and performance, leaving a significant data gap. We suggest a study design that could address this data gap.

Keywords

Cause Of Death; Death Certification

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	CDC (2003) Physicians handbook on medical certification of death. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Publication No. 2003-1108, Hyattsville.
[2]	Smith-Sehdev, A.E. and Hutchins, G.M. (2001) Problems with proper completion and accuracy of the cause-of-death statement. Archives of Internal Medicine, 161, 277-284. doi:10.1001/archinte.161.2.277
[3]	Lakkireddy, D.R., Gowda, M.S., Murray, C.W., Basarakodu, .KR. and Vacek, J.L. (2004) Death certificate completion: How well are physicians trained and are cardiovascular causes overstated? American Journal of Medicine, 117, 492-498. doi:10.1016/j.amjmed.2004.04.018
[4]	Selikoff, I.J. and Seidman, H. (1992) Use of death certificates in epidemiological studies, including occupational hazards: Variations in discordance of different asbestos-associated diseases on best evidence ascertainment. American Journal of Industrial Medicine, 22, 481- 492. doi:10.1002/ajim.4700220403
[5]	Pritt, B.S., Hardin, N.J., Richmond, J.A. and Shapiro, S.L. (2005) Death certification errors at an academic institution. Archives of Pathology and Laboratory Medicine, 129, 1476-1479.
[6]	Lloyd-Jones, D.M., Martin, D.O., Larson, M.G. and, Levy, D. (1998) Accuracy of death certificates for coding coronary heart disease as the cause of death. Annals of Internal Medicine, 129, 1020-1026.
[7]	Nielsen, G.P., Bjornsson, J. and Jonasson, J.G. (1991) The accuracy of death certificates. Implications for health statistics. Virchows Archiv. A, Pathological Anatomy and Histopathology, 419, 143-146. doi:10.1007/BF01600228
[8]	D'Amico, M., Agozzino, E., Biagino, A., Simonetti, A. and Marinelli, P. (1999) Ill-defined and multiple causes on death certificates―a study of misclassification in mortality statistics. European Journal of Epidemiology, 15, 141-148. doi:10.1023/A:1007570405888
[9]	Lu, T.H., Hsu, P.Y., Bjorkenstam, C. and Anderson, R.N. (2006) Certifying diabetes-related cause-of-death: A comparison of inappropriate certification statements in Sweden, Taiwan and the USA. Diabetologia, 49, 2878- 2881. doi:10.1007/s00125-006-0470-6
[10]	Degani, A.T., Patel, R.M., Smith, B.E. and Grimsley, E. (2009) The effect of student training on accuracy of completion of death certificates. Medical Education Online, 14, 17. doi:10.3885/meo.2009.Res00315
[11]	O'Donovan, B.G., Armstrong, P., Byrne, M.C. and Murphy, A.W. A mixed-methods prospective study of death certification in general practice. Family Practice, 27, 351-355. doi:10.1093/fampra/cmq012
[12]	Aung, E., Rao, C. and Walker, S. (2010) Teaching cause-of-death certification: Lessons from international experience. Postgraduate Medical Journal, 86, 143-152. doi:10.1136/pgmj.2009.089821
[13]	Lakkireddy, D.R., Basarakodu, K.R., Vacek, J.L., Kondur, A.K., Ramachandruni, S.K., Esterbrooks, D.J., et al. (2007) Improving death certificate completion: A trial of two training interventions. Journal of General Internal Medicine, 22, 544-548. doi:10.1007/s11606-006-0071-6
[14]	Villar, J. and Perez-Mendez, L. (2007) Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties. BMC Health Services Research, 7, 183. doi:10.1186/1472-6963-7-183
[15]	Hanzlick, R. (2006) Cause of Death and the Death Certificate. College of American Pathologists. Northfield, Illinois, 235.
[16]	Johansson, L.A., Westerling, R. and Rosenberg, H.M. (2006) Methodology of studies evaluating death certificate accuracy were flawed. Journal of Clinical Epidemiology, 59, 125-131. doi:10.1016/j.jclinepi.2005.05.006