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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

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

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

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Mortality statistics derived from cause of death data are an important source of information for population health monitoring, priority setting and planning. In Perú, almost all death certificates are issued by doctors because it is a legal requirement. However, the quality of cause of death data is poor. In August 2016, the Ministry of Health of Perú decided to make two specific interventions to improve cause of death data: to introduce an online death certification system and to train doctors in standard death certification practices.

Methods

The study comprised a random sample of 300 pre-intervention death certificates, 900 death certificates that were part of the online intervention, and 900 death certificates that were part of both the online and training interventions. All the deaths had occurred between January and September 2017. We used the Assessing the quality of death certification tool from the University of Melbourne for the assessment. We examined the frequency of common errors in death certificates, the frequency of any error and the average error score for each category of: age group, sex, doctor’s seniority, doctor’s speciality, level of health facility and broad cause of death.

Results

The average error score declined by 38% due to the online intervention and by a further 26% due to the training intervention. Improved certification practices remained after controlling for potentially confounding factors. Main improvements were reductions in the absence of a time interval (66% of certificates), incorrect sequence of causes (22%), and ill-defined conditions (13%).

Conclusions

This study demonstrates how the two interventions introduced by the Ministry of Health in Perú improved the correctness of death certificates. The study also provides evidence on necessary changes to the training program to address the poor certification practices that have remained after implementation of the online system.
Appendix
Available only for authorised users
Footnotes
1
SINADEF is the abbreviation in Spanish of Sistema Informático Nacional de Defunciones (National Death Information System).
 
Literature
1.
Hernandez B, Ramirez-Villalobos D, Romero M, Gomez S, Atkinson C, Lozano R. Assessing quality of medical death certification: concordance between gold standard diagnosis and underlying cause of death in selected Mexican hospitals. Popul Health Metr. 2011;9.
2.
Macintyre S, Chalmers I, Horton R, Smith R. Using evidence to inform health policy: case studs. Br Med J. 2001;322(7280):222–5.CrossRef
3.
Petticrew M, Whitehead M, Macintyre SJ, Graham H, Egan M. Evidence for public health policy on inequalities: 1: the reality according to policymakers. J Epidemiol Community Health. 2004;58(10):811–6.CrossRefPubMedPubMedCentral
4.
5.
AbouZahr C, De Savigny D, Mikkelsen L, Setel PW, Lozano R, Nichols E, et al. Civil registration and vital statistics: progress in the data revolution for counting and accountability. Lancet. 2015;386(10001):1373–85.CrossRefPubMed
6.
Mikkelsen L, Phillips DE, AbouZahr C, Setel PW, de Savigny D, Lozano R, et al. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet. 2015;386(10001):1395–406.CrossRefPubMed
7.
WHO. Improving the quality and use of birth, death and cause-of-death information, guidance for a standardsbased review of country practices. Geneva, Switzerland: World Health Organization 2010.
8.
Benavides FG, Bolumar F, Peris R. Quality of death certificates in Valencia. Spain Am J Public Health. 1989;79(10):1352–4.CrossRefPubMed
9.
Hazard RH, Chowdhury HR, Adair T, Ansar A, Rahman AMQ, Alam S, et al. The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the international form of medical certificate of cause of death. BMC Health Serv Res. 2017;17.
10.
Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ. 2005;83(3):171–7.PubMedCentralPubMed
11.
Filippatos G, Andriopoulos P, Panoutsopoulos G, Zyga S, Souliotis K, Gennimata V, et al. The quality of death certification practice in Greece. Hippokratia. 2016;20(1):19–25.PubMedCentralPubMed
12.
Nojilana B, Groenewald P, Bradshaw D, Reagon G. Quality of cause of death certification at an academic hospital in Cape Town, South Africa. Samj S Afr Med J. 2009;99(9):648–52.PubMed
13.
Pillay-van Wyk V, Bradshaw D, Groenewald P, Laubscher R. Improving the quality of medical certification of cause of death: The time is now! Samj S Afr Med J. 2011;101(9):626.PubMed
14.
GBD 2016 Mortality Collaborators. Global, regional, and national under-five mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1084–150.CrossRef
15.
Instituto Nacional De Estadisticia e Informatica. Peru: Estimaciones y proyecciones de población, 1950–2050. Boletin de Analisis Demografico No. 35. Lima; 2001.
16.
Ministerio de Salud DGE. Indicadores Básicos de Salud 2015. Lima; 2017.
17.
Rampatige R, Mikkelsen L, Hernandez B, Riley I, Lopez AD. Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers. Bull World Health Organ. 2014;92(11):807–16.CrossRefPubMedPubMedCentral
18.
Garg A, Singh SV, Gupta VK. Accuracy of medical certification of the cause of death in a rural non-teaching hospital in Delhi. Natl Med J India. 2012;25(3):185–6.PubMed
19.
Phillips DE, Lozano R, Naghavi M, Atkinson C, Gonzalez-Medina D, Mikkelsen L, et al. A composite metric for assessing data on mortality and causes of death: the vital statistics performance index. Popul Health Metr. 2014;12.
20.
Soto-Caceres V. Calidad del llenado de los certificados de defunción en un Hospital Público de Chiclayo, Perú 2006 [Quality of the filing of death certificates in a Public Hospital of Chiclayo, Perú 2006]. Rev Perú Med Exp Salud Publica. 2008;25(3):330–2.
21.
Loreto Núñez MGIM. Calidad de las estadísticas de mortalidad en Chile, 1997-2003 [quality of mortality statistics in Chile, 1997-2003]. Rev Med Chil. 2006;134:1191–6.
22.
Valdez WG, Gutiérrez C, Siura G. Análisis de la calidad de la certificación de defunciones en la región Ica, 2007 [Analysis of the quality of the certification of deaths in the Ica región, 2007]. Revista Perúana de Epidemiologia. 2013;17(1).
23.
Dirección Técnica de Demografía e Indicadores Sociales del Instituto Nacional de Estadística e Informática (INEI). Perú: Estimaciones y Proyecciones de Población Total, por Años Calendario y Edades Simples, 1950–2050. Lima, Perú; 2009.
24.
Perú Ministerio de Salud. Compendio de Estadísticas de Hechos Vitales: Perú 2011. Lima, Perú; 2013.
25.
26.
Lefeuvre D, Pavillon G, Aouba A, Lamarche-Vadel A, Fouillet A, Jougla E, et al. Quality comparison of electronic versus paper death certificates in France, 2010. Popul Health Metr. 2014;12(1):3.CrossRefPubMedPubMedCentral
27.
Pavillon GC, Coilland P, Jougla E. Mise en place de la certification électronique des causes médicales de décès en France : premier bilan et perspectives. BEH thématique. 2007;35–36:306–8.
28.
WHO. International Statisticsal Classiciation of Diseases and Related Health Problems. 10th revision, vol. 2, 10th ed. Geneva: World Health Organization; 2016.
29.
Aung E, Rao C, Walker S. Teaching cause-of-death certification: lessons from international experience. Postgrad Med J. 2010;86(1013):143–52.CrossRefPubMed
30.
Walker S, Rampatige R, Wainiqolo I, Aumua A. An accessible method for teaching doctors about death certification. Health Inf Manag J. 2012;41(1):4–10.
31.
Lakkireddy DR, Basarakodu KR, Vacek JL, Kondur AK, Ramachandruni SK, Esterbrooks DJ, et al. Improving death certificate completion: a trial of two training interventions. J Gen Intern Med. 2007;22(4):544–8.CrossRefPubMedPubMedCentral
32.
University of Melbourne. Strategies for improving the quality of cause of death data in hospitals. CRVS development series. Melbourne, Australia: Civil Registration and Vital Statistics Improvement, Bloomberg Philanthropies Data for Health Initiative, University of Melbourne; 2017.
33.
University of Melbourne. Assessing the quality of death certificates: Guidance for the rapid tool. CRVS resources and tools. Melbourne, Australia: Civil Registration and Vital Statistics Improvement, Bloomberg Philanthropies Data for Health Initiative, University of Melbourne; 2018.
34.
Long JS. Regression models for categorical and limited dependent variables. Thousand Oaks. Sage Publications. 1997:297.
35.
StataCorp. Stata 15.0. 2015; College Station: StataCorp LP.
36.
United Nations. United Nations e-Government Survey. Gearing e-government to support transformation towards sustainable and resilient societies. New York: United Nations; 2018. p. 2018.
37.
Abos R, Perez G, Rovira E, Canela J, Domenech J, Bardina JR. A pilot program to improve causes of death certification in primary care of Catalonia, Spain. Gac Sanit. 2006;20(6):450–6.CrossRefPubMed
38.
39.
Villar J, Perez-Mendez L. Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties. BMC Health Serv Res. 2007;7.
40.
Myers KA, Eden D. Death duties: workshop on what family physicians are expected to do when patients die. Can Fam Physician. 2007;53(6):1035–8.PubMedCentralPubMed
41.
Weeramanthri T, Beresford B. Death certification in Western Australia--classification of major errors in certificate completion. Aust J Public Health. 1992;16(4):431–4.CrossRefPubMed
42.
Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1151–210.CrossRef
43.
Maudsley G, Williams EM. Death certification by house officers and general practitioners--practice and performance. J Public Health Med. 1993;15(2):192–201.PubMed
44.
Messite J, Stellman SD. Accuracy of death certificate completion: the need for formalized physician training. JAMA. 1996;275(10):794–6.CrossRefPubMed
45.
Joshi R, Lopez AD, MacMahon S, Reddy S, Dandona R, Dandona L, et al. Verbal autopsy coding: are multiple coders better? Bull World Health Organ. 2009;87:51–7.CrossRefPubMed
Metadata
Title
Saving lives through certifying deaths: assessing the impact of two interventions to improve cause of death data in Perú
Authors
Janet Miki
Rasika Rampatige
Nicola Richards
Tim Adair
Juan Cortez-Escalante
Javier Vargas-Herrera
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6264-1

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