AHNA certificate program in holistic nursing courses. AHNA certificate program in healing touch courses.
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Education, Nursing, Continuing↗
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[Importance of certification of vaccination status with the vaccination certificate].
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Child↗
Trends in specialty certification.
From 1980 to 1994, 283,024 certificates were issued by the 23 specialty boards. Of these certificates, 137,852 (48.7%) were issued in primary care specialties, 84,993 (30.0%) were certificates in the other medical specialties, and 60,179 (21.2%) were certificates in the surgical specialties. The figure on page 26 illustrates the changes that have occurred in the pool of board-certified physicians from 1980 to 1994. Since 1980, the number of certificates issued in the primary care specialties and the number of certificates issued in the other medical specialties has consistently exceeded those issued in the surgical specialties. In 1977, Mr. James Haug, Director, ACS Socioeconomic Affairs Department, correctly predicted that the pool of board-certified surgeons as a percentage of the total pool of board-certified physicians would decline. In 1980, the total number of certificates issued by the 23 specialty boards was 16,034. Surgical specialty certificates accounted for 23.8 percent of the total number of certificates issued by the 23 specialty boards in 1980. In 1994, the total number of certificates issued by the 23 specialty boards was 22,090. Surgical specialty certificates accounted for 19.8 percent of the total number of certificates issued by the 23 specialty boards in 1994. In 1980, 1984, 1986, and 1989 primary care specialty certificates accounted for greater than 50.0 percent of the total number of certificates issued by the 23 specialty boards in those years. Given the substantial growth in the number of certificates in the primary care and other medical specialties depicted in the figure, certificates in the surgical specialties as a percentage of the total number of certificates has remained stable.
Certification↗
Incomplete and inaccurate death certification--the impact on research.
BACKGROUND: The objectives of this study were (1) to investigate the extent of erroneous and/or omitted information on death certificates of patients-implanted with Bjork-Shiley Convexo-Concave (BSCC) heart valves; (2) to determine whether this information could be associated with a possible under-reporting of acute mechanical failure of this valve. METHODS: A review was carried out of death certificates and clinical notes for patients implanted in the United Kingdom with BSCC valves. This was a multicentre study (38 hospitals) based at the Cardiothoracic Department, NHLI, Imperial College School of Medicine at Hammersmith Hospital, London. The subjects were 478 patients implanted with a BSCC valve between 1979 and 1986 who died in the following years: 1984, 1987, 1990, 1993 and 1996. The main outcome measures were: (1) percentage of death certificates that record the presence of a valve prosthesis; (2) percentage of death certificates that record the presence of a valve prosthesis for patients who had a post mortem; (3) percentage of death certificates that record inaccurate or incomplete information related to the surgery; (4) percentage of death certificates that do not record a post mortem where one is known to have been performed. RESULTS: Twenty-one per cent (101/478) of the total number of death certificates record the presence of the valve prosthesis. Thirty-five per cent (43/123) of the death certificates for patients who had a post mortem record the presence of a valve prosthesis. Six per cent (30/478) of death certificates report inaccurate information related to the valve surgery. Twenty-five per cent (118/478) of the total number of death certificates recorded a single cause of death. Twenty-three per cent (110/478) of all death certificates reviewed recorded only the mode of dying. Eight per cent (10/123) of the total number of death certificates for patients who had a post mortem did not record a post mortem. CONCLUSIONS: The relatively high number of death certificates that do not record the presence of a valve prosthesis and the observed under-reporting of post mortems may lead to inaccurate reporting of the number of BSCC valves that fail. Previous recommendations to improve accuracy in death certification appear to have gone unheeded, and changes in the way certificates are completed for patients with implanted cardiac devices should be considered.
Aged↗
[The medical certificate--contents, form, deficiencies, fees].
The medical certificate ist a written health certificate based on the results of a medical diagnosis or examination. It does not contain scientifically base conclusions. The various forms of the certificate can be, for example, certificates of unfitness for work, certificates for insurance companies, certificates for exemption from school sports, diet certificates for tax returns, confirmation of a stable diabetes condition for driving licence authorities, certificates as proof of unfitness to plead in the process of criminal law. It is an offence (section 278 German Penal Code) to issue false health certificates for use with a public authority or insurance company contrary to one's knowledge. The form of some certificates is free, in some cases forms are used. "Standard form certificates" for insurance company are extended certificates. Certificates, especially free-form certificates, often have deficiencies: the purpose or addressee is not quoted; the date of the examination has not been entered; it is not apparent whether the statement is based on objective results; "catchword" like diagnostic terms are used: the necessary form ist not adhered to. The "Law concerning Compensation for Witnesses and Experts" (ZSEG) and the Scale of Medical Fees (GOA) set the standards for assessing the fee for a certificate.
Confidentiality↗
Diversity in death certification: a case vignette approach.
Previous studies have revealed high rates of errors in death certification, but few have discussed the nature of these errors. To explore the diversity among physicians in death certification and its relationship with the complexity of the causal sequence of death, we asked 145 physicians attending a continuing medical education course to complete the cause-of-death section on dummy death certificates of four case vignettes. The difficulty in determining the causal sequence of death varied from relatively simple to complex. Variations in death certification were classified according to wording, diagnostic semantics, combinations of expressions, correctness of certification format, and concordance with the referent underlying cause of death (UCOD). Given the same case history information, physicians showed great variation in wording and diagnostic semantics in death certification. The rates of correct certification format and concordance with referent UCOD varied with the level of complexity of the causal sequence of death. The greatest source of diversity was choosing between an acute condition of a chronic disease and the chronic disease itself, and between competing prominent comorbidities. Experience in death certification was significantly associated with correct certification format but not with concordance with referent UCOD. Knowledge of death certification was not associated with correct certification format or concordance with referent UCOD. Our findings indicate that the traditional concept of UCOD tabulation and using a single standard ICD code in evaluating the quality of death certification oversimplifies a complex situation. Variations in death certification, especially the selection of UCOD, were due to differences in interpreting the information rather than differences in knowledge of death certification.
Acute Disease↗
Trends in specialty certification.
From 1980 to 1996, 334,597 certificates were issued by the 24 specialty boards. Of these certificates, 164,728 (49.2%) were issued in primary care specialties, 100,981 (30.2%) were certificates in the other medical specialties, and 68,888 (20.5%) were certificates in the surgical specialties. The figure above illustrates the changes that have occurred in the pool of board-certified physicians from 1980 to 1996. For the years reported, the number of certificates issued in the primary care specialties and in the other medical specialties has consistently exceeded those in the surgical specialties. It is clear that the pool of board-certified surgeons as a percentage of the total pool of board-certified physicians has declined. In 1980, the total number of certificates issued by the 24 specialty boards was 16,034, with surgical specialty certificates accounting for 23.8 percent of that number. By 1996, surgical specialty certificates accounted for 16.7 percent of the 26,462 certificates issued by the 24 boards. In 1980, 1986, 1989, 1995, and 1996 primary care specialty certificates accounted for more than 50 percent of the total number of certificates issued by the 24 specialty boards in those years. Given the substantial growth in the number of certificates in the primary care and other medical specialties depicted in the figure, certificates in the surgical specialties as a percentage of the total number of certificates has remained stable.
Certification↗
Mortality in Medicare beneficiaries following coronary artery bypass graft surgery in states with and without certificate of need regulation.
CONTEXT: Certificate of need regulation was designed to control health care costs by preventing health care facilities from expanding unnecessarily. While there have been several studies investigating whether these regulations have affected health care investment, few have evaluated the relationship between certificate of need regulation and quality of care. OBJECTIVE: To compare risk-adjusted mortality and hospital volumes for coronary artery bypass graft (CABG) surgery in states with and without certificate of need regulation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 911 407 Medicare beneficiaries aged 65 years or older, who underwent CABG surgery between 1994 and 1999 in 1063 US hospitals. MAIN OUTCOME MEASURES: States (and the District of Columbia) with continuous (n = 27), none (n = 18), or intermittent (n = 6) certificate of need regulation; mortality (in-hospital or within 30 days of CABG surgery) rates; and mean annual hospital volumes for CABG surgery. RESULTS: Unadjusted mortality was 5.1% in states without certificate of need regulation compared with 4.4% in states with continuous regulation, and 4.3% in states with intermittent certificate of need regulation (P<.001 for each comparison). Adjusting for demographic and clinical factors, mortality remained higher in states without certificate of need regulation compared with states with continuous certificate of need regulation (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.15-1.28; P<.001). Using the same groups for comparison, the mean annual hospital volume for CABG surgery was 84% lower in states without certificate of need regulation (104 vs 191; P<.001) and more patients underwent CABG surgery in low-volume hospitals (<100 procedures annually) (30% vs 10% for states with continuous certificate of need programs; P<.001). Following the repeal of certificate of need regulation in states categorized as intermittent, the percentage of patients undergoing CABG surgery in low-volume hospitals tripled. CONCLUSIONS: Mortality rates for Medicare patients undergoing CABG surgery were higher in states without certificate of need regulation. Repeal of certificate of need regulations during the study period was associated with declines in hospital volume for CABG surgery.
Aged↗
Development of a state wide tobacco treatment specialist training and certification programme for Massachusetts.
OBJECTIVE: To describe the research conducted to structure and develop a statewide tobacco training and certification programme for tobacco treatment specialists (TTSs) in Massachusetts. DESIGN: Qualitative research strategies were used to obtain information on certification development and opinions regarding TTS training and certification from key informants. A role definition and validation study was then conducted to determine the core competencies for TTSs. A comprehensive training programme was developed, piloted, and finalised, and a certification programme was initiated. PARTICIPANTS: Key informants included: individuals involved in the development of their professional certification programmes; tobacco treatment providers from across Massachusetts; and national tobacco treatment experts. MAIN OUTCOME MEASURES: Participants' opinions about the need for and structure of a training and certification programme for individuals specialising in the provision of moderate to intensive tobacco treatment; delineation of core competencies for TTSs, using the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) clinical practice guideline as a foundation for the development of evidence based standards of practice for the treatment of nicotine dependence. RESULTS: The data support a comprehensive training and certification programme for TTSs in Massachusetts. Main concerns include the cost of obtaining certification, the potential to exclude uncertified healthcare professionals from delivering basic tobacco treatment, and the role of the TTS in the healthcare delivery system and the community. The training programme developed for Massachusetts was piloted, and the structure of a statewide training and certification programme for TTSs was finalised. CONCLUSIONS: The research provides support for the need and acceptance of a training and certification programme for TTSs in Massachusetts, and presents the challenges to be addressed. We demonstrated the feasibility of developing and implementing an evidence based training programme, and of initiating a statewide certification programme in Massachusetts. This work will add to a national dialogue on the development of a training and certification programme for tobacco treatment providers and encourage further research into the potential impact of statewide and national certification.
Adult↗
Death certification errors at an academic institution.
CONTEXT: The correctly completed death certificate provides invaluable personal, epidemiologic, and legal information and should be thorough and accurate. Death certification errors are common and range from minor to severe. OBJECTIVE: To determine the frequency and type of errors by nonpathologist physicians at a university-affiliated medical center. DESIGN: Fifty random patients were identified who died at this academic medical center between January 2002 and December 2003 and did not undergo an autopsy. From medical chart review, clinical summaries were produced. Two pathologists used these summaries to create mock death certificates. The original and mock death certificates were then compared to identify errors in the original certificate. Errors were graded on a I to IV scale, with grade IV being the most severe. RESULTS: Of the 50 death certificates reviewed, grade I, II, and III errors were noted in 72%, 32%, and 30%, respectively. Seventeen certificates (34%) had grade IV errors (wrong cause or manner of death). Multiple errors were identified in 82% of the death certificates reviewed. CONCLUSIONS: The rate of major (grade IV) death certification errors at this academic setting is high and is consistent with major error rates reported by other academic institutions. We attribute errors to house staff inexperience, fatigue, time constraints, unfamiliarity with the deceased, and perceived lack of importance of the death certificate. To counter these factors, we recommend a multifaceted approach, including an annual course in death certification and discussion of the death certificate for each deceased patient during physician rounds. These measures should result in increased accuracy of this important document.
Cause of Death↗
Influence of death certificate errors on cancer mortality trends.
BACKGROUND: Evaluation of mortality data is an important tool in assessing both disease time trends and differences in populations. However, the reasons for changes in cancer mortality rates have been controversial. Questions have been raised concerning whether these increases are real or simply the result of changing diagnoses and death certificate reporting. PURPOSE: Our purpose was to determine on the basis of autopsy data if death certificate reporting varies over age, time, and cancer type and to explore the effect of death certificate error on recent cancer mortality trends. METHODS: Data were analyzed from 5886 autopsies collected by the Radiation Effects Research Foundation in Hiroshima, Japan, between 1961 and 1987. Death certificates were linked to autopsy data for analyses. An adjustment factor was calculated as a ratio of the accuracy of these death certificates in identifying cancer (detection rate) and listing cancer (confirmation rate) as the cause of death. This adjustment factor measures bias in mortality rates due to death certification errors and quantifies underestimation and overestimation of cancer mortality rates. RESULTS: Our analyses focused on lymphoma, breast cancer, neoplasms of the brain, multiple myeloma, and melanoma because of reported mortality increases. For these cancers, the adjustment factor decreased significantly (P = .02) over time, implying that death certificate accuracy has improved. This change appears to account for 60% of the observed increase in these cancers during the time period of study. For total cancer, persons 75 years or older have a high adjustment factor but it decreased over time. This decrease suggests an artifactual increase in total cancer mortality rates of about 1% per year for this older group. CONCLUSIONS: The quality of death certificate reporting has generally remained constant for most groups during the period 1961-1987. In the study population, there was a consistent underestimation of total cancer mortality of about 18%. For the five types of cancer studied, there has been less underestimation of cancer mortality since 1976. For some specific cancers and for persons 75 years or older, improvements in death certificate accuracy have occurred over time. These data imply that the total death certificate error rate varies considerably by cancer type, time period, and age at death. IMPLICATIONS: The changes in death certificate reporting for some sites and the elderly appear to have artifactually created increases in cancer mortality rates. These artifacts need to be considered when using mortality data for prevention research and health care planning.
Aged↗
Death certificates are not reliable: revivification of the autopsy.
BACKGROUND: Medicine assumes that vital statistics are accurate, but they are only as good as the death certificates. OBJECTIVE: To evaluate the accuracy of death certificates in reporting vital statistics with an emphasis on cardiac deaths. DESIGN: A population-based retrospective study within one community hospital. PATIENTS: During the study period, 1,619 patients expired during hospitalization, of which 223 underwent autopsy. INTERVENTIONS: Clinical diagnoses were determined from the death certificate and autopsy results from the final pathology reports. MEASUREMENTS: Concordance of myocardial infarction as the underlying cause of death between the death certificate and the autopsy was measured. New diagnoses uncovered by the autopsy were tabulated. RESULTS: The death certificate missed acute myocardial infarction in 25 of 52 autopsy-proven cases (48% errors of omission). Conversely, it erroneously asserted the presence of an acute myocardial infarction in 9/36 cases (25% errors of commission). Autopsy showed these nine cases actually were pneumonia (5), sepsis with ARDS (2), cerebral hemorrhage (1), and cardiac tamponade (1). Autopsy proved 52 myocardial infarctions causing death, while death certificates accurately reported only 27. Myocardial infarction was more likely to be unsuspected in extreme ages, in women, when found in right ventricle or posterior wall, and in the presence of sepsis or ARDS. Death certificates were frequently inaccurate and in 21.5% of cases were of no value because of an inadequate diagnosis, ie, cardiopulmonary arrest, arrhythmia or respiratory failure. CONCLUSION: Major discrepancies of commission and omission occur frequently between the death certificate and autopsy. 1) Death certificates are often wrong. 2) The time-honored autopsy is more valuable than ever. 3) Physicians need to write better death certificates and correct them. 4) Death certificate-based vital statistics should be corrected with autopsy results. 5) Vital statistics should note deaths confirmed by autopsy. 6) More autopsies would improve vital statistics and the practice of medicine.
Adult↗
Access control based on attribute certificates for medical intranet applications.
BACKGROUND: Clinical information systems frequently use intranet and Internet technologies. However these technologies have emphasized sharing and not security, despite the sensitive and private nature of much health information. Digital certificates (electronic documents which recognize an entity or its attributes) can be used to control access in clinical intranet applications. OBJECTIVES: To outline the need for access control in distributed clinical database systems, to describe the use of digital certificates and security policies, and to propose the architecture for a system using digital certificates, cryptography and security policy to control access to clinical intranet applications. METHODS: We have previously developed a security policy, DIMEDAC (Distributed Medical Database Access Control), which is compatible with emerging public key and privilege management infrastructure. In our implementation approach we propose the use of digital certificates, to be used in conjunction with DIMEDAC. RESULTS: Our proposed access control system consists of two phases: the ways users gain their security credentials; and how these credentials are used to access medical data. Three types of digital certificates are used: identity certificates for authentication; attribute certificates for authorization; and access-rule certificates for propagation of access control policy. Once a user is identified and authenticated, subsequent access decisions are based on a combination of identity and attribute certificates, with access-rule certificates providing the policy framework. CONCLUSIONS: Access control in clinical intranet applications can be successfully and securely managed through the use of digital certificates and the DIMEDAC security policy.
Certification↗
[How do physicians actually write guardianship certificates for elderly patients?].
UNLABELLED: Physicians participate in the legal process of appointing guardianship by writing medical certificates concerning guardianship. There are no instructions or clear-cut methods to examine how to determine a person's ability to handle his own affairs (estate and body), or to evaluate his ability to express his opinion concerning guardianship. There are, however, a number of ways to examine and analyze the subject. Our paper presents findings from 16 randomly collected medical certificates from diverse sources (13 different institutions, physicians from various specialties), for which the courts decision is known. We checked to see if the medical certificates relate to and fulfill basic medico-legal and clinical points referred to in the professional literature. RESULTS: We found that full demographic details were recorded in only one certificate (6.2%), the identity of the solicitor of the certificate was mentioned in 3 cases (18.7%) and the source/s of information in 6 cases (37.5%). Results of complete cognitive/mental examination (mental status) were mentioned in 4 cases (25%), psychiatric diagnoses in 12 cases (75%), level of severity in 9 cases (56.2%), reference to a temporary phenomenon in one case, and evaluation of basic daily functioning in 2 cases (12.5%). None of the cases included more complex daily functioning evaluations (instrumental). Similarly, none of the certificates mentioned whether or not legal criteria were used to evaluate the subjects ability to handle his estate or body or his ability to express his opinion concerning guardianship. On the other hand, formal reference to the ability to handle affairs (in 7 cases [43.7%] distinction between estate and body) and to express an opinion concerning guardianship was noted in 15 cases (93.75%). The length of the medical certificate averaged 13.8 lines (standard deviation 10.1, range 4-41); 13 of the certificates were written in public forums with an average length of 9.9 lines (standard deviation 4.6, range 4-20 lines), as opposed to 31 lines (standard deviation 9.5, range 22-41) for the private sector. Our findings suggest that the medical certificates were lacking in clinical facets examined, especially the medico-legal aspects. Despite these shortcomings, the courts accepted the overwhelming majority of the documents (15/16, 93.7%), perhaps because most of the certificates included formal reference to specific legal questions raised in the court (ability to handle affairs, ability to express opinion concerning guardianship). In our opinion, these findings, if validated in larger groups and in more courts, require multi-system re-evaluation of the subject of writing medical certificates for legal guardianship of the elderly.
Activities of Daily Living↗
Accuracy of the death certificate in a population-based study of asthmatic patients.
OBJECTIVE: To quantify the reliability of death certificate data concerning asthma. DESIGN: The complete medical records of decedents were reviewed by a physician certified in allergy and pulmonology who determined the cause of death without having access to the original death certificate. Disagreements between the death certificate and the reviewer were adjudicated by an expert panel. SETTING: The community of Rochester, Minn. PATIENTS: The mortality cohort included 339 deaths from a larger cohort of 5241 Rochester residents who received medical treatment for asthma between 1964 and 1983. MAIN OUTCOME MEASURES: Kappa coefficients were used to measure agreement beyond that expected by chance between the reviewer and the death certificate. The sensitivity and specificity of the death certificate diagnosis of asthma were calculated against the standard of the reviewer/panel diagnosis. RESULTS: Death certificates reported asthma as an immediate or underlying cause of death in 22 instances (6%), whereas the reviewer/panel identified asthma in 53 cases (16%). In four cases, the death certificate listed asthma and the panel identified another cause of death. The death certificate had a sensitivity of 42% and a specificity of 99% compared with the reviewer/panel. Agreement between death certificates and the reviewer was not influenced by whether an autopsy was performed. CONCLUSIONS: Death certificate diagnosis of asthma as an underlying cause of death had a low sensitivity but a high specificity. Increases in mortality due to asthma are not likely caused by false-positive diagnoses of asthma as an underlying cause of death. Asthma mortality rates, determined from death certificate data, may indeed underestimate actual asthma-related mortality.
Adolescent↗
Certificate of need regulations and use of coronary revascularization after acute myocardial infarction.
CONTEXT: Certificate of need regulations were enacted to control health care costs by limiting unnecessary expansion of services. While many states have repealed certificate of need regulations in recent years, few analyses have examined relationships between certificate of need regulations and outcomes of care. OBJECTIVE: To compare rates of coronary revascularization and mortality after acute myocardial infarction in states with and without certificate of need regulations. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 1,139,792 Medicare beneficiaries aged 68 years or older with AMI who were admitted to 4587 US hospitals during 2000-2003. MAIN OUTCOME MEASURES: Thirty-day risk-adjusted rates of coronary revascularization with either coronary artery bypass graft surgery or percutaneous coronary intervention and 30-day all-cause mortality. RESULTS: The 624,421 patients in states with certificate of need regulations were less likely to be admitted to hospitals with coronary revascularization services (321,573 [51.5%] vs 323,695 [62.8%]; P<.001) or to undergo revascularization at the admitting hospital (163,120 [26.1%] vs 163,877 [31.8%]; P<.001) than patients in states without certificates of need but were more likely to undergo revascularization at a transfer hospital (73,379 [11.7%] vs 45,907 [8.9%]; P<.001). Adjusting for demographic and clinical risk factors, patients in states with highly and moderately stringent certificate of need regulations, respectively, were less likely to undergo revascularization within the first 2 days (adjusted hazard ratios, 0.68; 95% confidence interval [CI], 0.54-0.87; P = .002 and 0.80; 95% CI, 0.71-0.90; P<.001) relative to patients in states without certificates of need, although no differences in the likelihood of revascularization were observed during days 3 through 30. Unadjusted 30-day mortality was similar in states with and without certificates of need (109,304 [17.5%] vs 90,104 [17.5%]; P = .76), as was adjusted mortality (odds ratio, 1.00; 95% CI, 0.97-1.03; P = .90). CONCLUSIONS: Patients with acute myocardial infarction were less likely to be admitted to hospitals offering coronary revascularization and to undergo early revascularization in states with certificate of need regulations. However, differences in the availability and use of revascularization therapies were not associated with mortality.
Acute Disease↗
Accuracy of industry and occupation on death certificates of electric utility workers: implications for epidemiologic studies of magnetic fields and cancer.
A substantial epidemiologic literature has relied on occupation and industry information from death certificates to make inferences about the association of electric and magnetic field exposure with cancer, but the validity of the occupational data on death certificates is questionable. We compared occupation and industry information from death certificates to company work histories for 793 electric utility workers who died from brain cancer (n=143), leukemia (n=156), lung cancer (n=246, randomly sampled), and non-cancer causes (n=248, randomly sampled). Nearly 75% of death certificates correctly indicated utility industry employment and of those, 48% matched the longest held occupation derived from company work histories. Hence, only 36% matched on both industry and occupation. We computed odds ratios relating occupations involving magnetic field exposure to brain cancer and leukemia both for the occupation listed on the death certificate and for the longest-held occupation based on company records in order to examine the impact of exposure misclassification based on reliance on the death certificate information. For brain cancer, the odds ratio was 1.2 based on death certificates and 1.7 based on company work history, suggesting some attenuation due to misclassification. For leukemia, death certificate information yielded an odds ratio of 0.9, whereas company work histories yielded an odds ratio of 1.3. Although work histories are limited to the period of employment in a specific company, these data suggest that there is substantial misclassification in use of death certificate information on industry and occupation of utility workers, as found in other industries. The limited quality of occupation and industry information on death certificates argues against relying on such information to evaluate modest associations with mortality.
Adult↗
Quality assurance review of death certificates: a pilot study.
BACKGROUND: Although quality assurance programs for medical examiners are required by the National Association of Medical Examiners' Inspection and Accreditation Checklist, quality assurance programs specifically targeting death certificate completion have not been addressed. The Fulton County Medical Examiner, Atlanta, GA, has implemented a pilot quality assurance program for death certificate information, and this report contains information about 1 year's experience with the program. METHODS: All death certificates are reviewed by the case medical examiner(s) and chief medical examiner prior to their release to funeral homes. Death certificates with errors are retained for quality assurance and review purposes, and needed corrections are made before death certificates are released. During a 1-year period, death certificates with errors were collected and then reviewed and tabulated by type of error. RESULTS: Between May 26, 2003, and May 25, 2004, the Fulton County Medical Examiner certified 1267 deaths. Of these, 47 (4%) were found to contain errors that were corrected and an additional 52 (4%) had been amended for various reasons. The most common errors were misspellings in causes of death or poor or incomplete wording in injury-related information. Forty-seven percent of errors involved omitted, incomplete, or incorrect information that was potentially significant. The most common reason for amended certificates was unexpected detection of acute intoxications among people with significant cardiovascular disease. CONCLUSIONS: Quality assurance review of death certificates can assist in preventing the release of death certificates with incomplete, erroneous, or omitted information and may also be useful as an educational forum regarding completion of the death certificate.
Benchmarking↗