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PubMed1998

Accuracy of death certificates for coding coronary heart disease as the cause of death.

BACKGROUND: Death certificates are widely used in epidemiologic and clinical investigations and for national statistics. OBJECTIVE: To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death. DESIGN: Community-based inception cohort followed since 1948. SETTING: Framingham, Massachusetts. PATIENTS: 2683 deceased Framingham Heart Study participants. MEASUREMENTS: Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians. RESULTS: Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1 % to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%), and negative predictive value of 92.9% (CI, 91.7% to 94.1%) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a cause. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group). CONCLUSIONS: Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as two-fold in older persons.

Adult↗

PubMed2002

Inadequacies of death certification in Beirut: who is responsible?

OBJECTIVE: To assess the completeness of data on death certificates over the past 25 years in Beirut, Lebanon, and to examine factors associated with the absence of certifiers' signatures and the non-reporting of the underlying cause of death. METHODS: A systematic 20% sample comprising 2607 death certificates covering the 1974, 1984, 1994, 1997 and 1998 registration periods was retrospectively reviewed for certification practices and missing data. FINDINGS: The information on the death certificates was almost complete in respect of all demographic characteristics of the deceased persons except for occupation and month of birth. Data relating to these variables were missing on approximately 95% and 78% of the certificates, respectively. Around half of the certificates did not carry a certifier's signature. Of those bearing such a signature, 21.6% lacked documentation of the underlying cause of death. The certifier's signature was more likely to be absent on: certificates corresponding to the younger and older age groups than on those of persons aged 15-44 years; those of females than on those of males; those of persons who had been living remotely from the registration governorate than on those of other deceased persons; and those for which there had been delays in registration exceeding six months than on certificates for which registration had been quicker. For certificates that carried the certifier's signature there was no evidence that any of the demographic characteristics of the deceased person was associated with decreased likelihood of reporting an underlying cause of death. CONCLUSION: The responsibility for failure to report causes of death in Beirut lies with families who lack an incentive to call for a physician and with certifying physicians who do not carry out this duty. The deficiencies in death certification are rectifiable. However, any changes should be sensitive to the constraints of the organizational and legal infrastructure governing death registration practices and the medical educational systems in the country.

Adolescent↗

PubMed1997

Limitations of school entry immunization certificates.

OBJECTIVE: To compare the immunization certificate submission rate for kindergarten school children on the Central Coast of New South Wales for 1994 and 1995; to contact individual parents of children with incomplete or missing immunization certificates by issuing a personalised immunization reminder letter, and measuring their response. METHODOLOGY: Seventy Central Coast schools were surveyed. Immunization documentation for 4177 kindergarten enrolements in 1995 were assessed. Children with incomplete or unknown immunization status were identified. Immunization reminder letters were sent by the schools to parents of the children that were identified. The school recorded any additional immunization certificates submitted. RESULTS: In 1995, 79% of kindergarten children submitted immunization certificates, unchanged from the previous year. Immunization reminder letters were sent to 856 families of children with no certificate and 215 families of children with an incomplete certificate. A further 263 immunization certificates were submitted, representing a 25% response rate. This intervention increased the percentage of kindergarten children with a certificate from 79% to 86%. CONCLUSIONS: Education of school staff during the 1994 immunization survey did not change the overall immunization certificate submission rate. Specifically targeting parents through schools can be an effective way of increasing immunization certificate submission.

Child, Preschool↗

PubMed2003

Forest certification--an instrument to promote sustainable forest management?

Forest certification was introduced in the early 1990s to address concerns of deforestation and forest degradation and to promote the maintenance of biological diversity, especially in the tropics. Initially pushed by environmental groups, it quickly evolved as a potential instrument to promote sustainable forest management (SFM). To date about 124 million ha or 3.2% of the world's forests have been certified by the different certification schemes created over the last decade. Forest certification shares the aim of promoting SFM with another tool, namely criteria and indicators (C&I) for SFM. C&I sets are mainly developed for the national level to describe and monitor status and trends in forests and forest management. They also provide an essential reference basis for forest certification standards, which set performance targets to be applied on a defined area. Progress in developing these two different tools has been significant. After 10 years of implementation, it is evident that the original intention to save tropical biodiversity through certification has largely failed to date. Most of certified areas are in the temperate and boreal zone, with Europe as the most important region. Only around ten per cent is located in tropical countries. The standards used for issuing certificates upon compliance are diverse, both between certification schemes and within one and the same scheme when applied in different regions. However, they are at least equal to legal requirements and often include elements that set actually higher standards. While the quality of actual audits of the standards is of varying quality, there are indications that independent audits are an incentive for improving forest management. As a voluntary market-based tool, forest certification is depending on the ability to cover the costs incurred and thus on often-elusive green consumer sentiment. Regardless of many difficulties, forest certification has been very successful in raising awareness and disseminating knowledge on a holistic SFM concept, embracing economic, environmental and social issues, worldwide. It also provides a tool for a range of other applications than assessment of sustainability, such as e.g. verifying carbon sinks.

Certification↗

PubMed1980

Accuracy of death certification in an autopsied population with specific attention to malignant neoplasms and vascular diseases.

Accuracy of certification of underlying cause of death and implications for US mortality statistics were assessed among 257 autopsied cases collected during the calendar year 1970 at a short-stay general hospital in Atlanta, GA. Clinicopathologic cause of death (CPCD) certificates, with assignment of underlying cause of death based on autopsy findings in combination with pertinent clinical data, were prepared by a pathologist and were employed as a standard of comparison against which the accuracy of the underlying cause of death on the original death certificate was measured. Results suggest that autopsy findings are not necessarily used to supplement clinical data in filling out death certificates. Improper recording of underlying cause of death was found in 42% of the autopsied cases. Malignant neoplasms were found to be underreported and vascular diseases overreported, each by approximately 10%, when original certificates were compared to CPCD certificates. The confirmation rate for original death certificate diagnoses was 89%. In the case of a confirmed diagnosis, the underlying cause of death was substantiated by postmortem findings as having existed regardless of its role in the sequence of events leading to death. The underlying cause of death as assigned by the pathologist was listed on the original death certificate among the sequence of events leading to or contributing to death at the rate of 72% (i.e., this rate measures the sensitivity of the death certificate).

Autopsy↗

PubMed1990

A study of selected death certificates from three Dublin teaching hospitals.

One hundred death certificates were compared over two time periods with the corresponding autopsy reports on the cases to ascertain if the causes of death from the two sources were similar. There was poor concordance between the two and it seems likely that reasons for requesting an autopsy did not extend to using the information to complete the death certificates. There were 55 errors on 45 certificates, and 19 certificates were so inaccurate as to warrant a change in the underlying cause of death. In only 10 cases was the certificate signed before the autopsy report was available; however, should clinicians have wished to add autopsy findings to the certificate later, there is no facility on the Irish death certificate to do so. A revision of the format of the certificate is recommended. An examination of death certificates from varied medical sources would be welcome to see if the serious errors identified in this study are more widespread.

Autopsy↗

PubMed2005

Lack of recording of systemic lupus erythematosus in the death certificates of lupus patients.

OBJECTIVE: To determine to what extent the diagnosis of systemic lupus erythematosus (SLE) in deceased lupus patients is under-reported in death certificates, and the patient characteristics associated with such an occurrence. METHODS: The death certificates of 76 of the 81 deceased SLE patients from two US lupus cohorts (LUMINA for Lupus in Minorities: Nature vs Nurture and CLU for Carolina Lupus Study), including 570 and 265 patients, respectively, were obtained from the Offices of Vital Statistics of the states where the patients died (Alabama, Georgia, North Carolina, South Carolina, Tennessee and Texas). Both cohorts included patients with SLE as per the American College of Rheumatology criteria, aged > or =16 yr, and disease duration at enrolment of < or =5 yr. The median duration of follow-up in each cohort at the time of these analyses ranged from 38.1 to 53.0 months. Standard univariable analyses were performed comparing patients with SLE recorded anywhere in the death certificate and those without it. A multivariable logistic regression model was performed to identify the variables independently associated with not recording SLE in death certificates. RESULTS: In 30 (40%) death certificates, SLE was not recorded anywhere in the death certificate. In univariable analyses, older age was associated with lack of recording of SLE in death certificates [mean age (standard deviation) 50.9 (15.6) years and 39.1 (18.6) yr among those for whom SLE was omitted and included on the death certificates, respectively, P = 0.005]. Patients without health insurance, those dying of a cardiovascular event and those of Caucasian ethnicity were also more likely to be in the non-recorded group. In the multivariable analysis, variables independently associated with not recording SLE as cause of death were older age [odds ratio = (95% confidence interval) 1.043 (1.005-1.083 per yr increase); P = 0.023] and lack of health insurance [4.649 (1.152-18.768); P = 0.031]. CONCLUSIONS: A high proportion of SLE diagnoses are not recorded in death certificates. Older patients and those without health insurance are more prone to have SLE not recorded. These findings do have implications for the assessment of the impact of this disease in epidemiological studies conducted using vital statistics records.

Adolescent↗

PubMed2002

Analysis of the sensitivity of death certificates in 440 hospital deaths: a comparison with necropsy findings.

BACKGROUND: There is current heightened public interest in issues surrounding death certification and necropsy. The present study was initiated to determine the accuracy of death certification in providing a correct diagnosis in a series of adult deaths occurring in hospital, all of which were followed by a necropsy. METHOD: We examined a series of 440 consecutive adult hospital necropsies performed at Addenbrooke's Hospital, without prior knowledge of the cause of death on the death certificate. The major causes of death at necropsy were subdivided on the basis of organ systems and subsequently compared with the cause of death stated on the death certificate. RESULTS: There were 448 stated causes of death on the death certificates, compared with 508 causes recorded at necropsy. The overall sensitivity of the death certificate in predicting an individual cause of death was 0.47, with sensitivities ranging from 0.90 in the neurological system to 0.28 in the cardiovascular system, and the sensitivity for all malignant causes of death was 0.65. No significant overall differences were noted in respiratory, gastrointestinal, malignant, and "other" systems when comparing causes of death on the death certificate with those at necropsy. CONCLUSIONS: There is a substantial discrepancy between the diagnosis given on death certificates compared with that at hospital necropsy. This paper discusses the importance of clinicopathological concordance and emphasises the importance of the necropsy in death certification.

Adult↗

PubMed2005

NIHSS training and certification using a new digital video disk is reliable.

BACKGROUND AND PURPOSE: NIH Stroke Scale certification is required for participation in modern stroke clinical trials and as part of good clinical care in stroke centers. The existing training and certification videotapes, however, are more than 10 years old and do not contain an adequate balance of patient findings. METHODS: After producing a new NIHSS training and demonstration DVD, we selected 18 patients representing all possible scores on 15 scale items for a new certification DVD. Patients were divided into 3 certification groups of 6 patients each, balanced for lesion side, distribution of scale item findings, and total score. We sought to measure interrater reliability of the certification DVD using methodology previously published for the original videotapes. Raters were recruited from 3 experienced stroke centers. Each rater watched the new training DVD and then evaluated one of the 3 certification groups. RESULTS: Responses were received from 112 raters: 26.2% of all responses came from stroke nurses, 34.1% from emergency departments/other physicians, and 39.6% from neurologists. One half (50%) of raters were previously NIHSS-certified. Item responses were tabulated, scoring performed as previously published, and agreement measured with unweighted kappa coefficients for individual items and an intraclass correlation coefficient for the overall score. kappa ranged from 0.21+/-0.05 (ataxia) to 0.92+/-0.09 (LOC-C questions). Of 15 items, 2 showed poor, 11 moderate, and 2 excellent agreement based on kappa scores. The intraclass correlation coefficient for total score was 0.94 (95% confidence interval, 0.84 to 1.00). Reliability scores were similar among specialists and centers, and there were no differences between nurses and physicians. kappa scores trended higher among raters previously certified. CONCLUSIONS: These certification DVDs are reliable for NIHSS certification, and scoring sheets have been posted on a web site for real-time, online certification.

Cerebrovascular Disorders↗

PubMedDate not supplied

Evaluation of death certificate-based surveillance for traumatic brain injury--Oklahoma 2002.

OBJECTIVES: Death certificate data are used to estimate state and national incidence of traumatic brain injury (TBI)-related deaths. This study evaluated the accuracy of this estimate in Oklahoma and examined the case characteristics of those persons who experienced a TBI-related death but whose death certificate did not reflect a TBI. METHODS: Data from Oklahoma's vital statistics multiple-cause-of-death database and from the Oklahoma Injury Surveillance System database were analyzed for TBI deaths that occurred during 2002. Cases were defined using the Centers for Disease Control and Prevention (CDC) ICD-10 code case definition. In multivariate analysis using a logistic regression model, we examined the association of case characteristics and the absence of a death certificate for persons who experienced a TBI-related death. RESULTS: Overall, sensitivity of death certificate-based surveillance was 78%. The majority (62%) of missed cases were due to listing "multiple trauma" as the cause of death. Death certificate surveillance was more likely to miss TBI-related deaths among traffic crashes, falls, and persons aged > or = 65 years. After adding missed cases to cases captured by death certificate surveillance, traffic crashes surpassed firearm fatalities as the leading external cause of TBI-related death. CONCLUSIONS: Death certificate surveillance underestimated TBI-related death in Oklahoma and might lead to national underreporting. More accurate and detailed completion of death certificates would result in better estimates of the burden of TBI-related death. Educational efforts to improve death certificate completion could substantially increase the accuracy of mortality statistics.

Adolescent↗

PubMed1995

Certification of pediatric oncology nurses: from roundtable discussion to reality.

Certification for pediatric oncology nurses became a reality in 1993 when the first national certification examination was administered in Reno, NV. Some members of the Association of Pediatric Oncology Nursing initially voiced an interest in certification at a roundtable discussion held during the 1988 annual meeting. The momentum lead to the formation of a task force to initiate the certification process. The task force led to an ad hoc committee, organized to design and implement certification. Certification is now overseen by the Certification Corporation of Pediatric Oncology Nurses. The benefits of certification and a historical overview of pediatric oncology nursing certification is discussed in this article. Details of how the test was designed are offered, as well as results from the pilot study. This article concludes with data from the first examination.

Certification↗

PubMed1989

[Epidemiological study of SMON death--from the observation of death certificates during a 13-year 6-month period from July 1972].

Eight hundred and twelve vital statistics death certificates, in which either the cause of death or complications was SMON, were selected from all the death certificates filed in Japan in a 13-year 6-month period from July 1972 to December 1985. In 411, or 50.6%, of these certificates, the SMON Research Committee had records of the clinical pictures as a result of the nationwide surveys conducted earlier. The epidemiological picture presented by the death certificates and the relationship between the information in these certificates and clinical records in nationwide surveys was observed. The results are summarized as follows: 1. The male/female ratio revealed in the 812 death certificates was 0.53, which is higher than those reported in nationwide surveys (0.4). 2. Although the yearly number of certificates was more than 70 in 1974 or before, it decreased year by year. The numbers in 1984 and 1985 were less than 50. 3. The leading underlying causes of death were; SMON in 44.0% of all the certificates, heart diseases in 10.3%, cerebrovascular diseases in 9.2% and malignant neoplasm in 8.6%. 4. The presence of clinical symptoms was compared between death cases and total cases reported by the nationwide surveys. Symptoms such as visual impairment and walking incapacity were seen more frequently in death cases. 5. From these results, it was suggested that the level of the severity of the disease at onset influences the long-term prognosis of the disease, although selection bias in the death certificates observed is unavoidable.

Adult↗

PubMedDate not supplied

White paper: value of specialty certification in pharmacy.

OBJECTIVE: To address the value of Board of Pharmaceutical Specialties (BPS) certification, particularly as perceived by different stakeholders (pharmacists, employers, government, and academia), and to draw a parallel between specialization and certification in pharmacy and in medicine. DATA SOURCES: Electronic databases (Medline, International Pharmaceutical Abstracts, Sociological Abstracts), associations/health care organizations Web sites, outside reports, and clinical pharmacists involved in certification processes. STUDY SELECTION: Studies and reports that addressed the value of specialty certification were selected by the authors. DATA EXTRACTION: By the authors. DATA SYNTHESIS: Pharmacists with specialty certification report enhanced feelings of self-worth, improved competence, and greater marketability. Other values of certification include increased acceptance by health care professionals, salary increases, and job promotions. Employers have acknowledged board-certified pharmacists through public recognition, increase in responsibility, and some types of monetary compensation. In some governmental organizations, certified pharmacists receive salary raises and are granted prescribing authority. However, the overall value of specialty certification in pharmacy as perceived by the public or payers lags behind when compared with the status of specialty certification in medicine. CONCLUSION: Board-certified pharmacists appreciate the value of pharmacy specialty certification, and in a number of organizations and practice settings, board-certified pharmacists are perceived as valuable. Still, unlike board-certified physicians, board-certified pharmacists are not widely recognized outside or even within the pharmacy profession. To address this challenge, board-certified pharmacists ought to market their services to assure that other stakeholders recognize their value.

Accreditation↗

PubMed1991

A minor office: the variable and socially constructed character of death certification in a Scottish city.

Those doctors in a Scottish city who had completed the most death certificates in 1985 were identified, interviewed about their certifying practices, and asked, for comparative purposes, to complete a series of dummy death certificates, based on case summaries. Analysis of the dummy certificates indicated substantial inter-practitioner variations in practice. From the interview data it is clear that the completion of death certificates is a very minor office: for most certifying doctors, death certification is an unsupervised, unreported, invisible, and unconsidered activity. It is argued that doctors who write large numbers of certificates conduct their certifications in Schutz's "world of routine activities" (Schutz 1970). It is this routinized orientation to certification that allows the practitioner to dwell within the "habitus" (Bourdieu 1977) of the medical collectivity but outside a normative order. Death certification may stand as an exemplar of a large number of medical activities, where wide and largely unacknowledged variations in practice occur with each practitioner investing his or her own practices with moral worth. Routinization ensures a moral order in the habitus, but not a normative order.

Death Certificates↗

PubMedDate not supplied

Board certification among preventive medicine residency graduates: characteristics, advantages, and barriers.

In 1991, a mail survey was conducted of graduates (1979-1989) of general preventive medicine/public health (GPM/PH) residency programs to obtain information about the graduates' demographic characteristics, training, and present professional work. Specifically, we evaluated the survey data for percentage of graduates with board certification, advantages of board certification, and barriers to board certification in preventive medicine (PM). The survey response rate was 74% (797 of 1,070 graduates). Only 45% of the respondents were board certified in PM as of 1991. The percentage of respondents board certified in PM was highest among military PM residency graduates and lowest among those from the Centers for Disease Control (CDC) PM residency. Reasons for not taking the board examination included the perception of limited benefit of board certification in current employment or professional endeavors, previous board certification in a clinical specialty, lack of a master of public health (MPH) degree, high cost and time commitment for the examination, and uncertainty about examination admission requirements. PM residency graduates with board certification in PM were more likely to be involved in public health and preventive medicine programs, devoted more time to administration and management, and earned more income than those PM residency graduates without PM board certification. Increasing the percentage of residency graduates who pursue PM board certification will require increasing the advantages of certification for practice, encouraging all residents to identify themselves as practicing the specialty of PM, and addressing the unique concerns of physicians who train both in PM and in a purely or primarily clinical specialty.

Attitude of Health Personnel↗

PubMed1994

[A today's trend of Japanese Council of Certification for Physicians--the current status in Japan].

Certification systems in Japanese medical associations basically involve review of educational background and experience by their own peers. The Japanese council for certification for physicians was built in 1981 to promote the understanding of certification for specialist and to ensure the system of certification. A tripartite commission, composed of Japan Medical Association, Japanese Council of Scientific Associations and Japanese Council for Certification for Physicians, was settled to promote the authorization of these certification systems. The commonly acceptable view is that certification has a number of valuable agreements including 1) examination may form a component of the certification system, 2) a renewal program is necessary, 3) the renewal program should be linked with an educational program of Japan Medical Associations, 4) post graduate education system should be included in the renewal program. Under these agreements, tripartite commission will be starting the authorization scheme of certified physicians in each medical association. Herein, we present a historical review of the Japanese councils of certification of physicians and authorization program of certified physicians including a brief discussion.

Certification↗

PubMed1998

Improving the accuracy of death certification.

BACKGROUND: Population-based mortality statistics are derived from the information recorded on death certificates. This information is used for many important purposes, such as the development of public health programs and the allocation of health care resources. Although most physicians are confronted with the task of completing death certificates, many do not receive adequate training in this skill. Resulting inaccuracies in information undermine the quality of the data derived from death certificates. METHODS: An educational intervention was designed and implemented to improve internal medicine residents' accuracy in death certificate completion. A total of 229 death certificates (146 completed before and 83 completed after the intervention) were audited for major and minor errors, and the rates of errors before and after the intervention were compared. RESULTS: Major errors were identified on 32.9% of the death certificates completed before the intervention, a rate comparable to previously reported rates for internal medicine services in teaching hospitals. Following the intervention the major error rate decreased to 15.7% (p = 0.01). The reduction in the major error rate was accounted for by significant reductions in the rate of listing of mechanism of death without a legitimate underlying cause of death (15.8% v. 4.8%) (p = 0.01) and the rate of improper sequencing of death certificate information (15.8% v. 6.0%) (p = 0.03). INTERPRETATION: Errors are common in the completion of death certificates in the inpatient teaching hospital setting. The accuracy of death certification can be improved with the implementation of a simple educational intervention.

Bias↗

PubMed1983

Impact of coaching certification on coaching attitudes.

The purpose of the present investigation was to examine the impact of coaching certification upon coaching attitudes toward important social psychological correlates of involvement in sport. Specifically, 249 coaches with 0, 1, 2, 3, 4 and 5 levels of certification in the National Coaching Certification Program for Hockey were compared on attitudes toward important social psychological correlates of athletic involvement. As a consequence of anomalies in the sample, the six levels of certification were collapsed to form a factorial design comprising 2 levels of certification (coaches with 0.1 and 2 levels versus coaches with 3, 4, and 5 levels) and 2 levels of competition (house league versus competitive league coaches). The results revealed that coaches with greater certification were older and more experienced. Also, coaches in competitive leagues were more experienced, attached more importance to setting realistic objectives and playing well, but less importance to providing a recreational experience for players than house league coaches. Also, with increasing certification, coaches in competitive leagues attached increased importance to beating an opponent and having a winning team while house league coaches showed a decrease. Finally, the emphasis planed upon providing equal ice time for all players remained low over the two levels of certification in the competitive league coaches; it showed a decrease with greater certification in the house league coaches.

Adult↗