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PubMed1991

The accuracy of death certificates. Implications for health statistics.

The death certificate is an important source of data on disease incidence, prevalence and mortality. It should therefore be as accurate and complete as possible. Death certificates from 433 autopsied hospital patients were reviewed and matched against the results of post-mortem examinations. Significant discrepancies between the two documents were observed in 50% of patients. In 25%, the immediate cause of death was incorrectly stated on the certificate, having been assigned to a different organ system in the majority of those cases. In 33%, there was disagreement on major disease other than the immediate cause of death. In 9%, the death certificate was signed before the autopsy was performed. The extent of disagreement was largely independent of whether the certificate was signed before or after the autopsy. We conclude that: (1) there is a significant discrepancy between autopsy diagnoses and entries on death certificates; (2) disagreement is not due to unavailability of autopsy data at the time of completion of the certificate; (3) death certificates should be completed or amended utilizing data gained at autopsy.

Autopsy↗

PubMed1994

Accuracy of fatal motorcycle-injury reporting on death certificates.

This study identifies differences in motorcycle injury fatality statistics gathered from different sources. Police Accidents Reports (PARs), identifying fatal motorcycle injuries occurring in Connecticut during 1987 were matched with state death certificates. Matched death certificates were analyzed in three major areas: content, coding, and motorcycle fatality reporting. Death certificates underreported motorcycle fatalities by 38% compared to PARs. Forty percent of death certificates were missing some or all of the required information: 7 did not include the word motorcycle, 18 did not contain acceptable ICD-9 terminology for a motorcyclist, and 17 did not describe how the injury occurred. Forty-one percent of death certificates contained external cause of injury code (E-code) errors. Incomplete information on death certificates was responsible for 52% of inaccurate reporting and E-code errors for 48%. The accuracy of fatal motorcycle injury cause of death reporting on death certificates could be improved by better physician training and rapid implementation of both the computerized death certificate coding systems and upcoming ICD-10 classification system.

Accidents, Traffic↗

PubMed2005

Board certification in obstetrics and gynecology: associations with physicians' demographics and performances during medical school.

OBJECTIVE: This study was undertaken to investigate the relationship of demographics, medical school performance, and licensing examination scores to board certification. STUDY DESIGN: A longitudinal follow-up study of graduates of Jefferson Medical College between 1968 and 1994 identified in the AMA Physicians' Professional Data (AMA-PPD) file as practicing obstetrics and gynecology in 2003. Demographics, grades, and licensing examination scores had been collected prospectively. Board certification status was obtained from the AMA-PPD in 2003. Bivariate differences were evaluated with t tests. Logistic regression was used to evaluate multivariate relationships to board certification status. RESULTS: Of 310 physicians in obstetrics and gynecology, 291 (94%) were board certified. Those without certification were more likely to be underrepresented minorities, to have been older in medical school, and to have weaker academic records. Logistic regression indicated that scores on step 2 of the United States Medical Licensing Examination were the single most important predictor of achieving board certification. Those with scores of 200 or higher were 7 times more likely to achieve certification than those below 200. CONCLUSION: Age, gender, and minority status are not independent predictors of achieving board certification. A low score on United States Medical Licensing Examination step 2 is a risk factor for not achieving certification.

Adult↗

PubMedDate not supplied

EMS certification requirements for flight nurses.

INTRODUCTION: Emergency medical technician (EMT) or paramedic (EMTP) certification requirements for flight nurses (FNs) providing on-scene patient care vary. We surveyed those requirements and evaluated the relationships between flight team composition or program location and FN EMS certification. METHODS: Telephone survey of all 184 rotor-wing programs responding with a nurse to scenes RESULTS: The overall EMS training requirement for FNs was: none-57.6%, EMT-21.7%, EMTP-14.7%, local credential (not EMT or EMTP)-6.0%. Second team members were EMTP, RN, physician, or respiratory therapist (RRT). Overall, team configuration related significantly to FN EMS certification (P =.01). FN/EMTP and FN/RRT teams were individually significant (P <.01), with FN/EMTP teams tending not to require certification and all FN/RRT teams tending toward a certification requirement. Neither FN/FN nor FN/physician pairings related significantly with FN EMS certification requirements. Regional patterns emerged to both crew configuration and FN EMS certification requirements. CONCLUSION: Most flight programs do not require FN EMT/EMTP certification. Team configuration and geography are related to those requirements.

Air Ambulances↗

PubMed2005

A history and overview of the certification exam for medical dosimetrists.

During the last century, the creation and implementation of board certification has had a powerful impact on the medical community. Board certification has helped to shape the scope and practice of medical professionals and the care they provide, as well as to influence the way the health insurance industry sets standards for reimbursement. One profession that offers board certification to its members is medical dosimetry. The Medical Dosimetrist Certification Board exam has been administered since 1988 and its content covers a broad spectrum of information from the radiation therapy sciences. The exam has strict application requirements and is rather difficult to pass. Those who pass the exam can then call themselves Certified Medical Dosimetrists. For data purposes of this study, several members of the dosimetry community were solicited to participate in a survey regarding the exam's content and history, and to provide relevant statistical data. Currently 2,177 medical dosimetrists are board certified, with an additional 1,500 estimated to be working without certification. Although board certification is not currently required to practice medical dosimetry, new legislation known as the CARE Bill could change this. The CARE Bill, if passed, would mandate nationwide compulsory licensure and/or certification for medical dosimetrists and other medical professionals who want to work in radiation-related health care. Health maintenance organizations and other insurance carriers may likewise require certification for reimbursement purposes.

Certification↗

PubMedDate not supplied

The costs and benefits of getting the ISO 9000 certification in the manufacturing sector in Saudi Arabia.

Many Saudi companies, in their journey to improve quality, efficiency and competitiveness, are pursuing and obtaining the ISO 9000 certificate. Many studies have evaluated how to implement ISO 9000 in different sectors, but none have analyzed the effectiveness of ISO 9000 certification (costs and benefits) on improving the overall quality and on meeting expectations. This study addressed these issues by investigating manufacturing organizations in Saudi Arabia that have the ISO 9000 certification. A survey questionnaire was distributed to firms throughout the kingdom. Thirty-two firms participated in the study. Results indicate that increased consistency of operations, improved service, and product quality are among the top motivators for pursuing the ISO certificate. The benefits most often experienced were improved awareness of procedural problems, better management control, keeping existing customers, increased customer satisfaction, and improved customer service. Difficulties experienced during the certification process involved time and cost, but these were not considered to be major problems. A high volume of paperwork was the main problem experienced following initial certification. Respondents in general said that the ISO 9000 certification met their expectations and that their level of satisfaction regarding the impact of ISO 9000 was high. Most recommended that other organizations pursue the certificate.

Certification↗

PubMed1993

Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records.

In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live Birth. The data now being collected are intended to provide improved information for understanding maternal and infant health issues. To assess data quality, the authors compared information reported on the 1989 Tennessee birth certificates with the same data obtained from an ongoing case-control study in which the delivery hospital medical records of mothers and infants were reviewed by trained nurse abstractors using a structured data collection instrument. Cases (n = 1,016) were all infants born in Tennessee in 1989 with birth weights less than 1,500 g or other infants who died during the first 28 days of life. The infants were identified from linked birth-death certificate files. Control infants (n = 634) were randomly selected from the noncase population. The most reliable information obtained from birth certificates was descriptive demographic data and birth weight. The quality of information obtained from the new birth certificate checkboxes varied. Routine medical procedures were better reported on the birth certificates than relatively uncommon conditions and occurrences, even serious ones. Caution is needed in using birth certificate data for assessment of maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies, since sensitivity is low.

Birth Certificates↗

PubMed2001

Report on the 2003 revision of the U.S. Standard Certificate of Death.

The National Center for Health Statistics (NCHS) is responsible for publishing Standard Certificates of Birth and Death for the United States of America. The standard certificates are revised roughly every 10 years. The revision process is designed to ensure that the standard certificates meet, as nearly as possible, the use for which they are intended at all levels: individual, local, state, and federal. The authors report on the most recent revision of the U.S. Standard Certificate of Death, recording the process and the role of the National Association of Medical Examiners in the process. Changes recommended during revision include requesting known aliases of a decedent and rearrangement of the certificate to provide more room for those items requesting dates and for describing how the injury occurred. New items have been added asking for information regarding traffic fatalities, the role of tobacco use in causing death, and whether female decedents were pregnant. Once approved by the Department of Health and Human Services, the new standard certificate will be made available to the states. Each state will have 2 years to adapt the U.S. Standard Certificate of Death to its use and to implement new state death certificates on January 1, 2003.

Death Certificates↗

PubMed2006

Mind your manners: quality of manner of death certification among medical examiners and coroners in Taiwan.

To assess the quality of manner of death (MOD) certification among medical examiners/coroners (ME/Cs) in Taiwan, death certificates issued in 2002 for which the final MOD was suicide or undetermined were extracted for analysis. Indicators of the quality of MOD certification included (1) MOD not given by the ME/Cs; (2) MOD assigned by the ME/Cs was changed by the coder; (3) ratio between undetermined and suicide deaths (U/S ratio). There were 450 death certificates for which the ME/Cs did not assign the MOD in the original certificate. Three fifths (285/450) of them were issued by 4 ME/Cs. The same 4 ME/Cs also had extremely high U/S ratios (1.25-1.84) compared with the average (0.31). The overall quality of MOD certification among ME/Cs in Taiwan was fair; only a small number of ME/Cs had poor quality in MOD certification. The high U/S ratio among the 4 ME/Cs would certainly affect the suicide mortality rates of the counties the 4 ME/Cs were in charge of. Actions should be taken to improve the certification quality of these 4 ME/Cs.

Coroners and Medical Examiners↗

PubMed1984

Pilot study of revised stillbirth and neonatal death certificates.

Draft revised stillbirth and early infant death certificates were sent with a short questionnaire to certifying doctors for 206 stillbirths and 198 neonatal deaths for which death certificates had been received in the Office of Population Censuses and Surveys over a three week period in 1982. The new certificates complied with the recommendations of the World Health Organisation and asked for details of the cause of death, including separate sections for maternal and fetal conditions. Replies were received for 163 stillbirths and 151 neonatal deaths. Questionnaires were examined clerically and answers and comments analysed. Draft certificates were processed by computer to examine any differences between the causes of death given on the new forms and information given on the original certificates. This testing suggested that revised certificates are acceptable. Extension of the early infant death certificate to cover all neonatal deaths does not seem to create problems and should provide information on the association between maternal conditions and deaths occurring in the second to fourth weeks of life. If the full potential of the new certificates is to be realised, attention needs to be given to the detailed layout of the forms and clearer notes of guidance. Certifiers need to be encouraged to give appropriate details of any obstetric problems.

Attitude of Health Personnel↗

PubMed1996

Death from airways obstruction: accuracy of certification in Northern Ireland.

BACKGROUND: Studies of mortality from asthma and chronic obstructive pulmonary disease (COPD) have relied on death certification or registration for case finding. The aim of this study was to determine the accuracy of death certification and registration in asthma and COPD. METHODS: All death certificates in Northern Ireland for 1987 where asthma or COPD (defined as International Classification of Diseases 9th Revision (ICD9) 490, 491, 492, 496) were listed in part I or part II were identified. The following certificates were then selected for further investigation: those mentioning asthma for all ages, those mentioning COPD for ages less than 56 years, and a 50% sample of those mentioning COPD aged 56-75 years. For these selected deaths the general practitioners' case notes, hospital records, and necropsy findings were reviewed. Questionnaires detailing the clinical history and circumstances of death were completed by the general practitioner by post and by a close relative or associate of the deceased (doctor administered) if, after initial investigation, the death was likely to be due to COPD or asthma. A panel of two respiratory physicians reviewed each death and, using clinical diagnostic criteria, assessed the accuracy of the registered cause of death. RESULTS: Of 50 registered asthma deaths 43 were confirmed as being due to asthma. In nine registered deaths from COPD in cases aged less than 56 years one was confirmed as COPD, two as asthma, and six as other respiratory conditions. Of 105 registered deaths from COPD in cases aged 56-75, 42 were confirmed as COPD, 27 as asthma, eight as other respiratory conditions, and 28 as other causes. Although few errors in registration were found, 21% of certificates mentioning asthma and 38% of certificates mentioning COPD but not asthma in part I were subject to variable application of the classification rules by the registering officers. For all deaths under 75 years of age in Northern Ireland in 1987 where either asthma or COPD was mentioned anywhere on the death certificate, the estimated sensitivity and specificity of the registered cause of death in predicting the "true" cause of death were 29% and 98.6% for asthma and 69% and 70% for COPD. CONCLUSIONS: In a population of subjects where asthma or COPD was mentioned anywhere on the death certificate, the registered cause of death is a relatively poor indicator of the "true" cause of death for both asthma and COPD. Variation occurred in the application of death classification rules by registration officers. Many deaths certified and registered as COPD could have been called asthma using current standards of clinical diagnosis. In studies investigating risk factors for deaths from asthma, case finding should consider deaths registered as COPD.

Aged↗

PubMed1995

Death certificates: an efficient source for ascertainment of Creutzfeldt-Jakob disease cases.

Case ascertainment for an epidemiologic study of Creutzfeldt-Jakob disease (CJD) can be difficult. This report investigates the efficiency of various sources of case ascertainment for CJD. Cases were identified utilizing neuropathologists, hospitals and death certificates from 11 targeted states. For the period of 1986-1988, 247 death certificates indicating a diagnosis of CJD were obtained. Only 26 potential cases were identified without death certificates. The proportion of neuropathologically confirmed cases identified by death certificates only, i.e., which were not identified through any other source, was 42%. Furthermore, 80% of all the neuropathologically confirmed cases were ascertained utilizing death certificates as a source. Of the remaining 20%, 7% were ascertained through neuropathologists only, 10% through hospitals only, 1.5% through a combination of hospitals and neuropathologists, and 1.5% through another source. The false-positive rate for death certificates with neuropathology (which may have been performed after the death certificate was filled out) was estimated to be 8.3%. The results indicate that death certificates were by far the most efficient source for initial ascertainment of potential CJD cases to be followed by verification of diagnosis.

Creutzfeldt-Jakob Syndrome↗

PubMed1995

A survey of psychiatrists with APA certification in administrative psychiatry.

OBJECTIVE: Psychiatrists with American Psychiatric Association certification in administrative psychiatry were surveyed to determine their perceptions of the benefits of certification, their certification-related learning activities and interests, and their recommendations for enhancing the value of certification. METHODS: A questionnaire was mailed in January 1994 to all 427 psychiatrists who had obtained certification in administrative psychiatry. A total of 254 usable responses were received. Respondents were divided into two age groups, younger than 50 years and age 50 and older, for comparison purposes. RESULTS: Fifty-five percent of the older group (204 psychiatrists) and 89 percent of the younger group (50 psychiatrists) responded. Nine percent of the older group and 18 per cent of the younger group held advanced degrees in administration, mainly master's degrees in public health. Both groups devoted 62 percent of their time to administrative work. Roughly 80 percent of both groups would recommend that colleagues seek administrative certification. Both groups rated self-satisfaction and increased skills as the greatest benefits of certification, and increased income as the least. As learning activities, the older group was more likely to participate in mentorships, and the younger group in self-study and continuing education activities. CONCLUSIONS: Interest in administrative psychiatry and certification should be stimulated by increased emphasis on administration in residency programs and in continuing education, linkages with degree programs, recognition of administrative psychiatry as a subspecialty by the American Board of Psychiatry and Neurology, and increased support from APA and the American Association of Psychiatric Administrators.

Adult↗

PubMed2004

Time trends in personnel certification and turnover in the Collaborative Ocular Melanoma Study.

BACKGROUND: The purpose of this analysis was to examine and quantify the coordinating center workload in regard to certification and turnover of clinical personnel who participated in the Collaborative Ocular Melanoma Study (COMS). METHODS: The COMS was a set of multicenter, multidisciplinary randomized clinical trials conducted to evaluate radiotherapy for initial treatment of choroidal melanoma, a primary eye cancer. Patients were screened, enrolled, treated, and followed for mortality and clinical outcomes at 43 clinical centers in the United States and Canada, beginning late in 1986. Clinical centers were added to the COMS during three calendar periods. Training and certification of clinical personnel was performed by five resource centers and coordinated at the COMS coordinating center. A personnel database was maintained at the coordinating center for tracking certification progress, recertification, transfers and resignations. Certification records were analyzed for the period 1986 through 1998 when patient accrual and treatment were completed. RESULTS: Clinical personnel (929 individuals) were certified for one or more of nine distinct roles in the COMS, resulting in 1,342 certifications; 26% were certified for two or more positions. The total number certified for each role ranged from 114 to 208. Certifications per year ranged from 260 in 1987 to 35 in 1997. The certification workload at the coordinating center rose following addition of each group of new clinical centers. It also increased in 1995 as a result of recertification of current personnel mandated by the external data monitoring committee. CONCLUSIONS: This analysis documented that training and certification were continuing tasks, and not limited to initiation of the study. Resignations and reassignments of certified personnel were responsible for 642 decertifications.

Certification↗

PubMed1989

Predictive validity of certification by the American Board of Internal Medicine.

STUDY OBJECTIVE: To determine the predictive validity of the American Board of Internal Medicine (ABIM) certification process. DESIGN: Prospective measurement of the knowledge, skills, and attitudes of 185 ABIM-certified and 74 noncertified internists by a written examination; evaluation by professional associates; a patient questionnaire assessing satisfaction with care, physician's counseling role, and preventive care; and review of records of patients with common illnesses. SUBJECTS: Practicing internists who completed training or received ABIM certification 5 to 10 years previously. SETTING: Office-based practices in six western states. RESULTS OF DATA ANALYSIS: Physicians certified by the ABIM had significantly higher scores on the written examination than the noncertified physicians, and scores on our examination correlated highly with the ABIM certification examination (r = 0.73). Ratings of clinical skills by professional associates were significantly higher for certified internists and also correlated highly with ABIM examination scores (r = 0.53 to 0.59). Regression analysis showed that ABIM certification status was the major variable affecting performance on these measures of clinical competence. Results from other measures did not show many differences between certified and noncertified physicians in the care of patients with common illnesses, but modest differences in preventive care and a few differences in outcome favored the certified physicians. CONCLUSIONS: Comparison of findings from the written examination and the professional associate ratings with certification status and original ABIM certification examination scores shows predictive validity of ABIM certification. Further studies are needed to determine if certification status predicts important differences in the care of patients with complex illnesses.

Certification↗

PubMed2000

Board certification in optometry.

BACKGROUND: In keeping with current expectations in the health care community, the purpose of the American Board of Optometric Practice (ABOP) is to enhance the quality of optometric care available to the public by fostering continued competence for practitioners through administering education and examinations for certification and re-certification. The formation of ABOP makes possible for the first time a board certification process for optometrists. METHODS: The optometry model for board certification and recertification emphasizes the breadth of the profession. ABOP certification will be accomplished through a combination of examinations and high-quality, tested Board Certified Continuing Education (BCCE). Specific requirements for practitioners at various stages of their careers are presented. RESULTS: Board certification provides one important mechanism for an optometrist to demonstrate commitment to quality, professionalism, and ongoing clinical competence. The optometrist benefits from high-quality continuing education designed for timeliness, importance, and breadth. The public benefits by the enhancement of continued competence within the optometric profession. Health care agencies benefit by being able to recognize providers who have elected to demonstrate their qualifications through certification. CONCLUSIONS: Through board certification, optometrists will be able to demonstrate their commitment to maintaining clinical competence through a nationally uniform program, and they will be able to comply with standards that are generally recognized and required throughout the health care community.

Certification↗

PubMed2001

Risk adjusting cesarean delivery rates: a comparison of hospital profiles based on medical record and birth certificate data.

OBJECTIVES: Compare the discrimination of risk-adjustment models for primary cesarean delivery derived from medical record data and birth certificate data and determine if the two types of models yield similar hospital profiles of risk-adjusted cesarean delivery rates. DATA SOURCES/STUDY SETTING: The study involved 29,234 women without prior cesarean delivery admitted for labor and delivery in 1993-95 to 20 hospitals in northeast Ohio for whom data abstracted from patient medical records and data from birth certificates could be linked. STUDY DESIGN: Three pairs of multivariate models of the risk of cesarean delivery were developed using (1) the full complement of variables in medical records or birth certificates; (2) variables that were common to the two sources; and (3) variables for which agreement between the two data sources was high. Using each of the six models, predicted rates of cesarean delivery were determined for each hospital. Hospitals were classified as outliers if observed and predicted rates of cesarean delivery differed (p < .05). PRINCIPAL FINDINGS: Discrimination of the full medical record and birth certificate models was higher (p < .001) than the discrimination of the more limited common and reliable variable models. Based on the full medical record model, six hospitals were classified as statistical (p < .01) outliers (three high and three low). In contrast, the full birth certificate model identified five low and four high outliers, and classifications differed for seven of the 20 hospitals. Even so, the correlation between adjusted hospital rates was substantial (r = .71). Interestingly, correlations between the full medical record model and the more limited common (r = .84) and reliable (r = .88) variable birth certificate models were higher, and differences in classification of hospital outlier status were fewer. CONCLUSION: Birth certificates can be used to develop cesarean delivery risk-adjustment models that have excellent discrimination. However, using the full complement of birth certificate variables may lead to biased hospital comparisons. In contrast, limiting models to data elements with known reliability may yield rankings that are more similar to rankings based on medical record data.

Adult↗

PubMed2002

Certification and quality assurance in Dutch occupational health services.

Since 1994, each Dutch enterprise has to be affiliated to an independent occupational health service (OHS), recognized by the government. In addition, each enterprise has to be supported by this occupational health service in its activities for the improvement of working conditions, and in the guidance of employees absent from work. From 1994 to 1998, the government was carrying out the certification and recognition of occupational health services. Since 1998 the certification has been carried out by private certifying institutions, in general consultancy bureaus that also provide ISO certification. In the Netherlands, the supervision of the quality of occupational safety and health care is twofold. Firstly, the Labor Inspectorate is checking if the enterprises keep to the rules. For example, each enterprise should have a risk assessment report at its disposal. The latter should be approved by the OHS. If an enterprise does not meet these rules, a penalty may be imposed. In practice, this happens rather seldom. Secondly, each OHS unit should be recognized by the Ministry of Social Affairs and Employment. The recognition takes place if the private certifying institution has assessed that the OHS meet a large number of requirements laid down in the "Guideline for the Certification of Occupational Health Services". This Guideline consists of 50 conditions and about 200 verification points. The requirements deal with the internal organzation and the output. By order of the Dutch government the IVA, a Dutch institute for social research, has recently investigated if this certification leads to a sufficient guarantee for appropriate occupational safety and health care. By means of a large number of discussions and workshops, the IVA has investigated how OHS, employees, employers, insurance companies and others judge the quality management. In this study, the current method of certification turned out to produce insufficient incentives for quality improvement. None of the involved parties turned out to be satisfied with the current system. The fundamental problem of this certification system can be summarized as follows. The requirements prescribe a quality management system in conformity with ISO, but they also contain a lot of organization rules, much more than ISO. It is this degree of specification that, if practiced slavishly, leads to an output that is not able to satisfy the needs and demands of employers, employees and government. There are no rules with regard to this output, but only to the process, e.g. the way an advice has been brought about. In this paper, we show how the current certification system is working, how this system has been evaluated, and what criticisms have been uttered. We also indicate how we might achieve a real improvement of quality management in prescribing much less details about the OHS internal organization, and in demanding employers and employees to make clear agreements about the desired OHS output and to monitor carefully if the agreed output quality has been achieved.

Certification↗