提高死亡原因医学证明的质量：基于“健康数据倡议”经验的有效策略和方法。
Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative.
机构信息
Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia.
The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, 2042, Australia.
出版信息
BMC Med. 2020 Mar 9;18(1):74. doi: 10.1186/s12916-020-01519-8.
BACKGROUND
Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification.
METHODS
The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne.
RESULTS
The TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles.
CONCLUSIONS
The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.
背景
准确和及时的死因（COD）数据对于明智的公共卫生决策至关重要。医学认证的 COD 通常提供了人群中大部分的 COD 数据，是民事登记和生命统计（CRVS）系统的重要组成部分。医生正确填写死因医学证明书（MCCOD）应该是一个相对简单的程序，但错误很常见。在这里，我们介绍了在墨尔本大学（UoM）的彭博慈善基金会健康数据（D4H）倡议支持下，在五个国家实施的三种培训策略，并评估了对认证质量的影响。
方法
评估的三种培训策略是：（1）在菲律宾、缅甸和斯里兰卡进行培训师培训（TOT）；（2）UoM D4H 在巴布亚新几内亚（PNG）直接培训医生；（3）在秘鲁实施在线和基础培训策略。评估使用墨尔本大学开发的评估工具，在培训前后评估 MCCODs。
结果
TOT 策略导致斯里兰卡的不正确填写证书减少了 28%，菲律宾减少了 40%。在 PNG 对医生进行直接培训后，不正确填写的证书减少了 30%。在秘鲁，仅实施和培训在线系统后，不正确的证书减少了 30%，在线系统和基本医学认证原则培训后减少了 43%。
结论
这项研究的结果表明，各种培训策略可以提高认证质量，但仍有进一步改进的空间。D4H 的经验表明，应该进一步发展策略的几个方面，以改善结果，特别是从干预早期开始，关键利益相关者的参与，以及地方委员会来监督活动，并支持在医院建立更好的文化，以支持更好的诊断技能和实践。
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