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提高菲律宾死因认证质量:实施电子死因推断辅助决策工具(SmartVA auto-analyse)以帮助医生诊断院外死亡。

Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths.

机构信息

The George Institute for Global Health, University of New South Wales, Sydney, Australia.

The George Institute for Global Health, New Delhi, India.

出版信息

BMC Public Health. 2021 Mar 22;21(1):563. doi: 10.1186/s12889-021-10542-0.

DOI:10.1186/s12889-021-10542-0
PMID:33752622
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7986549/
Abstract

BACKGROUND

The majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.

METHOD

We conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.

RESULTS

Of the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.

CONCLUSION

Standardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths.

摘要

背景

菲律宾大多数死亡发生在医疗机构外,需要由市卫生官员(MHO)出具死因医学证明才能下葬。MHO 缺乏针对医疗机构外死亡的标准化认证流程,并且在没有医疗记录的情况下,他们会对很大比例死因不明的情况进行认证。我们旨在开发并引入 SmartVA Auto-Analyse,这是一种基于死因推断(VA)的电子决策支持工具,旨在帮助 MHO 认证医疗机构外的死亡事件。

方法

我们进行了利益攸关者磋商、流程映射和预测试,以评估 SmartVA Auto-Analyse 的可行性和可接受性。MHO 首先被要求对死者的家属进行开放式访谈,如果无法做出诊断,则使用标准化的 SmartVA 问卷继续访谈。Auto-Analyse 随后向 MHO 呈现了三种最可能的死因。在试点阶段,干预措施扩大到 91 个市镇。我们使用死因数据进行了混合方法评估,并与 MHO 进行了小组讨论。

结果

在登记的 5649 例死亡中,有 4586 例(81%)使用 Auto-Analyse 进行了认证。对于其余的 19%,医生认为他们可以根据医疗记录的可用性和 VA 开放式叙述来确定死因。在使用时,医生在 85%的情况下使用 Auto-Analyse 诊断来认证死因。在干预下的死亡中,只有 13%的死因不明。小组讨论确定了两个主题:Auto-Analyse 使家庭死亡的认证标准化,并帮助 MHO 提高死亡认证的质量。

结论

标准化的 VA 结合使用 SmartVA Auto-Analyse 支持工具的医生诊断,在菲律宾很容易被 MHO 使用,并且可以提高家庭死亡的死亡认证质量。

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Implementing and scaling verbal autopsies: into the unknown.实施和推广口头尸检:进入未知领域。
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