Anand Akash, Khanna Divya, Singh Payal, Singh Anuj, Pandey Abhishek, Budukh Atul, Pradhan Satyajit
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India.
Centre for Cancer Epidemiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India.
Health Inf Manag. 2024 May;53(2):121-128. doi: 10.1177/18333583221144665. Epub 2023 Jan 21.
Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information.
To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020).
A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded.
A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors.
A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control.
This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors.
死因医学证明（MCCD）为了解社区疾病负担和制定卫生政策提供了有价值的数据。不准确的MCCD会严重损害国家卫生信息的准确性。
评估印度北部两家三级癌症护理医院在研究期间（2018年5月至2020年12月）开具的死亡证明的准确性。
在印度瓦拉纳西的两家三级癌症护理医院进行了一项为期两年半的回顾性观察研究。检查了所有死者的病历和死亡证明。使用世界卫生组织推荐的死亡证明收集人口统计学特征、管理细节和死因数据。通过电子病历验证死亡证明的准确性，并对错误进行分级。
研究期间，两个中心共发生778例死亡。其中，只有30份（3.9%）证明无错误；591份（75.9%）证明的直接死因不合适；231份（29.7%）证明将错误的死亡方式标记为直接死因；585份（75.2%）证明的根本死因不正确。大多数证明由初级医生开具，且与较高的证明错误率显著相关。
在研究期间，癌症护理医院的死亡证明错误率很高。与癌症相关的不准确的MCCD可能会影响癌症统计数据，从而影响癌症控制政策的制定。
本研究确定了迫切需要采取适当干预措施，通过培训医生来提高证明质量。
