Maudsley G, Williams E M
Department of Public Health, University of Liverpool.
J Public Health Med. 1996 Mar;18(1):59-66. doi: 10.1093/oxfordjournals.pubmed.a024463.
This review aims to document and analyse aspects of death certification that are relevant to public health.
A literature review on death certification primarily used the computerized Index Medicus (1981 to mid-1995), and concentrated on completing death certificates, accuracy, standards, education and procedural requirements. Further sentinel publications pre-dating this were identified from the main literature base.
The uses of mortality data, historical and procedural context for recording death, the philosophy of Underlying Cause of Death and its relationship to the truth, the extent and impact of "inaccuracy', the certificate and the certifier, and possible ways forward are discussed. It is argued that the question "How inaccurate are cause of death data?' is harder to answer than the literature suggests. Deriving a useful estimate is difficult because of inter-study differences in (1) definition, measurement (how and by whom?) and practical importance of error, and standards used; (2) focus (e.g. death certificate or mortality data), observing everyday practice or simulation exercises, diagnostic and/or semantic issues.
The traditional perspective on improving the quality of death certification has not worked. There is a need for reorientated thinking rather than just urging more education. Evidence-based educational interventions are needed. The flaws in the theoretical framework of cause of death and the routine nature of death certification are unavoidable, but require consideration. Certifiers need practical feedback mechanisms, integral to continuing quality assurance at all levels and fostering an understanding of the construction of mortality data. Continued development should be a core public health medicine role.
本综述旨在记录和分析与公共卫生相关的死亡证明方面的内容。
关于死亡证明的文献综述主要使用计算机化的《医学索引》（1981年至1995年年中），并集中于填写死亡证明、准确性、标准、教育和程序要求。在此之前的进一步哨点出版物是从主要文献库中确定的。
讨论了死亡率数据的用途、记录死亡的历史和程序背景、根本死因的理念及其与真相的关系、“不准确”的程度和影响、证明和证明者以及可能的前进方向。有人认为，“死亡原因数据有多不准确？”这个问题比文献所表明的更难回答。由于以下研究间差异，得出有用的估计很困难：（1）定义、测量（如何测量以及由谁测量？）、误差的实际重要性以及所使用的标准；（2）重点（例如死亡证明或死亡率数据）、观察日常实践或模拟练习、诊断和/或语义问题。
提高死亡证明质量的传统观点并未奏效。需要重新定位思维，而不仅仅是敦促更多的教育。需要基于证据的教育干预措施。死亡原因理论框架中的缺陷以及死亡证明的常规性质是不可避免的，但需要加以考虑。证明者需要实际的反馈机制，这是各级持续质量保证不可或缺的一部分，并有助于理解死亡率数据的构建。持续发展应是公共卫生医学的核心作用。
