Myers K A, Farquhar D R
Department of Medicine, Queen's University, Kingston, Ont.
CMAJ. 1998 May 19;158(10):1317-23.
Population-based mortality statistics are derived from the information recorded on death certificates. This information is used for many important purposes, such as the development of public health programs and the allocation of health care resources. Although most physicians are confronted with the task of completing death certificates, many do not receive adequate training in this skill. Resulting inaccuracies in information undermine the quality of the data derived from death certificates.
An educational intervention was designed and implemented to improve internal medicine residents' accuracy in death certificate completion. A total of 229 death certificates (146 completed before and 83 completed after the intervention) were audited for major and minor errors, and the rates of errors before and after the intervention were compared.
Major errors were identified on 32.9% of the death certificates completed before the intervention, a rate comparable to previously reported rates for internal medicine services in teaching hospitals. Following the intervention the major error rate decreased to 15.7% (p = 0.01). The reduction in the major error rate was accounted for by significant reductions in the rate of listing of mechanism of death without a legitimate underlying cause of death (15.8% v. 4.8%) (p = 0.01) and the rate of improper sequencing of death certificate information (15.8% v. 6.0%) (p = 0.03).
Errors are common in the completion of death certificates in the inpatient teaching hospital setting. The accuracy of death certification can be improved with the implementation of a simple educational intervention.
基于人群的死亡率统计数据源自死亡证明上记录的信息。该信息用于许多重要目的，如制定公共卫生项目和分配医疗资源。尽管大多数医生都面临填写死亡证明的任务，但许多人并未接受过此项技能的充分培训。由此导致的信息不准确会损害源自死亡证明的数据质量。
设计并实施了一项教育干预措施，以提高内科住院医师填写死亡证明的准确性。对总共229份死亡证明（干预前填写146份，干预后填写83份）进行了重大和轻微错误审核，并比较了干预前后的错误率。
干预前填写的死亡证明中有32.9%存在重大错误，这一比例与先前报道的教学医院内科服务的比例相当。干预后，重大错误率降至15.7%（p = 0.01）。重大错误率的降低是由于无合法根本死因的死亡机制列出率显著降低（15.8%对4.8%）（p = 0.01）以及死亡证明信息排序不当率显著降低（15.8%对6.0%）（p = 0.03）。
在住院教学医院环境中，填写死亡证明时错误很常见。通过实施简单的教育干预措施，可以提高死亡证明的准确性。
