Steven Stellman - Accuracy of death certificate completion: the need for formalized physician training

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      Publication Details (including relevant citation   information):

      Messite, J., Stellman, S. D. 275 (10) 794-6-

      Abstract: OBJECTIVE: To assess the extent to   which accuracy of death certificate completion varies with level   of physician training and experience. DESIGN AND SETTING: In a   classroom setting, subjects were presented with six written cases   of hospital deaths adapted from materials from the National   Center for Health Statistics and were asked to complete the   cause-of-death section of the New York City death certificate.   PARTICIPANTS: A total of 12 practicing general internists, 21   internal medicine residents, and 35 senior medical students.   OUTCOME MEASURES: The underlying cause of death recorded by each   participant was compared with the correct cause determined by a   nosologist. Agreement and disagreement were classified as major   or minor depending on concordance within the 17 International   Classification of Diseases categories. RESULTS: Only one   internist and five residents had received formal training in   death certificate completion. The overall level of agreement   between underlying cause of death reported by the three groups of   participants and the correct cause was 56.9% for internists,   56.0% for residents, and 55.7% for medical students, although   agreement varied with the type of case, ranging from 15% to 99%.   CONCLUSION: If the misclassification observed in this pilot study   were widespread, it would imply a substantial underreporting of   mortality from both circulatory diseases and diabetes. These data   strongly support the need to include training in death   certificate completion as part of physician education.

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