The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the International Form of Medical Certificate of Cause of Death
The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the International Form of Medical Certificate of Cause of Death
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DOI：
10.1186/s12913-017-2628-y
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发表时间：
2017-10-02
影响因子：
2.8
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Hazard, Riley H.;Chowdhury, Hafizur Rahman;Lopez, Alan D.
背景：准确和及时的死因数据对于指导卫生规划和政策至关重要。医生证明的死亡被认为是可靠和准确的，但国际死因医学证明提供的信息质量通常因参与证明的人员、医院的诊断能力和医院类别而异。没有发表的研究分析了孟加拉国的认证医生在完成MCCD时是如何遵守国际规则的，也没有评估临床记录保存的质量。方法：该研究于2011年1月至2014年4月在孟加拉国的Chandpur和Comilla地区进行。我们向所有研究医院介绍了国际MCCD。经过培训的项目医生指定了潜在的死亡原因，评估了死亡证明的质量，并报告了针对特定原因提供的医疗记录的确定程度。我们检查了填写MCCD时常见错误的频率、院内死亡的主要原因以及死亡原因数据的确定性程度。结果：纳入4914份死亡证明。72.9%的医疗记录质量太差，无法确定死亡原因，年龄、医院和死因差异不大。95.6%的死亡证明没有表明发病和死亡之间的时间间隔，31.6%需要改变顺序，13.9%需要包括新的诊断，50.7%使用缩写，41.5%使用每一行多个原因，33.2%使用定义不清的疾病作为潜在的死亡原因。99.1%的死亡证明至少有一个错误。成人死亡的主要原因是中风（15.8%），儿童死亡的主要原因是肺炎（31.7%），新生儿死亡的主要原因是出生窒息（52.8%）。结论：孟加拉国医院医师在正确完成MCCD方面存在困难。医生在死亡证明实践中经常出现错误，医疗记录质量差。如果要使孟加拉国的医院数据对政策有用，就迫切需要改进死亡证明做法和医院数据的质量。
Background: Accurate and timely data on cause of death are critically important for guiding health programs and policies. Deaths certified by doctors are implicitly considered to be reliable and accurate, yet the quality of information provided in the international Medical Certificate of Cause of Death (MCCD) usually varies according to the personnel involved in certification, the diagnostic capacity of the hospital, and the category of hospitals. There are no published studies that have analysed how certifying doctors in Bangladesh adhere to international rules when completing the MCCD or have assessed the quality of clinical record keeping.Methods: The study took place between January 2011 and April 2014 in the Chandpur and Comilla districts of Bangladesh. We introduced the international MCCD to all study hospitals. Trained project physicians assigned an underlying cause of death, assessed the quality of the death certificate, and reported the degree of certainty of the medical records provided for a given cause. We examined the frequency of common errors in completing the MCCD, the leading causes of in-hospital deaths, and the degree of certainty in the cause of death data.Results: The study included 4914 death certificates. 72.9% of medical records were of too poor quality to assign a cause of death, with little difference by age, hospital, and cause of death. 95.6% of death certificates did not indicate the time interval between onset and death, 31.6% required a change in sequence, 13.9% required to include a new diagnosis, 50.7% used abbreviations, 41.5% used multiple causes per line, and 33.2% used an ill-defined condition as the underlying cause of death. 99.1% of death certificates had at least one error. The leading cause of death among adults was stroke (15.8%), among children was pneumonia (31.7%), and among neonates was birth asphyxia (52.8%).Conclusion: Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death certification practices and medical record quality was poor. There is an urgent need to improve death certification practices and the quality of hospital data in Bangladesh if these data are to be useful for policy.