Accuracy of death certificate completion - The need for formalized physician training
Accuracy of death certificate completion - The need for formalized physician training
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DOI：
10.1001/jama.275.10.794
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发表时间：
1996-03-13
影响因子：
120.7
通讯作者：
Stellman, SD
中科院分区：
文献类型：
--
作者：
Messite, J;Stellman, SD
客观。-为了评估死亡证明完成的准确性随医生培训和经验水平而变化的程度。在课堂上，研究人员向受试者展示了六个医院死亡的书面案例，这些案例是根据国家卫生统计中心的材料改编的，并要求受试者完成纽约市死亡证明的死因部分。共有12名执业普通内科医生，21名内科住院医师和35名高年级医学生。将每位参与者记录的潜在死亡原因与疾病学家确定的正确原因进行比较。根据17个国际疾病分类中的一致性，将一致性和不一致性分为主要或次要。只有一名内科医生和五名住院医生接受了填写死亡证明的正式培训。三组参与者报告的潜在死亡原因与正确原因之间的总体一致率为内科医生56.9%，居民56.0%，医学生55.7%，尽管协议因病例类型而异，范围从15%到99%不等。如果在这项试点研究中观察到的错误分类是普遍的，这将意味着循环系统疾病和糖尿病的死亡率大大低估。这些数据有力地支持了将完成死亡证明的培训作为医生教育的一部分的必要性。
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%.Conclusions.-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.