'Inaccuracy' in death certification - Where are we now?
'Inaccuracy' in death certification - Where are we now?
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DOI：
10.1093/oxfordjournals.pubmed.a024463
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发表时间：
1996-03-01
期刊：
影响因子：
--
通讯作者：
Williams, EMI
中科院分区：
文献类型：
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作者：
Maudsley, G;Williams, EMI
背景本审查al-no文件和分析方面的死亡证明，是相关的公共health.Methods的文献回顾死亡证明主要使用计算机化的医学索引（1981年至1995年中期），并集中在完成死亡证明，准确性，标准，教育和程序要求。在此之前，进一步哨兵出版物确定从主要的文献based.Results的使用死亡率数据，历史和程序的情况下，记录死亡，基本死亡原因的哲学和它的关系，以“真相”，“不准确”的程度和影响，证书和认证，并可能的前进方向进行了讨论。有人认为，问题“如何不准确的死因数据？比文献所建议的更难回答，由于研究间在（1）定义，测量（如何和由谁？）结论传统的提高死亡证明质量的观点已经不起作用。需要重新定位思维，而不仅仅是敦促更多的教育。需要采取循证教育干预措施。死因理论框架的缺陷和死亡证明的常规性是不可避免的，但需要考虑。认证机构需要切实可行的反馈机制，这是持续高水平质量保证和促进对死亡率数据结构的理解所不可或缺的。可持续发展应该是公共卫生医学的核心作用。
Background This review al-no document and analyse aspects of death certification that are relevant to public health.Methods 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.Results 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.Conclusion 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 tall levels and fostering an understanding of the construction of mortality data. Continued development should be a core public health medicine role.