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The impact of errors in medical certification on the accuracy of the underlying cause of death
BACKGROUND: Correct certification of cause of death by physicians (i.e. completing the medical certificate of cause of death or MCCOD) and correct coding according to International Classification of Diseases (ICD) rules are essential to produce quality mortality statistics to inform health policy. D...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575485/ https://www.ncbi.nlm.nih.gov/pubmed/34748575 http://dx.doi.org/10.1371/journal.pone.0259667 |
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author | Gamage, U. S. H. Adair, Tim Mikkelsen, Lene Mahesh, Pasyodun Koralage Buddhika Hart, John Chowdhury, Hafiz Li, Hang Joshi, Rohina Senevirathna, W. M. C. K. Fernando, H. D. N. L. McLaughlin, Deirdre Lopez, Alan D. |
author_facet | Gamage, U. S. H. Adair, Tim Mikkelsen, Lene Mahesh, Pasyodun Koralage Buddhika Hart, John Chowdhury, Hafiz Li, Hang Joshi, Rohina Senevirathna, W. M. C. K. Fernando, H. D. N. L. McLaughlin, Deirdre Lopez, Alan D. |
author_sort | Gamage, U. S. H. |
collection | PubMed |
description | BACKGROUND: Correct certification of cause of death by physicians (i.e. completing the medical certificate of cause of death or MCCOD) and correct coding according to International Classification of Diseases (ICD) rules are essential to produce quality mortality statistics to inform health policy. Despite clear guidelines, errors in medical certification are common. This study objectively measures the impact of different medical certification errors upon the selection of the underlying cause of death. METHODS: A sample of 1592 error-free MCCODs were selected from the 2017 United States multiple cause of death data. The ten most common types of errors in completing the MCCOD (according to published studies) were individually simulated on the error-free MCCODs. After each simulation, the MCCODs were coded using Iris automated mortality coding software. Chance-corrected concordance (CCC) was used to measure the impact of certification errors on the underlying cause of death. Weights for each error type and Socio-demographic Index (SDI) group (representing different mortality conditions) were calculated from the CCC and categorised (very high, high, medium and low) to describe their effect on cause of death accuracy. FINDINGS: The only very high impact error type was reporting an ill-defined condition as the underlying cause of death. High impact errors were found to be reporting competing causes in Part 1 [of the death certificate] and illegibility, with medium impact errors being reporting underlying cause in Part 2 [of the death certificate], incorrect or absent time intervals and reporting contributory causes in Part 1, and low impact errors comprising multiple causes per line and incorrect sequence. There was only small difference in error importance between SDI groups. CONCLUSIONS: Reporting an ill-defined condition as the underlying cause of death can seriously affect the coding outcome, while other certification errors were mitigated through the correct application of mortality coding rules. Training of physicians in not reporting ill-defined conditions on the MCCOD and mortality coders in correct coding practices and using Iris should be important components of national strategies to improve cause of death data quality. |
format | Online Article Text |
id | pubmed-8575485 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-85754852021-11-09 The impact of errors in medical certification on the accuracy of the underlying cause of death Gamage, U. S. H. Adair, Tim Mikkelsen, Lene Mahesh, Pasyodun Koralage Buddhika Hart, John Chowdhury, Hafiz Li, Hang Joshi, Rohina Senevirathna, W. M. C. K. Fernando, H. D. N. L. McLaughlin, Deirdre Lopez, Alan D. PLoS One Research Article BACKGROUND: Correct certification of cause of death by physicians (i.e. completing the medical certificate of cause of death or MCCOD) and correct coding according to International Classification of Diseases (ICD) rules are essential to produce quality mortality statistics to inform health policy. Despite clear guidelines, errors in medical certification are common. This study objectively measures the impact of different medical certification errors upon the selection of the underlying cause of death. METHODS: A sample of 1592 error-free MCCODs were selected from the 2017 United States multiple cause of death data. The ten most common types of errors in completing the MCCOD (according to published studies) were individually simulated on the error-free MCCODs. After each simulation, the MCCODs were coded using Iris automated mortality coding software. Chance-corrected concordance (CCC) was used to measure the impact of certification errors on the underlying cause of death. Weights for each error type and Socio-demographic Index (SDI) group (representing different mortality conditions) were calculated from the CCC and categorised (very high, high, medium and low) to describe their effect on cause of death accuracy. FINDINGS: The only very high impact error type was reporting an ill-defined condition as the underlying cause of death. High impact errors were found to be reporting competing causes in Part 1 [of the death certificate] and illegibility, with medium impact errors being reporting underlying cause in Part 2 [of the death certificate], incorrect or absent time intervals and reporting contributory causes in Part 1, and low impact errors comprising multiple causes per line and incorrect sequence. There was only small difference in error importance between SDI groups. CONCLUSIONS: Reporting an ill-defined condition as the underlying cause of death can seriously affect the coding outcome, while other certification errors were mitigated through the correct application of mortality coding rules. Training of physicians in not reporting ill-defined conditions on the MCCOD and mortality coders in correct coding practices and using Iris should be important components of national strategies to improve cause of death data quality. Public Library of Science 2021-11-08 /pmc/articles/PMC8575485/ /pubmed/34748575 http://dx.doi.org/10.1371/journal.pone.0259667 Text en © 2021 Gamage et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Gamage, U. S. H. Adair, Tim Mikkelsen, Lene Mahesh, Pasyodun Koralage Buddhika Hart, John Chowdhury, Hafiz Li, Hang Joshi, Rohina Senevirathna, W. M. C. K. Fernando, H. D. N. L. McLaughlin, Deirdre Lopez, Alan D. The impact of errors in medical certification on the accuracy of the underlying cause of death |
title | The impact of errors in medical certification on the accuracy of the underlying cause of death |
title_full | The impact of errors in medical certification on the accuracy of the underlying cause of death |
title_fullStr | The impact of errors in medical certification on the accuracy of the underlying cause of death |
title_full_unstemmed | The impact of errors in medical certification on the accuracy of the underlying cause of death |
title_short | The impact of errors in medical certification on the accuracy of the underlying cause of death |
title_sort | impact of errors in medical certification on the accuracy of the underlying cause of death |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575485/ https://www.ncbi.nlm.nih.gov/pubmed/34748575 http://dx.doi.org/10.1371/journal.pone.0259667 |
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