Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative.

Autor: Hart JD; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia. john.hart@unimelb.edu.au., Sorchik R; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Bo KS; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Chowdhury HR; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Gamage S; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Joshi R; The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, 2042, Australia., Kwa V; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Li H; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Mahesh BPK; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Mclaughlin D; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Mikkelsen L; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Miki J; Civil Registration and Vital Statistics, Vital Strategies, Bloomberg Data for Health Initiative, Santiago de Surco, Lima, Peru., Napulan R; Health Facility Development Bureau, Department of Health, Manila, Philippines., Rampatige R; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Reeve M; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Sarmiento C; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., War NS; John Snow, Inc. (JSI Research & Training Institute, Inc.), Mandalay, Myanmar., Richards N; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Riley ID; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia., Lopez AD; Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2020 Mar 09; Vol. 18 (1), pp. 74. Date of Electronic Publication: 2020 Mar 09.
DOI: 10.1186/s12916-020-01519-8
Abstrakt: Background: Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification.
Methods: The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne.
Results: The TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles.
Conclusions: The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.
Databáze: MEDLINE
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