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PubMed1979

Community participation in the certificate-of-need process: a look at ten-taxpayer groups in Massachusetts.

Certificate-of-need statutes give designated state agencies veto power over investment in health care facilities. Some states have sought to temper the arbitrary character of this power by expanding the opportunities for community input into the certificate-of-need process. Massachusetts, for example, has enacted a statute that allows groups of ten taxpayers to petition for a public hearing on any certificate-of-need application. Some observers question whether the benefits of taxpayer-group participation are substantial enough to compensate for the delays and abuses that the statute allegedly invites. To help resolve this question, this Comment examines historical data on Massachusetts taxpayer groups and on their activities and assesses the significance of their composition and tactics to the certificate-of-need process. Although flaws exist in the Massachusetts ten-taxpayer mechanism, in this writer's view it has succeeded partially in making the certificate-of-need process responsive to community opinion. Many groups lack the skills and qualities needed to make constructive use of the ten-taxpayer mechanism. Nevertheless, it serves a valuable purpose by creating a public forum for and by encouraging public participation in the certificate-of-need process, especially by those who might otherwise try to circumvent that process through use of special legislation, of private pressure, or of other similar means.

Certificate of Need↗

PubMed1995

[The validity of the certification of natimortality: the experience of a local study].

Although several study confirmed the inaccuracy of information in death certificates, very few investigations were performed to assess the validity of stillbirth certificate reporting. The aim of the present study was to evaluate the extent to which the clinical diagnosis of stillbirth cause reported in certificates can be considered sensitive and specific. Eighty-five consecutive stillbirths were independently classified by two neonatologists with certificate information, using the new Wigglesworth classification, and the reliability of the classification process was evaluated. Afterwards we compared the classes made with certificate causes and the ones made with clinical-autoptic data (the "gold standard") and we estimated sensitivity and specificity of certificate cause of stillbirth. The reliability of the classification process was very high. Values of sensitivity were considered unacceptable, mainly in the field of congenital malformations, intra-partum asphyxia and other specific causes. By contrast, specificity was found to be satisfactory. The accuracy of clinical stillbirth diagnosis is not sufficient and good description needs the contribute of post-mortem necropsy.

Autopsy↗

PubMedDate not supplied

Correctness of racial coding of American Indians and Alaska Natives on the Washington State death certificate.

Underestimation of death rates for specific races can obscure health problems and impair the ability of public programs to prevent premature death and disability. For accurate race-specific death rates, the racial classification of both the population at risk and the decreased population must be accurately ascertained. However, studies suggest that the American Indian (AI) and Alaska Native (AN) races may be not be accurately recorded on the death certificate. We performed a computerized linkage between the Indian Health Service (IHS) patient registry and the 1985-1990 computerized Washington State death certificate data. The deceased was correctly identified as AI or AN on the death certificate for 1,088 (87.2%) of 1,248 matched deaths. The majority (93%) of deceased persons identified on the death certificate as not AI or AN were listed as white. The percentage of American Indian ancestry was strongly associated with correct racial classification on the death certificate (P < .001). Birth in Washington State, membership in a large Washington State tribe, and death from an alcohol condition independently added to the likelihood of correct AI or AN racial classification. Persons who died from cancer were significantly less likely to be correctly coded as AI or AN on the death certificate.

Alaska↗

PubMedDate not supplied

[Errors in the certification of deaths from cancer and the limitations for interpreting the site of origin].

The aim of this study is to assess errors in the filling-out of death certificates and difficulties for disclosing the origin of neoplasms. This study was carried out in Tijuana, Mexico. Death certificates containing a diagnosis of cancer were selected from all death certificates issued from January 1 to December 31, 1989. The following variables were identified: age, sex, place of residence and cancer site. Using these criteria, we found that 74.9 per cent of death certificates had been correctly filled out and 21.5 per cent were errors. It was seen that the main cancer sites causing mortality were the lungs, breast, cervicouterine and stomach. Cancer in unknown sites was registered in 20.5 per cent of all certificates. Implications of these results are analyzed in the light of mortality trends by causes and risk factors. We suggest that training courses are given to physicians so that they fill out the certificates properly.

Adolescent↗

PubMed1993

Errors in death certificate completion in a teaching hospital.

A retrospective chart review was conducted to determine the types and frequency of errors, other than those of diagnostic accuracy, made in recording information on death certificates and to assess factors that might affect those rates. The sample (n = 426) consisted of 50% of all deaths in a London, Ontario teaching hospital over one year. For each certificate reviewed, 6 questions were asked based on W.H.O. guidelines: 1) Was there an acceptable cause of death? 2) If mechanisms of death were recorded, were they adequately explained by an underlying cause of death? 3) Were there any sequencing errors? 4) Were there 2 competing causes of death listed? 5) Was there recorded any time interval between onset of the condition and death? 6) Was there any other inappropriate information recorded? The death certificates were filled out in an acceptable fashion 68.1% of the time. Comparing the 6 major departments in the hospital, there was significant difference in the error rates of the different departments (p = .0035). Error rates were not significantly better for certificates that had been signed by a coroner nor in those that had an autopsy performed. The majority of the death certificates (89.4%) were completed by house staff. More attention has to be devoted to raising physicians' awareness of the types of errors made in completing death certificates. Recurring educational sessions and feedback, if provided in teaching hospitals, could be helpful to increase the accuracy of these important documents.

Autopsy↗

PubMed1993

State board requirements for CPR certification for licensure in independent health professions.

CPR certification requirements for licensure were obtained from 50 states and the District of Columbia for the fields of medicine, osteopathy, podiatry, chiropractic, dentistry, and optometry. It was found that none of the states required CPR certification for initial medical, osteopathic or chiropractic licensure or license renewal, while 4 percent required certification for initial podiatric licensure and license renewal. For initial licensure in dentistry, 25 percent of the boards required CPR certification while 29 percent required CPR certification to renew dental licensure. For initial optometric licensure with diagnostic pharmaceutical agents, 44 percent of the states required CPR certification.

Cardiopulmonary Resuscitation↗

PubMedDate not supplied

Death certification: is correct formulation of cause of death related to seniority or experience?

We looked at a series of death certificates completed by various grades of hospital clinicians, general practitioners (GPs) and pathologists. Specific error types were defined and identified in each group. In hospital it is still the pre-registration house officer who completes most of the death certificates. Senior hospital doctors make more errors than their juniors while GPs and pathologists make fewest errors. Even amongst pathologists 11% of certificates recorded no adequate underlying cause of death, 85.7% failed to record organisms identified and 76.7% failed to record the site or histological type of tumours. This agrees with other studies that show that inaccuracies in death certificates arise from inadequate formulation of cause of death and failure to record relevant information. It reveals that little heed has been paid to the recommendation in the joint report of the Royal College of Physicians and Pathologists that senior doctors should be more involved in certification--the frequency of errors in this group suggests that it might not, in any case, lead to a great improvement. The number or errors made by GPs and pathologists suggest that even practitioners with clinical experience and regular exposure to certification frequently make errors. The reasons for this are discussed and possible solutions proposed.

Cause of Death↗

PubMed1997

Graduates of foreign medical schools: progression to certification by the Educational Commission for Foreign Medical Graduates.

The application process leading to certification by the Education Commission for Foreign Medical Graduates (ECFMG) was studied using the group of 9,491 graduates of foreign medical schools who initiated their applications in 1988. Using the ECFMG's database, these applicants' countries of citizenship, examination histories, certification status, and exchange visitor status were determined for a period of seven years and 9 months, ending in September 1995. Within that time, 45% of these applicants became ECFMG-certified, and 26% of that group entered residency programs accredited by the Accreditation Council for Graduate Medical Education. Of the total number of non-U.S. citizens (2,243) who entered such programs, 61% did so as exchange visitor physicians. The remainder had other kinds of visa status, such as permanent resident, or had become U.S. citizens. Although U.S. citizens and non-U.S. citizens achieved certification at the same rate (45%), the U.S. citizens had greater success in obtaining positions in graduate medical education (GME). Seventy-four percent of the ECFMG-certified certified U.S. citizens entered GME, versus 57% of the ECFMG-certified non-U.S. citizens. The status of the 55% of the 9,491 applicants who did not obtain certification is discussed; a portion of this group of this group continues to pursue certification. Details and requirements of the ECFMG certification process are also described.

Certification↗

PubMed1997

[Validation of perinatal causes of death in death certificates].

OBJECTIVE: The objective of this study was to assess the validity of perinatal causes of death in death certificates and the influence of some variables related to perinatal mortality. PATIENTS AND METHODS: All perinatal deaths having occurred in Barcelona in 1994 and reported in death certificates were included. Additional sources of information were certificates of abortions and also other documents such as autopsy reports and medical records, that served as references to determine the most reliable or standard cause of death (SBC) The SBC was determined by a group of experts. The validity was assessed by comparing the cause of death as stated in the death certificate (BC) and the SBC, calculating the general agreement, the detection rate (DR) or sensitivity and the confirmation rate (CR) or positive predictive value. The chi-square test was used to compare proportions. RESULTS: In 166 (91.2%) of the 182 cases, the BC and SBC were assigned to the same group of the International Classification of Diseases. For congenital defects, the DR was 85.7 (95% CI: 75.1-96.3) and the CR was 81.8 (95% CI: 70.4-93.2). For problems in the perinatal period the DR was 95.6 (95% CI: 92.1-99.1) and the CR was 94.9 (95% CI: 91.2-98.6). Both were considered reliable causes. These rates were similar for the different categories of other variables (birth weight, gestational age, vital status, sex, hospital of birth, autopsy and mother's age). Nevertheless, in the study of detailed causes (3 digits of the International Classification of Diseases) the general agreement was much lower (40.1%). Except for the congenital defects of the nervous system, the remaining causes of death had a low validity. CONCLUSIONS: This study shows the low validity of detailed causes of perinatal death reported in death certificates. It is necessary to improve the completion and coding of death certificates following the WHO recommendations.

Cause of Death↗

PubMed2001

Sickness certification in primary care.

OBJECTIVES: Sickness certification is a common task, which is however insufficiently studied. Our objective was to describe, prospectively, prescription practices in sickness certification by primary care physicians. METHODS: We recorded patients receiving a sickness certificate during a six-week study period. The main outcome measures were: duration of sick-leave according to age, profession, diagnosis, nationality, somatic, or psychiatric comorbidity as well as co-factors related to the familial or professional environment. RESULTS: Out of a total of 6,433 consultations, 602 patients received a sickness certification, and in 56% of these, sick-leave duration was > or = 6 days. Multivariate analysis showed that presence of co-morbidity and co-factors, greater age and musculoskeletal, cardiovascular, psychiatric disease and injury were independently associated with a longer sickness certification duration. CONCLUSIONS: Sickness certification is a complex task which entails not only consideration of the diagnosis but also of other factors such as co-morbidity, as well as familial and professional environment. Physicians should be aware of these elements and of situations, which might lead to a longer sick-leave period.

Adolescent↗

PubMed2006

[Quality of medical diagnosis in sick leave certificates for non-occupational diseases and injuries].

OBJECTIVE: To evaluate the quality of medical diagnosis in the sick leave certificate. DESIGN: Retrospective, observational study. SETTING: Castelldefels Primary Care Centre, Barcelona, Spain. MEASUREMENTS AND INTERVENTIONS: 205 sick leave episodes of patients reported as non-occupational diseases and injuries were analyzed. The diagnosis of the sick leave certificate was checked against the clinical report carried out by the same physician who made out the sick leave certificate. To assess the quality of medical diagnosis, sensitivity, positive predictive value and the percentage of positive agreement were calculated. The variability of these indicators was also assessed according to the duration of the sick leave episode. RESULTS: Simple agreement between the diagnoses of the sick leave certificate and the clinical report was 92%. The sensitivity of the sick leave certificate in relation to the clinical report by diagnostic group ranged from 75% to 97%; positive predictive value, from 81% to 100%; and the percentage of positive agreement, from 86% to 97%. Short-term sick leave episodes (< or =15 days) had lower values than long-term sick leave (>15 days). CONCLUSIONS: Our findings confirm that the quality of diagnosis on the sick leave certificate is high. The availability of more medical information about the reasons for the sick leave episode does not modify the quality of the diagnosis substantially.

Diagnostic Techniques and Procedures↗

PubMed1989

Duration of episodes of sickness certification.

The duration of episodes of sickness certification are reported according to cause, sex, and age. The study is based on the 5,042 initial certificates issued to residents of Buskerud county in Norway during a period of four weeks in 1985. Forty per cent were still certified sick after two weeks, 14.2% after eight weeks, and 1.3% at the end of one year. The mean duration of the 5,042 episodes of sickness certification was 34 calendar days for both sexes, increasing significantly with age (range 16-57 days). Patients with a high probability of long-term sickness certification were those with circulatory system diseases, musculoskeletal/connective tissue diseases, neoplasms, endocrine/nutritional/metabolic diseases, and mental disorders. The same was true for patients certified sick due to "other complications of pregnancy", syndromes related to the cervical spine, and back pain with radiating symptoms. Information on cause-, sex-, and age-specific duration of episodes of sickness certification, such as provided by the present study, may help general practitioners to select those patients who should be given priority for early rehabilitation. A systematic follow-up of patients with a high probability of long-term sickness certification is an important task in primary health care, and should be carried out in co-operation with other health- and social-workers.

Absenteeism↗

PubMed1995

Assessment of sickness certification and concepts of musculoskeletal disease and illness in the general population.

OBJECTIVE: To investigate how laymen assess the need for sickness certification and how they use the concepts "disease" and "illness" in relation to musculoskeletal disorders. DESIGN: Mail questionnaire with simulated case histories. SUBJECTS: A stratified, random sample of 600 Norwegians, aged 16-69 years. MAIN OUTCOME MEASURES: Scores that measured the respondents' use of the concept "illness", and their view on need for sickness certification were constructed and analysed. RESULTS: Response rate was 54%. The respondents perceived seven case histories describing musculoskeletal health problems more often as "illness" (61%) than as "disease" (46%). There was a close correlation between the use of "illness" and assessed need for sickness certification. However, sickness certification could be suggested for cases with neck pain, even if the patient was not perceived as ill. Women suggested sickness certification significantly more often than men. Age, length of education, and personal experience with serious musculoskeletal health problems influenced suggestions on certification among men. However, these variables could not explain any difference in use of the concept "illness".

Absenteeism↗

PubMed2002

Reduction of Death Certificate Only (DCO) Registrations by Active Follow Back.

Death certificates are an important source of information for cancer registries that help to improve completeness of case finding. In many countries where routine mortality data are considered of poor quality, this source is often regarded as being of little value. We evaluated the contribution of death certificates to the total number of registrations in the years 1993-1997, in the Manila Cancer Registry (MCR). We compared the "standard" practice of retrieving clinical information if the death certificate was completed in a hospital, with active search of additional information from the deceased's relatives when the death was certified at home.The standard procedure allowed us to reduce the proportion of cases registered from a death certificate by 5%. The improvement varied significantly among the most common sites with a reduction of 10% for lymphomas to less than 1% for cancers of the cervix.The proportion of liver cancers registered from a death certificate only (DCO), originally 47%, was reduced to 29% by contacting relatives of the deceased patients. In countries with limited investment in information systems, death certificates, even when recognised as being of poor quality, are an important source of information for cancer registries.

Journal Article↗

PubMed2005

Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality.

OBJECTIVES: I studied the extent to which maternal deaths are underreported on death certificates. METHODS: We collected data on maternal deaths from death certificates, linkage of death certificates with birth and fetal death records, and review of medical examiner records. RESULTS: Thirty-eight percent of maternal deaths were unreported on death certificates. Half or more deaths were unreported for women who were undelivered at the time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder. CONCLUSIONS: The number of maternal deaths is substantially underestimated when death certificates alone are used to identify deaths, and it is unlikely that the Healthy People 2010 objective of reducing the maternal mortality rate to no more than 3.3 deaths per 100000 live births by 2010 can be achieved. Increasing numbers of births to older women and multiple-gestation pregnancies are likely to complicate efforts to reduce maternal mortality.

Adolescent↗

PubMed1978

Specialty board certification rates. A longitudinal tracking study of US medical school graduates.

This study is follow-up analysis of increments in specialty board certification rates occurring between 1971 and 1976 for 2,046 physicians who graduated in 1960, 1964, and 1968. Data obtained at 8-, 12-, and 16-year intervals following graduation from medical school indicate that it is not until 12 years' following receipt of the MD degree that most physicians will have entered the certification process or be certified. An additional increment is found 16 years following graduation. At eight and 12 years following graduation, the more recent graduates showed a much higher rate of board certification than earlier graduates at a comparable interval following graduation. Of the total study population, 81% are either board certified or in the certification process. When two essentially office-based specialties are excluded, 92% of the study population have formally entered the certification process.

Certification↗

PubMed2006

Policies and practices related to the role of board certification and recertification of pediatricians in hospital privileging.

CONTEXT: Privileging involves the granting of permission to perform specific professional activities under the jurisdiction of a governing body's (hospital) authority. In 1951, the Joint Commission on the Accreditation of Hospitals (later renamed the Joint Commission on Accreditation of Healthcare Organizations) was formed to codify the process of hospital assessment. In the early part of the 20th century, a parallel process was being undertaken by the medical specialties to evaluate and recognize competence among physicians through the creation of specialty boards. OBJECTIVES: To describe the use of board certification in hospital privileging policies for general pediatricians and pediatric subspecialists and to identify any variation among types of hospitals. DESIGN, SETTING, AND PARTICIPANTS: A telephone survey between January 1 and June 30, 2005, of privileging personnel among a random, weighted sample of 200 nonspecialty hospitals stratified by teaching status, children's vs general hospitals, freestanding children's hospital vs part of hospital system, and urban vs rural location. MAIN OUTCOME MEASURES: Proportion of hospitals that require board certification at initial privileging or at some point to maintain privileges and recertification to maintain privileges. RESULTS: Of 200 hospitals, 7 hospitals were ineligible because they did not have at least 1 pediatrician on staff. One hundred fifty-nine hospitals completed the telephone interview, resulting in an overall response rate of 82%. A total of 124 (78%) of 159 hospitals did not require general pediatricians to be board certified at initial privileging; however, 111 (70%) did require pediatricians to become board certified at some point during their tenure. Of these 124 hospitals, 52 (42%) did not report a time frame in which certification must be achieved. Forty-nine (43%) of 113 hospitals required pediatric subspecialists to achieve subspecialty certification within a specific time frame. CONCLUSIONS: These results raise issues regarding the manner in which board certification is used or not used by hospitals in their efforts to ensure the practice of high-quality care within their institutions. The premise for recertification is the need to assure the public of continued competence of physicians over the course of their professional careers. Increased attention by the public and regulatory agencies regarding patient safety and quality of care will likely have an impact on hospital privileging processes.

Certification↗

PubMed1991

A comparison of occupational data from death certificates and interviews.

A comparison was made of the occupational data reported on the death certificates of 586 men with their employment history obtained by interviews. Agreement was assessed for 19 occupational and 14 industrial categories of usual employment, with the highest levels of concordance (greater than or equal to 80%) found for agricultural, medical, and public administration activities. Between the two sources of information, there was overall agreement of 56% for usual occupation and 51% for usual industry of employment. Concordance was highest among the 68 self-respondents (usual occupation 66%; usual industry 53%). Among the 518 surrogates, spousal agreement was highest (58% for occupation and 51% for industry). For other surrogate types, agreement was 49% for both industry and occupation. Agreement varied by duration of employment and by level of education, with concordance tending to increase as length of employment and educational attainment rose. These relationships remained when examined by respondent type. Evaluation of agreement levels by age and other study subject characteristics showed little effect on concordance. Review of verbatim data from the interviews and death certificates revealed that most disagreements could be attributed to coding problems caused by vague or misleading information on the death certificates, although some disconcordance was due to uncodable and missing information in the interview history. Based on results from this and prior studies, the value of occupational data derived from death certificates in epidemiologic studies may be limited, although the addition of explicit instructions on the death certificate itself may aid in providing more useful and complete information for usual employment.

Death Certificates↗