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PubMed1960

Medico-legal aspects of medical certification of cause of death.

This paper deals with the medico-legal aspects of death certification, the inadequate attention accorded to these aspects in most of the present death certificate forms, and the consequences resulting from this circumstance. A description is also given of the revision of the national system of medical certification of causes of death in Finland. This revision seeks to avoid the drawbacks mentioned by means of an improved form of death certificate introduced in 1960. Certain recommendations are also made on the basis of the experience acquired so far.

Cause of Death↗
PubMed1997

Certification of death by family physicians.

Death certificates are important because morbidity and mortality statistics often come from death-certification data. These statistics are vital in developing approaches to disease treatment and strategies for increasing longevity. It is often the primary care physician who is responsible for completing the death certificate, for explaining the cause of death to the family and, if appropriate, for referring some cases to the medical examiner. The primary care physician should have an explicit understanding of how to determine the cause and manner of death and should use succinct, clear language in completing the death certificate. When doubt exists or an external cause of death is a possibility, the coroner or the medical examiner is the appropriate public health official to contact.

Aged↗
PubMed2006

Use of board certification and recertification of pediatricians in health plan credentialing policies.

CONTEXT: Health plans conduct credentialing processes to select and retain qualified physicians who will provide high-quality care to their subscribers. One of the tools available to health plans to help ensure physician competence is assessment of board certification status. OBJECTIVE: To determine the credentialing policies of health plans regarding the use of board certification and recertification for general pediatricians and pediatric subspecialists. DESIGN, SETTING, AND PARTICIPANTS: Telephone survey conducted February through July 2005 of credentialing personnel from a US national sample of 244 health plans stratified by enrollment size, Medicaid proportion, and for-profit or not-for-profit status. MAIN OUTCOME MEASURES: Proportion of health plans that require general or subspecialty board certification at initial contract or at any time during association with the plan and recertification to maintain credentialing or to bill as a specialist or subspecialist; percentage of physicians credentialed in each health plan and credentialing goals for each plan regarding the proportion of physicians to be board certified. RESULTS: Response rate was 193 of 244 (79%). Overall, 174 (90%) of the plans do not require general pediatricians to be board certified at the time of initial credentialing, and only 41% ever require a general pediatrician to become board certified. Similarly, only 80 (40%) ever require subspecialists to become board certified in their subspecialty. Although 80 of 192 (41%) report requiring recertification of general pediatricians, almost half do not have a time frame in which recertification must occur. Seventy-seven percent of plans allow physicians to bill as subspecialists with expired certificates. CONCLUSIONS: These findings, although specific to pediatrics, likely apply to other primary care disciplines and raise questions regarding the ability of plans to ensure initial or continued competence of their credentialed physicians. Growing public concern regarding patient safety, as well as demonstrated patient preferences for certified physicians, will likely result in greater emphasis on quality assessments in physician credentialing.

Certification↗
PubMed1987

Comparison of occupational interview data to death certificate data in Utah.

Lifelong occupational histories obtained by interview prior to death were compared to death certificate data for 87 male bladder cancer patients in Utah. Agreement was defined as identical Bureau of Census codes, after predetermined groupings were made. Usual occupation, defined as that with the longest duration, agreed with the death certificate occupation for 54% of the individuals; usual industry agreed for 72%. Most recent occupation and industry agreed for 47% and 53%, respectively. For 69%, at least one interview occupation agreed with the death certificate occupation, and at least one industry agreed for 84%. Variables affecting agreement were duration of the job and education. Also examined were interview data about employment either during the last 15 years or prior to age 65 years, obtained from 112 male colon cancer patients. The Bureau of Census codes were in agreement for occupation in 63% and for industry in 65%. Duration of the job and education were related to percent agreement. We conclude that occupations and industries listed on death certificates reflect at least part of the work history of the majority of individuals.

Adult↗
PubMed1990

Occupation and industry on death certificates of long-term chemical workers: concordance with work history records.

This study evaluated the concordance between occupation and industry listed on death certificates with actual work history information for a group (n = 5,882) of long-term (10 years or more) workers at a chemical company. Match rates were calculated as the percent of death certificate occupation and company entries that were confirmed by work history data using 3-digit 1980 U.S. Census Bureau group codes. The concordance rate for industry differed by employment status at death: employed, 94.9%; inactive, 30.8%; and retired, 91.1%. Concordance on occupation was analyzed for employed (n = 467) and retired (n = 932) subjects who had computerized work histories (randomly done prior to the study) and who had matched on the company on the death certificate. Concordance ranged from 0 to 50% for the first job, to 50 to 70% for the last job, longest job, and longest job in the last 10 years of company employment. The most consistent predictor of concordance was job duration. Misclassification was reviewed by occupational category. Results from this and other investigations lead to the inevitable conclusion that usual occupation data from death certificates are grossly inadequate for studies of occupational risks.

Aged↗
PubMed2006

Problems in using birth certificate files in the capture-recapture model to estimate the completeness of case ascertainment in a population-based birth defects registry in New York State.

BACKGROUND: The limitations and underlying assumptions of the capture-recapture methods have hindered their application in epidemiological settings, especially in evaluating the completeness of birth defects registries. This study explored the possibility of using birth certificates as the secondary data source in a simple two-source capture-recapture model to estimate the completeness of case ascertainment of the Congenital Malformations Registry (CMR) for selected major birth defects. METHODS: The CMR and the birth certificates were used as the primary and secondary sources, respectively. Children who were born in 1996-2001 and had selected major birth defects were identified from the two sources. The accuracy of the diagnoses was examined by comparing the individual birth defect categories of the children from the two sources. RESULTS: Discrepancies in birth defect categories in the two data sources and false positives in the birth certificates were the major problems encountered in estimating the completeness of the CMR using the simple two-source capture-recapture method. The estimated completeness for selected major birth defects was only about 71%. Stratified analyses resulted in relatively high estimated completeness for oral clefts (90%) and Down syndrome (88%). CONCLUSIONS Although the birth certificate data was not a good source for estimating the completeness of case ascertainment of the CMR using capture-recapture methods, the analyses provided reasonable estimates for some conditions that were relatively easy to identify and diagnose at birth, such as oral clefts and Down syndrome.

Birth Certificates↗
PubMed2004

An audit of a British sample of death certificates in which anorexia nervosa is listed as a cause of death.

OBJECTIVE: Anorexia nervosa is associated with an increased mortality rate. National mortality statistics based on statutory death certification are potentially an important source of information. However, there are reasons to believe that these statistics may be subject to significant errors. An audit of the quality of information and diagnosis was conducted on death certificates in which anorexia nervosa was mentioned. METHOD: The current study examined data from death certificates of people who died in England and Wales between 1993 and 1999. RESULTS: There were 230 such deaths, but only 128--just over one half--were rated as likely to be deaths associated with true anorexia nervosa. DISCUSSION: National mortality statistics derived from death certificates are a flawed source of information on deaths from anorexia nervosa when taken at face value. There may be both underreporting and overreporting. Detailed examination may improve their usefulness by reducing the overerreporting. It seems likely that the association of deaths with anorexia nervosa is systematically underreported.

Adult↗
PubMed1986

Causes of death in Huntington disease as reported on death certificates.

Huntington disease (HD) is a late onset autosomal dominant neurological disorder. Two hundred fifty-three death certificates of HD-affected individuals from four midwestern states were examined to determine the completeness of reporting HD on the death certificates. Overall, 66% of death certificates indicated HD as a primary or contributory cause of death. There was significantly better reporting on more recent death certificates, but even since 1979, 16% did not report HD. The implications to those researching HD family histories and to the accuracy of mortality rates are discussed.

Death Certificates↗
PubMedDate not supplied

Empowerment through rehabilitation nursing certification.

Certification empowers nurses by validating their clinical competency and continued professional growth. This article discusses the current state of certification in the nursing profession. The potential benefits to the certified nurse and the costs in both time and money needed to achieve and maintain certification are addressed. The article also describes how the nursing department of a 284-bed rehabilitation hospital developed a program to promote specialty certification among its nursing staff. The process and outcome of this program revealed several potential research topics.

Certification↗
PubMed1995

Reliability of death certificates in the study of stroke mortality. A retrospective study in a Sicilian municipality.

The subjects who died in the Sicilian municipality of Riposto between 1985 and 1992, and whose death certificates reported diagnoses of cerebrovascular disease, were re-evaluated with the aim of verifying the reliability of the certificates themselves. The relatives of the deceased were interviewed to confirm or exclude stroke, and about 35% of the cases proved to be false positives. Among the causes reported on the death certificates, "stroke", "cerebral hemorrhage" and "cerebral thrombosis" presented the smallest number of false positives. Our results show that the sensitivity and specificity of the death certificates was poor, and there would also seem to be a large number of false negatives. However, the official mortality rates for cerebrovascular disease are probably not very far from the truth.

Adolescent↗
PubMed2004

Influence of motivations for seeking ISO 14001 certification on perceptions of EMS effectiveness in China.

This study examines the motivations of mainland Chinese facilities in seeking ISO 14001 certification and examines the linkages between these motivations and self-reports of the effectiveness of major environmental management system (EMS) components. In a sample of 128 facilities in Beijing, Shanghai, and Guangzhou, the main drivers for certification were reported to be to ensure regulatory compliance, to enhance the firm's reputation, and to improve environmental performance, in that order. Although motivation to achieve cost reductions were least emphasized, a broad range of motivations appears to be considered in the decision to seek certification to ISO 14001. Regression models linking these motivations to the EMS components suggests that internal motivations have an influence on most EMS components. One interesting exception to this, however, is that no significant relationship was observed between internal motivations and the promulgation of environmental objectives and targets. The relationships associated with external motivations for certification (i.e., those in response to customer and other stakeholder pressures) and EMS components, on the other hand, are weaker and tend to occur earlier in the process cycle. No significant relationships were found between motivations to reduce costs and perceptions of the effectiveness of EMS components. Overall, these findings suggest that ISO 14001, as currently being implemented in mainland China, may have a modestly useful role when used in combination with other policy mechanisms to move the Chinese economy toward more sustainable practices. It is asserted that the ISO standard could provide even greater benefits if Chinese registrars were more proactive in developing EMS in conjunction with even more rigorous third-party audits.

Certification↗
PubMed1985

Death certification of farmer's lung and chronic airway diseases in different countries of the EEC.

An EEC Working Party has investigated death certification of respiratory disease in eight EEC countries by sending ten standard case histories to a sample of certifying doctors in each country. Results of interest to clinicians with reference to certification of farmer's lung, and of obstructive airway diseases, are presented. For a case of farmer's lung, a majority of certifying doctors in all countries certified an interstitial lung disease, but the proportion certifying farmer's lung ranged from 70% to 0% (overall 26%). Rural doctors certified farmer's lung more frequently than others only in some countries. For four cases of different types of airways disease (chronic obstructive bronchitis, emphysema or asthma) there were wide differences between countries of certification of these conditions or of unspecified chronic airways obstruction. Some countries certify more emphysema, and others, particularly younger doctors in English speaking countries, more unspecified chronic airways obstruction. There are also large differences in the certification of asthma. The differences are presumed to be attributable to differences of medical education. Epidemiological studies and patient care might be helped by more uniformity of diagnostic criteria within the EEC.

Age Factors↗
PubMed1993

The proportion of death certificates of diabetic patients that mentioned diabetes in Osaka District, Japan.

To determine the accuracy of the stated causes of death in diabetic patients, we analyzed 503 death certificates of diabetic patients who had been followed up for 9.4 years on average at Osaka Medical Center for Adulthood Diseases and had died during the observation period from 1960 to 1984. Of the certificates examined, only 213 (42.4%) mentioned diabetes, either as the underlying cause or as a contributory condition. The proportion of certificates that mentioned diabetes was related to the underlying cause of death; it was 18.7% for malignant neoplasms, 40.5% for cerebrovascular disease and 46.9% for disease of the heart, while it was 81.8% for renal disease. The proportion was higher for females (48.7%) than for males (39.5%), and a significant difference was observed between the sexes in the proportion in the case of disease of the heart. The proportion was not related to any significant extent to the year of death or the age at death. However, it was related to fasting plasma glucose (FPG) level and type of treatment. It was 37.8% and 54.4% for patients with FPG < 200 mg/dl and FPG > or = 200 mg/dl, respectively, 24.1% for those treated with diet, 51.4% for those treated with oral hypoglycemic agent and 80.7% for those treated with insulin. As a result, it was found that the proportion of death certificates that mentioned diabetes was related to the accompanying complications and the severity of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMed1986

Certification: philosophy, goals, and methods, with application to the discipline of infection control practice.

The philosophy, goals, and methods of certification are complex and need to be understood in general before they can be applied to a specific practice discipline. This article is intended to provide background information about certification, summarize the history of credentialing for health occupations, and briefly describe methods for test design and construction. Philosophy, goals, methods, and preparation for certification are then applied to the discipline of infection control practice, with specific reference to the Infection Control Certification Examination, offered for the first time in November 1983 and in each subsequent year.

Certification↗
PubMed1988

Validating the certification process for infection control practice.

Approximately 5 years ago a task analysis was conducted by the Certification Board of Infection Control (CBIC) to describe infection control practice. This task analysis served as the basis for development of the certification examination. This article describes the process used to update and revalidate the original task analysis to ensure the continued validity and job relatedness of the certification process. Using a modified Delphi technique, several panels of representative expert infection control practitioners (ICPs), a total of 29 persons, participated in an iterative process to define the practice dimensions of infection control and to link these practice dimensions to the certification examination. In general, there was a high level of congruence between respondents on the original task analysis and the expert panels, although a few differences in practice were identified among ICPs in extended care facilities and a few new tasks were identified. In addition, a revised content outline for the examination was created by placing clusters of knowledge statements together around common themes.

Certification↗
PubMed2004

Death certificate completion: how well are physicians trained and are cardiovascular causes overstated?

PURPOSE: To determine the ability of residents in completing death certificates correctly. METHODS: A total of 4800 residents were asked to complete a survey and cause-of-death statement using a sample case of in-hospital death due to urosepsis, of whom 590 residents (12%) responded. A scoring scale designed based on instructions from the National Association of Medical Examiners and the American College of Pathologists was used to measure responses quantitatively. RESULTS: Overall performance was poor, with only 23% (n = 137) of responses in the optimal scoring range. The average score was influenced significantly by level of residency training, as well as previous experience, prior formal training, and awareness of the guidelines regarding death certificate completion. Optimal scores correlated with level of residency training and prior formal training in death certificate completion, suggesting the benefits of experience and instruction. Forty-five percent (n = 267) of respondents incorrectly identified a cardiovascular event as the primary cause of death. CONCLUSION: The residents in this study demonstrated suboptimal performance in death certificate completion. Cardiovascular events were often incorrectly identified as the primary cause of death. Formal training can improve performance and should be emphasized in medical schools and residencies.

Analysis of Variance↗
PubMed2006

Special certification in physical medicine and rehabilitation: yesterday and tomorrow.

The Zeiter Lecture is given annually to honor Walter J. Zeiter, MD, the first executive director of the American Academy of Physical Medicine and Rehabilitation. In this lecture, I discuss the certification process for specialists in physical medicine and rehabilitation. I look at the history of initial certification, discussing the origins of both the written and oral examinations. I trace the development of these examinations and comment on potential developments in the initial certification process. I discuss the development of maintenance of certification in organized medicine and physiatry and comment on its future direction in physiatry.

Certification↗
PubMed2006

Community health worker training and certification programs in the United States: findings from a national survey.

OBJECTIVE: To analyze trends and various approaches to professional development in selected community health worker (CHW) training and certification programs in the United States. We examined the expected outcomes and goals of different training and certification programs related to individual CHWs as well as the community they serve. METHOD: A national survey of CHW training and certification programs. Data collection was performed through personal interviews, phone interviews and focus groups. Data sources included public health officials, healthcare associations, CHW networks, community colleges, and service providers. Initial screening interviews resulted in in-depth interviews with participants in 19 states. We applied human capital theory concepts to the analysis of the rich qualitative data collected in each state. RESULTS: CHW programs in the U.S. seem to have been initiated mainly due to lack of access to healthcare services in culturally, economically, and geographically isolated communities. Three trends in CHW workforce development were identified from the results of the national survey: (1) schooling at the community college level - provides career advancement opportunities; (2) on-the-job training - improves standards of care, CHW income, and retention; and (3) certification at the state level - recognizes the work of CHWs, and facilitates Medicaid reimbursement for CHW services. CONCLUSION: Study findings present opportunities for CHW knowledge and skill improvement approaches that can be targeted at specific individual career, service agency, or community level goals. Trained and/or certified community health workers are a potential new and skilled healthcare workforce that could help improve healthcare access and utilization among underserved populations in the United States.

Certification↗