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PubMed2003

Interexaminer agreement on the American Board of Emergency Medicine oral certification examination.

STUDY OBJECTIVE: One of the principal criticisms of performance assessments, particularly those using an oral format to evaluate physician performance, is the lack of interrater reliability. The objective of this study was to assess interexaminer agreement in the scoring of candidates taking the American Board of Emergency Medicine (ABEM) oral certification examination. METHODS: Examiner-observer pairs independently scored individual candidates on each of the 6 simulated cases selected for the October 1999 examination. Simple proportionate agreement for "acceptable" and "unacceptable" scores on critical actions and performance ratings were used to measure interexaminer (examiner-observer) agreement. Further analyses were performed to assess interexaminer agreement at the level of the raw scores of all performance ratings. The candidate's actual score was determined entirely by the examiner administering the case. The study examiner was present only to observe and independently score the candidate. Examiners were blinded to each other's scoring. All examiner-observer, examiner-candidate, and observer-candidate pairings were uniquely randomized and occurred only once during the examination. RESULTS: Of 564 candidates, 186 were randomly selected for scoring by examiner-observer pairs drawn from a pool of 107 trained oral examiners. Interexaminer agreement for 47 critical actions was 97% (95% confidence interval [CI] 96% to 98%), and interexaminer agreement for 68 performance ratings was 95% (95% CI 94% to 96%). Further analyses of raw scores of performance ratings indicated that 94% (95% CI 93% to 95%) of 2,648 pairs of ratings differed by 1 point or less. CONCLUSION: High interexaminer agreement on the scoring of the ABEM oral certification examination supports the reliability of this final step in the certification process. On the basis of these findings, ABEM has incorporated this methodology into the administration of each oral examination as an ongoing quality control measure.

Adult↗

PubMed1987

Incorrect death certification. An invitation to obfuscation.

The physician responsible for signing a death certificate has an obligation to complete the medical part of the form, which includes entering the cause of death. In a review of 384 death certificates signed by house staff and attending physicians at a university hospital over a one-year period, 59% contained errors in cause-of-death entries. The most common error was listing mechanisms rather than causes of death. Since death certificates are used in calculating basic mortality statistics, such a large percentage of error can lead to considerable statistical misinformation.

Death↗

PubMed2001

The development of reference materials for paralytic shellfish poisoning toxins in lyophilized mussel. II: Certification study.

This paper describes the second part of a project undertaken to develop certified mussel reference materials for paralytic shellfish poisoning toxins. In the first part two interlaboratory studies were undertaken to investigate the performance of the analytical methodology for several PSP toxins, in particular saxitoxin and decarbamoyl-saxitoxin in lyophilized mussels, and to set criteria for the acceptance of results to be applied during the certification exercise. Fifteen laboratories participated in this certification study and were asked to measure saxitoxin and decarbamoyl-saxitoxin in rehydrated lyophilized mussel material and in a saxitoxin-enriched mussel material. The participants were allowed to use a method of their choice but with an extraction procedure to be strictly followed. The study included extra experiments to verify the detection limits for both saxitoxin and decarbamoyl-saxitoxin. Most participants (13 of 15) were able to meet all the criteria set for the certification study. Results for saxitoxin.2HCl yielded a certified mass fraction of <0.07 mg/kg in the rehydrated lyophilized mussels. Results obtained for decarbamoyl-saxitoxin.2HCl yielded a certified mass fraction of 1.59+/-0.20 mg/kg. The results for saxitoxin.2HCl in enriched blank mussel yielded a certified mass fraction of 0.48 +/- 0.06 mg/kg. These certified reference materials for paralytic shellfish poisoning toxins in lyophilized mussel material are the first available for laboratories to test their method for accuracy and performance.

Animals↗

PubMed1992

Certification for hospice nurses? Assessment of need.

An assessment of need survey questionnaire sent to the hospice nursing community yielded a substantial return (1,550). The respondents overwhelmingly endorsed a certification process. They also emphasized the value of hospice experience and caring personal attitudes over formal educational preparation both for hospice work and for certification purposes. The preferences of these nurses for various elements of a certification process are compared to those revealed in a Delphi study of 16 hospice nursing leaders. Certain of their experimental and demographic characteristics are related to other research findings about the characteristics of hospice nurses.

Attitude of Health Personnel↗

PubMed1996

Ambulatory care certificate program for pharmacists.

An ambulatory care certificate program tailored to meet the educational needs of Department of Veterans Affairs (VA) and Navy pharmacists is described. In 1992, the College of pharmacy, University of Illinois at Chicago, worked with the VA and the Navy to design an ambulatory care certificate program for pharmacists in VA and Navy hospitals. The pilot course consisted of 103 hours of didactic and experiential education. The 10 didactic modules covered both disease management and clinical skills. The experiential component incorporated pharmaceutical care steps as applied to therapeutic areas taught in the course. Although the pilot course met most of the original objectives, several unanticipated problems emerged, including distance learning issues, the number of hours for completing the course requirements, learner variance, the impact of institutional support on participants' academic success, participants' difficulty in assimilating education into practice, and difficulty with the clinical evaluation tool developed for the course. The course was modified over the next year to address these problems. Now in its fourth year, the course is offered nationally to the VA and the Department of Defense. In the first three years, 72 of 99 enrolled pharmacists completed the course. An ambulatory care certificate program helps Navy and VA pharmacists develop patient care skills.

Ambulatory Care↗

PubMed1986

Accuracy of certification of deaths due to asthma. A national study.

In a two-year study of asthma mortality in New Zealand conducted between August 1981 and July 1983, the certified cause of death and its subsequent statistical coding was compared with the opinion of a panel of respiratory physicians who had made detailed enquiry into the medical history and circumstances surrounding the death of each patient. When the panel's opinion was taken as the reference standard, the national health statistics overestimated asthma mortality for all age groups by 26.0%. For patients aged 15-64 years, the net overestimate was 12.9%, no greater than that found in a similar study in this age group in the United Kingdom. Failure of certifying doctors and coroners to follow appropriate procedures for identification of the primary condition leading to death, or misdiagnosis of other lung disease as asthma, accounted for most inaccuracies in certification. In patients under age 35 years, certification and statistical coding of asthma death was considered accurate in 97.8% of all cases, but accuracy declined with increasing age. The high New Zealand asthma mortality rate, especially in young people, could not be explained by inaccuracies in death certification or statistical coding.

Adolescent↗

PubMed1995

The accuracy of death certificates in identifying work-related fatal injuries.

Three national US agencies report on work-related fatal injuries, and one uses the "injury at work" designation on the death certificate to identify and characterize these fatalities. The accuracy of the "injury at work" notation has not been validated. The authors used selected external causes of death (from the International Classification of Diseases, Ninth Revision, Clinical Modification) that are highly likely to be work-related or not work-related as a standard to compare with the California death certificate "at work" designation for the years 1979-1989. Data from the National Center for Health Statistics for the years 1979-1984 were used to measure prevalence for purposes of determining the predictive value of a positive or negative work-related notation on the death certificate. The sensitivity of the "at work" designation was 77.6%, with a specificity of over 99%. Sensitivity but not specificity varied by age, sex, and specific external cause of death. The predictive value positive of the "at work" designation was about 60%, which suggests caution in using it for some epidemiologic purposes.

Accidents, Occupational↗

PubMed1989

Accuracy of death certificates in neonatal deaths.

Death certificates of neonates were compared with detailed clinical and pathological information provided for a national neonatal mortality survey. The systematic method of assigning the cause of death to one of seven broad categories in the survey found complete agreement with the underlying cause of death on the death certificate in 83 per cent of cases (274/330). There was only a minor disagreement involving clinical opinion in a further 6.7 per cent (22). The reasons for disagreement in the remaining 10.3 per cent (34) were examined. In the majority of instances, 6.0 per cent (20), the fault lay with the certifying doctor who provided inadequate or inaccurate information on the death certificate or who, in providing all the information, appeared to be ignorant of coding rules. In 1.2 per cent (4) the fault lay with coding inaccuracies or misapplication of coding rules in failing to select the underlying cause in a correct sequence of clinical events. In the remaining 3.0 per cent (10) of cases the rules governing the survey did not follow the WHO coding rules.

Cause of Death↗

PubMed2003

Multiple-cause coding of death from myocardial infarction: population-based study of trends in death certificate data.

BACKGROUND: Data on long-term trends in mortality are generally unavailable for multiple-cause coding of deaths. We wanted to know whether multiple-cause coding of deaths for myocardial infarction contributes much to the interpretation of death certificate data on mortality rates for this condition. METHODS: We analysed all causes of death on death certificates in the former Oxford health service region from 1979 to 1998. RESULTS: Of 69,333 death certificates that included myocardial infarction as a cause of death, it was the underlying cause of death in 93.6 per cent. The ratio of 'mentions' to 'underlying cause' was broadly similar over the study period, during which time there were substantial falls in mortality rates. There were significant changes to the ratios, associated with timing of changes to coding rules; but their effects were small. The ratio of mentions to underlying cause was similar in men and women and in different age groups. CONCLUSION: The underlying cause of death was a robust and almost complete measure of certified deaths for myocardial infarction.

Adult↗

PubMed2006

Gaining competitive advantage in personal dosimetry services through ISO 9001 certification.

This paper discusses the advantage of certification process in the quality assurance of individual dose monitoring in Malaysia. The demand by customers and the regulatory authority for a higher degree of quality service requires a switch in emphasis from a technically focused quality assurance program to a comprehensive quality management for service provision. Achieving the ISO 9001:2000 certification by an accredited third party demonstrates acceptable recognition and documents the fact that the methods used are capable of generating results that satisfy the performance criteria of the certification program. It also offers a proof of the commitment to quality and, as a benchmark, allows measurement of the progress for continual improvement of service performance.

Body Burden↗

PubMed1988

Death certificates, natural death, and alcohol. The problem of underreporting.

Previous studies have identified an apparent underreporting of alcohol-related natural deaths on death certificates. This survey consists of a review of death certificates in one urban county, and provides further evidence that alcohol-caused natural deaths are underreported by physicians who sign death certificates.

Alcoholism↗

PubMed1997

Lawsuits against medical examiners or coroners arising from death certificates.

A data base search through Westlaw was conducted to ascertain lawsuits in which a medical examiner or coroner (ME/C) was sued because of the cause or manner of death stated on the death certificate. Sixteen reported cases were found between 1948 and 1995, with 10 of the cases occurring since 1985. The frequency of reported cases is approximately 1/400,000 ME/C death certificates, but based on certain assumptions, the actual frequency may be estimated at 1/40,000 ME/C death certificates. Nine cases involved plaintiffs who contested when the manner of death was indicated as suicide. In 15 of the 16 cases, the lower court decision favored the ME/C viewpoint. Five of the 15 decisions were ultimately reversed by a higher court, but the ultimate outcomes of these cases were not available. Overall, it appears that most courts and decisions have recognized ME/C actions as discretionary or immune and that ME/Cs have been at low risk for such suits to date. This seems especially true if the ME/C position is defensible and the ME/C has acted in accordance with statute and without evidence of corruption, incompetence, arbitrariness, capriciousness, abuse of discretion, or outrageous conduct.

Cause of Death↗

PubMed1996

Validity of education information on the death certificate.

We compared education as recorded on the death certificate with education ascertained before death from a household survey of 10,423 persons age 25 years or more who died in 1989. There was a tendency for the decedent's education to be reported at a higher level on the death certificate than at baseline. Of those who were reported as high school graduates on the death certificate, 38% reported that they had less than a high school education at baseline. The bias was more pronounced in older than younger decedents.

Adult↗

PubMed1985

Impact of board certification on physician practice characteristics.

In the study reported here, the authors, using data from two American Medical Association surveys, examine the impact of board certification on selected physician practice characteristics. The results indicate that board certification is more prevalent for certain specialties, ages, types of practice, and locations of practice. Board certification has a substantial impact on the gross income of most major specialties, but these differences decline significantly for net incomes. Finally, comparisons of the hours worked per week and weeks worked per year show only small differences between board-certified and nonboard-certified physicians.

Adult↗

PubMedDate not supplied

Realizing your marketing influence, Part 3: professional certification as a marketing tool.

This is the last in a series of articles guiding nursing administrators from broad marketing strategy to tactics and specific applications. The first article laid the foundation for developing a market-driven strategic plan. The second focused on marketing from the inside out. This final article explores the benefits of specialty nurse certification as a strategy for nursing administrators to retain and recruit the most qualified nurses and to differentiate their services from those of competitors. The article includes findings from the American Association of Critical-Care Nurses' proprietary research, suggestions on how to support certification, and a case study of one hospital's experience in conducting a CCRN certification drive as part of their critical care nurse competency program.

Certification↗

PubMedDate not supplied

Development of the orthopaedic nurses certification examination.

The certification examination for orthopaedic nurses was developed by the Orthopaedic Nurses Certification Board and the Committee for Test Development with guidance from the National League for Nursing Test Services. The construction of a written examination is a complex task and is part of the continuing responsibility of the Orthopaedic Nurses Certification Board. This paper focuses on the process of actual test construction: the organization, development, evaluation, and quality of test items.

Certification↗

PubMed1996

Use of Texas birth certificate data to predict measles immunization status.

Inadequate immunization has been a major cause of epidemic measles, but risk factors for inadequate immunization are poorly characterized. By using measles data bases and computerized birth certificate files, we identified a retrospective cohort of 1,070 Texas-born children who were aged 15 months to 10 years when they had measles during the 1988 to 1991 epidemics. We used measles and birth certificate data, including prenatal care and demographic information, to determine immunization status and risk factors for inadequate measles immunization. Risk factors predicting lack of immunization in children with measles in stepwise logistic regression were black ethnicity, urban residence, poor prenatal care, preschool age, and an unknown father. Birth certificates contain information that can predict inadequate measles vaccination and should be evaluated prospectively.

Birth Certificates↗

PubMed1999

Improving medical risk factor reporting on birth certificates in Alabama.

BACKGROUND: In 1995, a program was begun at the University of South Alabama (USA) to improve the reporting of medical risk factors on birth certificates. METHODS: Data on medical risk factors for USA Hospital and the remainder of the state for 1994 and 1996 were examined to observe the effects of the USA Medical Center program. RESULTS: The number of medical risk factors reported changed markedly between 1994 and 1996 for most items and changed hardly at all for the remainder of the state. The changes for selected factors from 1994 to 1996 were as follows: anemia, 19 (0.4% of all birth certificates) to 489 (12.3%); acute or chronic lung disease, 1 (<0.1%) to 405 (10.2%); cardiac disease, 10 (0.2%) to 99 (2.5%); diabetes, 111 (2.6%) to 160 (4.0%); genital herpes, 3 (0.1%) to 81 (2.0%); and hemoglobinopathy, 0 (0%) to 166 (4.2%). Changes in other factors were similar. CONCLUSIONS: The USA Medical Center program has significantly increased the frequency and percent of birth certificates indicating medical risk factors.

Adolescent↗