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PubMed2001

The credentialing of a population-based health profession: lessons learned from health education certification.

This article summarizes research and issues related to health education certification. Health education's experience with certification provides valuable insight for other public health professions because of the credential's population-based emphasis, its recent development, and its broadly defined cross-cutting skill set. Although data are still emerging on the outcomes of health education certification, most studies indicate that it has had a positive impact across multiple dimensions. Critical to this success has been providing profession-wide opportunities for input, communicating with key stakeholders, establishing an independent credentialing agency, and basing the credential on scientifically and legally defensible competencies that are linked to job responsibilities.

Certification↗
PubMed2002

Linking birth certificates with Medicaid data to enhance population health assessment: methodological issues addressed.

This study linked birth certificates with Minnesota Medicaid deliveries in order to identify Medicaid births. This article describes the link between methodology and results. Medicaid claims from 1997 were used to identify women with a delivery code. Identifiers for these women were linked to birth certificate files, with a match rate of 93.2 percent. Women's match status did not differ by maternal age. Women in some border counties matched at much lower rates than the rest of the population. The methodology was effective in linking Medicaid and birth certificate data and will be implemented as a data linkage protocol for Minnesota.

Birth Certificates↗
PubMed2007

Certification and education: do they affect pressure ulcer knowledge in nursing?

OBJECTIVE: To determine whether wound care certification and education affect nursing knowledge. This study examined pressure ulcer knowledge among registered nurses who were (1) certified in wound care, (2) certified in specialty areas other than wound care, or (3) not certified in any specialty area. DESIGN: A convenience sample of 460 nurses, located in both urban and rural areas, provided demographic information and completed a standardized pressure ulcer knowledge test using (Pieper Pressure Ulcer Knowledge Tool). RESULTS: The mean standardized test score for the total sample was 78%, with nurses certified in wound care scoring 89%, nurses certified in specialties other than wound care scoring 78%, and nurses receiving no certification scoring 76.5%. CONCLUSION: Wound care certification and education significantly affect nursing knowledge.

Adult↗
PubMed2003

Use of birth certificates and surveillance data to characterize reported pertussis among Texas infants and young children, 1995 to 2000.

BACKGROUND: Pertussis morbidity is increasing, especially among young infants and children, who are more likely to be hospitalized and have more severe complications. Maternal and pediatric factors associated with underimmunization and hospitalization for pertussis are poorly understood, but young maternal age and low birth weight have been associated with pertussis among young infants. METHODS: We used pertussis surveillance data, matching cases to the birth certificates of 416 Texas infants and children reported as pertussis cases during 1995 to 2000. Maternal/pediatric information gathered from birth certificates included birth weight, gestational age, and maternal factors (age, birthplace and education level, prenatal care, and previous live births). We assessed the immunization status of the cases and maternal/pediatric factors associated with underimmunization with a pertussis-containing vaccine and hospitalization using descriptive statistics and logistic regression. RESULTS: The 416 cases represented 20% of the pertussis morbidity in Texas from 1995 through 2000. Most children had not been vaccinated (275 [66%]), even though 374 (90%) were old enough for at least one dose. Among those 374 children, only those younger than 6 months were associated with underimmunization (odds ratio [OR], 9.98; 95% confidence interval [CI], 6.24-15.97). Most patients (253 [61%]) were hospitalized. Hospitalization was associated with complications of apnea (OR, 2.13; 95% CI, 1.39 2.38), pneumonia (OR, 5.26; 95% CI, 2.94-11.59), and age younger than 6 months (OR, 2.11; 95% CI, 1.38-3.23). CONCLUSION: More than two-thirds of the children reported as pertussis cases were old enough to have at least one dose of a pertussis-containing vaccine but were not immunized. Maternal and pediatric characteristics on birth certificates were not useful in predicting either underimmunization or hospitalization for pertussis complications. More current assessments of maternal and pediatric characteristics should be part of pertussis contact investigations.

Adolescent↗
PubMed2003

Interoperability among healthcare organizations acting as certification authorities.

One of the main problems in public key infrastructures (PKI) is currently the lack of interoperability at international level, which is greatly dependent on the automation of the cross-certification procedure using certificate policies (CP). This paper addresses the aforementioned need by presenting a method for the automated development and comparison of CPs, with main emphasis on healthcare environments. The basic elements of this method include standardization of the CP content for healthcare, a prototype decision-making algorithm for CPs comparison, representation of CPs in extensible markup language, as well as a JAVA-based CP comparison tool. The final aim of the paper is to contribute toward the technical implementation of an on-line automated cross-certification service, yielding PKI interoperability and promoting information exchange between healthcare establishments.

Certification↗
PubMed1996

Death certification: production and evaluation of a training video.

The purpose of this study was to produce an effective training video on death certification suitable for use by medical students and postgraduates. A 15-minute video was commissioned from a video production unit and two authors (PA and CP) provided advice and support in the process of script writing and production. An evaluation by means of a randomized controlled trial took place among 185 first year medical students at the University of Leicester. The video was shown as an addition to the usual lecture on death certification. Performance in a test of knowledge, skill and motivation was recorded in each of the two groups. Students assigned to see the video scored slightly better overall in a test of knowledge and skill (difference in medians = 3, in a test marked out of 68, P = 0.046). The intervention group also gave a significantly higher priority to avoiding distress caused to relatives as a reason for certifying death accurately (60% vs. 35%, difference in proportions = 24%, P = 0.002). There was no evidence that enjoyment or views about the nature or content of the video had an impact on performance in the test. It is concluded that adding the video to the usual lecture had a limited effect on the overall knowledge and skills of undergraduate students but was highly effective in conveying the message that inaccurate death certification can cause distress to relatives. The randomized controlled trial is a practical and simple means of evaluating teaching methods for medical undergraduates.

Death Certificates↗
PubMed2006

Back to the future? A critical commentary on the 2003 U.S. National standard certificate of live birth.

Vital statistics documents for the United States have been revised approximately decennially throughout the past century. In this commentary we review the contents of the 2003 revision of the national standard certificate of live birth, focusing on changes from the certificates in use nationally since 1989, and identifying strengths and weaknesses of key data elements. Additional federal-state partnership funding is imperative to support the transition to the new standard certificates, and to ensure a focus on data quality at the state and national levels.

Adult↗
PubMed2006

Principles to consider in defining new directions in internal medicine training and certification.

SGIM endorses seven principles related to current thinking about internal medicine training: 1) internal medicine requires a full three years of residency training before subspecialization; 2) internal medicine residency programs must dramatically increase support for training in the ambulatory setting and offer equivalent opportunities for training in both inpatient and outpatient medicine; 3) in settings where adequate support and time are devoted to ambulatory training, the third year of residency could offer an opportunity to develop further expertise or mastery in a specific type or setting of care; 4) further certification in specific specialties within internal medicine requires the completion of an approved fellowship program; 5) areas of mastery in internal medicine can be demonstrated through modified board certification and recertification examinations; 6) certification processes throughout internal medicine should focus increasingly on demonstration of clinical competence through adherence to validated standards of care within and across practice settings; and 7) regardless of the setting in which General Internists practice, we should unite to promote the critical role that this specialty serves in patient care.

Certification↗
PubMed1992

Sensitivity and specificity of death certificate diagnoses for dementing illnesses, 1988-1990.

OBJECTIVE: To evaluate the extent to which mortality data, which is often used to track secular trends for specific diseases, underestimates the prevalence of dementia. DESIGN: Retrospective analysis of existing data. SETTING: Department of Mental Health inpatient facilities in South Carolina. SUBJECTS: Inpatients at Department of Mental Health facilities who were listed in the South Carolina Statewide Alzheimer's Disease and Related Disorders Registry and who died between 1988 and 1990 (n = 450). MAIN OUTCOME MEASURES: Sensitivity and specificity of dementia diagnoses on death certificates compared to medical record diagnoses for inpatients with a pre-mortem dementia diagnosis. RESULTS: Twenty-three percent of death certificates contained any dementia diagnosis (104/450). The sensitivity of death certificates varied by type of dementia (28 percent for Alzheimer's disease; 8 percent for multi-infarct dementia) as well as by race, sex, and age. CONCLUSIONS: Mortality statistics substantially underestimate the prevalence of dementing illnesses and do not fully represent the public health burden of dementia.

Age Factors↗
PubMed1998

Survey of educationally qualified and board-eligible prosthodontists on the board-certification process.

PURPOSE: A survey of prosthodontists who have not achieved diplomate status from the American Board of Prosthodontics was conducted to identify the reasons why they have or have not pursued and/or achieved board certification in prosthodontics. MATERIALS AND METHODS: A survey was sent to 500 educationally qualified or board-eligible prosthodontists in the summer of 1997. A total of 364 responses were received, for a response rate of 73%. The responses and comments were analyzed. RESULTS: The majority of respondents listed private practice as their primary area of professional activity. Personal accomplishment was cited by 80% of the respondents as a major motivational factor. Three major impediments to taking the examination included: time away from practice (65%), time away from family (59%), and financial sacrifice (57%). More than one third of the respondents believed there was no advantage to attempting the board examination. Less than half of the respondents have attended The American College of Prosthodontists (ACP)-sponsored Board Preparation Course, and half have used the ACP Study Guide. The respondents have perceived these to be useful in their preparation efforts. The survey presented four potential changes in the exam format that might encourage greater participation in the board-certification process. Respondents showed the greatest support (64%) for the concept of a written examination only (i.e., elimination of Parts 2, 3, and 4). CONCLUSIONS: Personal accomplishment was the most important motivational factor in starting the examination process. The greatest impediments to pursuing board certification were the time involved and financial resources expended. The greatest interest in a potential change in the examination format was the use of a written examination only.

Certification↗
PubMed1998

Physicians in rural West Virginia emergency departments: residency training and board certification status.

OBJECTIVE: To describe the training and certification of physicians who staff small EDs in rural West Virginia. METHODS: A survey of rural hospital-based EDs was performed. The authors chose to study all hospitals in counties with populations of <30,000 and in which the hospital was the only one in the county. Interviews were conducted with the medical director of the ED or the hospital administrator, depending on who was available at the time of interview. Data collected describing the emergency physicians (EPs) employed at each facility included: medical school and residency training, specialty board certification, and certification in a variety of life support courses. General information about each ED, such as census and hospital resources, was also obtained. Interview data were collected on a survey form and subsequently entered into a database. Descriptive analyses were performed. RESULTS: 20 hospitals met rural criteria for inclusion in the study and all were included. The median number of full-time physicians per ED was 2 (IQR 2-4). 98 part-time doctors were identified; 28 (29%) of these were residents in training. 13/40 (33%) of full-time and 37/98 (38%) of part-time physicians were foreign medical graduates. Only 3/40 (7.5%) of full-time EPs completed residency training in emergency medicine (EM). Only 4/98 (4%) of part-time EPs were residency-trained in EM. 50% of full-time EPs were board-certified in a primary care specialty. Only 5/42 (12%) of full-time EPs were board-certified in EM. One third of full-time and the majority of part-time EPs were not board-certified in any specialty whatsoever. The majority of EPs had been certified in Advanced Cardiac Life Support, but fewer had been certified in Advanced Trauma Life Support and/or Pediatric Advanced Life Support/Advanced Pediatric Life Support. CONCLUSIONS: The majority of physicians staffing small rural EDs in West Virginia are neither residency-trained nor board-certified in EM. Further studies are warranted to determine the most efficient and effective way to maximize the skills and availability of emergency care providers in rural settings.

Certification↗
PubMed1992

Is board certification necessary for school health educators?

Voluntary certification through the National Board of Professional Teaching Standards currently is being promoted as a mechanism for achieving higher quality instruction in the nation's schools as well as raising the prestige of the teaching profession. This article examines controversies surrounding this movement, including the Board's decision that a teacher's eligibility to be "board certified" in school health does not depend on prior completion of a health education major. The National Board of Professional Teaching Standards believes their assessment approach will be superior to current quality controls. An analysis of existing certification, accreditation, and external review mechanisms, however, does not support this view. Policy formation strategies to ensure continued viability of Certified Health Education Specialist certification mechanisms are offered.

Accreditation↗
PubMed1990

Accuracy of death certificates and mortality statistics in Victorian testis cancer deaths 1950-1977.

426 death certificates relating to testicular cancer in Victoria, from 1950 to 1977, were examined for inaccuracies in cause of death narrative and coding for cause of death statistics. the narrative was inaccurate in major diagnosis in 33 certificates (21 false positives and 12 false negatives) and 17 accurately written certificates were mis-coded (12 false positives and 5 false negatives). Review of the pathological terms used revealed 10 lymphomas incorrectly ascribed to germ cell malignancy. The term "seminoma" seems to have been employed as a generic term for testis tumour, only 50 per cent of the tumours so designated being confirmed as seminoma. It is concluded that although Victorian figures relating to mortality from testis cancer are reasonably accurate (for 337 cases for which relevant records were available the detection rate was 95%, the confirmation rate 96% and concordance 91%), little reliance can be placed on the recorded pathological sub-type.

Cause of Death↗
PubMed1989

Certification change versus actual behavior change in teenage suicide rates, 1955-1979.

National data on firearm suicides and accidental firearm deaths for persons aged 15-19 from 1955 to 1979 were examined to test hypotheses of increases in reported suicide rates as resulting from (1) improved accuracy in the determination and certification of suicide in equivocal firearm deaths; (2) actual increases in the rate of firearm suicides among teens; or (3) some combination of these factors. Data presented support the hypothesis of certification changes as the primary factor influencing suicide rates during the first 12-year segment, but suggest a period of actual growth combined with continued certification change from 1967 to 1979.

Accidents↗
PubMed2003

[Survey of the past history of measles and rubella and advocacy for vaccination and certificates of vaccination at entry to kindergarten, primary school and junior high school in Kurashiki City--to improve the vaccination rate].

Although there have been measles outbreaks involving more than 100,000 patients every few years in Japan, vaccination is not compulsory under Japanese law and the vaccination rate remains low. In addition, because MMR vaccines have been suspended due to complications, monovalent measles vaccine is still used and administered only once for life. Under these circumstances, a new system was started to develop motivation for vaccination in order to try to eliminate measles and rubella. Although educational campaigns for vaccination are important, their effect is frequently temporary. To maintain a high vaccination rate after such campaigns, we advocated checking children for susceptibility, recommended vaccination and asked for certificates of vaccination at school entry. The participating subjects were 65/68 kindergartens, 55/55 primary schools and 24/24 junior high schools in Kurashiki City, Japan. The total number of subjects was 11,365. The susceptibility rate for measles and the unknown rate were 5.6% and 2.0% at kindergartens, 4.6% and 4.4% at primary schools, and 3.0% and 8.3% at junior high schools, whereas the susceptibility rate for rubella and the unknown rate were 14.0% and 2.3% at kindergartens, 21.8% and 5.4% at primary schools, and 35.2% and 11.7% at junior high schools. Among the children who were susceptible to measles, we confirmed that a certificate of vaccination was presented by 38.0% of pupils in kindergartens, 85.3% of those in primary schools and 43.7% of those in junior high schools. As for rubella, we confirmed 21.8% presented a certificate in kindergartens, 28.6% in primary schools and 11.6% in junior high schools. As a result, we achieved our goal for measles, which was previously determined as more than 90% for students with past history of infection or vaccination. However, we could not attain our goal for rubella. These systems were more effective than educational campaigns alone and were thought to increase the motivation for vaccination through their continuation. The rate of those who could not receive the vaccination due to allergy or seizure among the susceptible was 26% in total but more than 40% in some schools. We should educate not only parents but also doctors regarding vaccination and advocate that it be done.

Adolescent↗
PubMed1984

Death certification in general practice: review of records.

The records of death that had been certified by general practitioners in one practice over 18 years were assessed in the light of the recent joint publications of the Royal College of Physicians and the Royal College of Pathologists. Over this period roughly 30% of the deaths in the practice population occurred outside hospital and a total of 262 certificates were issued. A review of 262 counterfoils of records of death certification showed that 12 counterfoils (4.6%) had no age and sex mentioned, and three counterfoils did not describe the place of death. The average age at death outside hospital was 71.6 years--the age of women being 75.1 years compared with that of men of 68.2 years. Only 2% of patients had had a necropsy. The common causes of death stated in the certificates were: cardiovascular 41%, carcinoma 35%, respiratory 15%, and stroke 8%. All contributory causes are also mentioned. Ninety seven per cent of the patients were seen after death by the doctors in the practice and 68% had been seen in the two days preceding death. We emphasise the importance of keeping accurate records of deaths in general practice for audit and research as well as for planning services for terminally ill and recently bereaved patients.

Adult↗
PubMed1982

Death certification by British doctors: a demographic analysis.

Regional differences in mortality from cardiovascular diseases, respiratory diseases, strokes, and other causes have been observed in England and Wales. To determine to what extent the death certification practices of doctors influence these variations, we surveyed 123 British general practitioners and housemen. Each doctor completed death certificates based on fictitious case histories. We found that diagnostic groupings did not vary significantly according to the doctors' region, type of practice, place of medical training, sex, or year of qualification. Doctors qualifying before 1955, however, appeared more inclined than their younger colleagues to list stomach cancer on the death certificate.

Age Factors↗
PubMed1992

Certification of cause of death in French diabetic patients.

STUDY OBJECTIVE: The aim was to assess the level of mortality related to diabetes in France. In other countries, an underrecording of diabetes on the death certificates of diabetic patients has been reported. DESIGN AND SETTING: Estimated death rate of diabetic patients was calculated using (a) the actual number of death certificates where diabetes was registered either as an underlying or as a contributory cause of death, and (b) estimates of the prevalence of diabetes in the population, by sex and age group, from which expected numbers of diabetic deaths were determined. Standardised mortality ratios were calculated using 1988 French mortality statistics as reference. MAIN RESULTS: The estimated standardised mortality ratio for diabetic subjects, with diabetes registered as the underlying cause, was 0.36. This standardised mortality ratio increased to 0.92 if both the underlying and contributory causes were considered. The estimated death rate, by sex and age group, implies that diabetes has a protective effect between the ages of 45 and 64 years, particularly in men. CONCLUSIONS: Evidence suggests that diabetes is completely omitted on the death certificates of many diabetic subjects, especially for those between the ages of 45 and 64 years. Using mortality statistics underestimates the prevalence of diabetes and its effects on public health. The difference in diabetes mortality between countries will not be reliable until there is a better registration of the causes of death in diabetic patients, and contributory as well as the underlying cause are coded and published.

Adult↗