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Evaluation of death certificates' quality: Report of the feasibility study


The comparison of international mortality statistics necessitates to be sure of the comparability of data. The main objective of this study was to test the feasibility of a concerted action to address this challenging question.
In order to compare international mortality statistics it is necessary to ensure that the data can be compared. Research was carried out to test the feasibility of a concerted action to address this challenging question.

Field visits to different European Community (EC) countries permitted the collection of basic information on the certification and coding procedures of the causes of death as well as models of death certificates in use. There appeared to be many differences in the procedures and forms. Nevertheless, the proposed concerted action in quite feasible according to a protocol which has been widely reviewed and amended. Only one country (Germany) would have to overcome serious technical problems to be able to apply the protocol as it was prepared, and in 5 centres confidential inquiry would present some difficulties.

In addition, a small scale recoding exercise has been performed involving 3 countries: this test showed that such an exercise is both feasible and able to quantify intercountry variation in the discrepancy level between national and independent coding.
The European Community Atlas of Avoidable Death, which is concerned with geographical avoidable mortality variations as a tool in health services assessment, clearly demonstrates important variations in reported levels of mortality rates.

Such differences can be real but can also be the consequence of variations in certification and/or codification practices between EC countries.

Such variations have been well established for certain causes of death. Some of them belong to the Avoidable Deaths project, others do not.

In order to clarify this issue members of the research group involved in the publication of the European Community Atlas of Avoidable Death have prepared a draft protocol for a collaborative research aimed to evaluate the impact on mortality rates of the certification and coding practices variations between EC countries. The design of the study is basically dealing with:

1) the evaluation of confirmation fractions of death codes by the recoding of random samples of death certificates by independent coders.
2) the evaluation of the formal quality of the certification.
3) a confidential inquiry to the certifier to assess the comparability of the certification.

In order to improve the draft protocol and to test its feasibility in the different EC countries, a feasibility study has been proposed with the following objectives:

1/ Hold local inquiries in the EC Countries in order to:
1.1 collect different medical certificates in use with the EC countries.
1.2 collect local informations about additional coding rules in use in countries (additional to those recommended by ICD 9).
1.3 collect local informations about procedures of certification and coding in use in countries.
1.4 consider the local investigations in certification and coding practice for some selected causes (for which greater accuracy could locally be expected).

2/ Realize a pre-test of the study with:
2.1 small samples of certificates
2.2 in three countries

3/ Organize expert meetings in order to:
3.1 consider results of local inquiries and of the pre-test.
3.2 finalize the protocol for the collaborative project.
3.3 identify teams in each participating country.


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School of Public Health
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CP 590/7, 808 Route de Lennik
1070 Brussels

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