Systematic Review of Statistics on Causes of Deaths in Hospitals: Strengthening the Evidence for Policy- makers/Examen Systematique Des Statistiques Sur Les Causes De Deces En Milieu Hospitalier: Renforcement Des Preuves Pour Les Responsables politiques/Revision Sistematica De Las Estadisticas Sobre Las Causas De Muerte En Los Hospitales: Fortalecimiento De la Evidencia Para Los Creadores De Politicas

By Rampatige, Rasika; Mikkelsen, Lene et al. | Bulletin of the World Health Organization, November 2014 | Go to article overview

Systematic Review of Statistics on Causes of Deaths in Hospitals: Strengthening the Evidence for Policy- makers/Examen Systematique Des Statistiques Sur Les Causes De Deces En Milieu Hospitalier: Renforcement Des Preuves Pour Les Responsables politiques/Revision Sistematica De Las Estadisticas Sobre Las Causas De Muerte En Los Hospitales: Fortalecimiento De la Evidencia Para Los Creadores De Politicas


Rampatige, Rasika, Mikkelsen, Lene, Hernandez, Bernardo, Riley, Ian, Lopez, Alan D., Bulletin of the World Health Organization


Introduction

The poor state of health information systems and, particularly, mortality statistics in many countries is widely documented in the literature and in country reports to the World Health Organization (WHO). (1-5) However, health systems worldwide depend on reliable information about causes of mortality to be able to respond effectively to changing epidemiological circumstances. Such responses depend critically on accurate data to guide decision-making. (6) Within a health information system, accurate and timely data on the cause of death are fundamental for programme and policy development and for measuring change in the magnitude and distribution of ill-health and disease in populations. (8) Assessments of vital registration systems in low- and middle-income countries consistently reveal substantial weaknesses in the generation of cause-of-death statistics. (9-11) In a recent editorial, we drew attention to the fact that even hospital statistics on cause of death cannot be assumed to be correct--a fact that is not widely appreciated by governments and other users of these data. (12)

The gold standard for cause-of-death reporting is to have the cause certified by a medical practitioner using the rules and procedures of the International classification of diseases and related health problems (ICD), which is currently available in its tenth revision (ICD-10). (13) Although most countries with statistical systems for cause of death now use the ICD classification for coding, not all countries have introduced the international standard certificate for reporting cause of death. Furthermore, physicians often do not receive adequate training in standard ICD death certification practices. It is, therefore, not surprising that comparative assessments commonly find that the quality of medical certification of the cause of death is poor. (3,8) Cause-of-death statistics of poor quality have limited policy utility and may even seriously mislead policy debates. (14)

In most developing countries, more than half of all deaths occur outside hospitals. Since out-of-hospital deaths are rarely medically certified, most of the physician-certified deaths come from hospitals. (3,4) Can we automatically assume that the cause assigned to a death in hospital is accurate? Unfortunately, even in countries where hospital data are the only source of cause-of-death information, data quality is rarely evaluated. Research in different countries has repeatedly identified substantial misclassification of the cause of death of people who die in hospitals--with attendant implications for the use of cause-of-death data in informing policy. (14-20)

To carry out a validation study of cause-of-death data collected in hospitals, we need a gold standard against which the hospital cause-of-death reports can be compared. While autopsy findings provide the ideal gold standard for cause-of-death evaluations, this approach is prohibitively expensive, rarely applied and likely to be based on a biased sample of deaths assigned to coroners. It would not be practical to carry out autopsies for all of the deaths occurring in a country--or even for all of the hospital deaths in a country. (19) Instead, researchers have reviewed the medical records of people who have died in hospitals as a reference standard for validating the accuracy of the causes of deaths recorded by the hospitals. Although all hospitals have medical records for their patients, such records are rarely used for carrying out routine assessments of the extent and nature of any diagnostic misclassifications among hospital deaths. In part, this reflects a lack of awareness of the existence of such misclassification or--because there is no standard method and framework for carrying out routine evaluations of the quality of cause-of-death data--a lack of knowledge of how such misclassification might be identified. Here, we perform a systematic review of studies that used medical records to assess the quality of hospital cause-of-death data to ascertain the pattern and extent of diagnostic misclassification of the cause of death. …

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Systematic Review of Statistics on Causes of Deaths in Hospitals: Strengthening the Evidence for Policy- makers/Examen Systematique Des Statistiques Sur Les Causes De Deces En Milieu Hospitalier: Renforcement Des Preuves Pour Les Responsables politiques/Revision Sistematica De Las Estadisticas Sobre Las Causas De Muerte En Los Hospitales: Fortalecimiento De la Evidencia Para Los Creadores De Politicas
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