An Intervention to Improve Cause-of-Death Reporting in New York City Hospitals, 2009–2010

Ann Madsen, PhD, MPH; Sayone Thihalolipavan, MD, MPH; Gil Maduro, PhD; Regina Zimmerman, PhD, MPH; Ram Koppaka, MD, PhD; Wenhui Li, PhD; Victoria Foster, MPH; Elizabeth Begier, MD, MPH

Suggested citation for this article: Madsen A, Thihalolipavan S, Maduro G, Zimmerman R, Koppaka R, Li W, et al. An Intervention to Improve Cause-of-Death Reporting in New York City Hospitals, 2009–2010. Prev Chronic Dis 2012;9:120071. DOI: http://dx.doi.org/10.5888/pcd9.120071

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Release date: October 17, 2012; Expiration date: October 17, 2013

Learning Objectives

Upon completion of this activity, participants will be able to:

Distinguish common mistakes made in completing a death certificate
Identify appropriate causes of death
Analyze an intervention to improve the accuracy of a death certificate

CME EDITOR
Rosemarie Perrin, Editor; Caran Wilbanks, Editor, Preventing Chronic Disease. Disclosure: Rosemarie Perrin and Caran Wilbanks have disclosed no relevant financial relationships.
CME AUTHOR
Charles P. Vega, MD, Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.
AUTHORS AND CREDENTIALS
Disclosures: Ann Madsen, PhD, MPH; Sayone Thihalolipavan, MD, MPH; Gil Maduro, PhD; Regina Zimmerman, PhD; Ram Koppaka, MD, PhD; Wenhui Li, PhD; Victoria Foster, MPH; Elizabeth Begier, MD, MPH have disclosed no relevant financial relationships.

Affiliations: Ann Madsen, Sayone Thihalolipavan, Gil Maduro, Regina Zimmerman, Ram Koppaka, Wenhui Li, Victoria Foster, Elizabeth Begier, NYC Department of Health & Mental Hygiene, New York, NY.

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Abstract

Introduction
Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC’s health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting.
Methods
From June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals.
Results
At intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period.
Conclusion
This NYC health department’s hospital-level intervention led to durable changes in COD reporting.