Effectiveness of training interventions to improve quality of medical certification of cause of death: systematic review
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RESEARCH ARTICLE
Open Access
Effectiveness of training interventions to improve quality of medical certification of cause of death: systematic review and meta-analysis U. S. H. Gamage†, Pasyodun Koralage Buddhika Mahesh†, Jesse Schnall, Lene Mikkelsen, John D. Hart, Hafiz Chowdhury, Hang Li, Deirdre McLaughlin and Alan D. Lopez*
Abstract Background: Valid cause of death data are essential for health policy formation. The quality of medical certification of cause of death (MCCOD) by physicians directly affects the utility of cause of death data for public policy and hospital management. Whilst training in correct certification has been provided for physicians and medical students, the impact of training is often unknown. This study was conducted to systematically review and metaanalyse the effectiveness of training interventions to improve the quality of MCCOD. Methods: This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration ID: CRD42020172547) and followed Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. CENTRAL, Ovid MEDLINE and Ovid EMBASE databases were searched using predefined search strategies covering the eligibility criteria. Studies were selected using four screening questions using the Distiller-SR software. Risk of bias assessments were conducted with GRADE recommendations and ROBINS-I criteria for randomised and non-randomised interventions, respectively. Study selection, data extraction and bias assessments were performed independently by two reviewers with a third reviewer to resolve conflicts. Clinical, methodological and statistical heterogeneity assessments were conducted. Meta-analyses were performed with Review Manager 5.4 software using the ‘generic inverse variance method’ with risk difference as the pooled estimate. A ‘summary of findings’ table was prepared using the ‘GRADEproGDT’ online tool. Sensitivity analyses and narrative synthesis of the findings were also performed. Results: After de-duplication, 616 articles were identified and 21 subsequently selected for synthesis of findings; four underwent meta-analysis. The meta-analyses indicated that selected training interventions significantly reduced error rates among participants, with pooled risk differences of 15–33%. Robustness was identified with the sensitivity analyses. The findings of the narrative synthesis were similarly suggestive of favourable outcomes for both physicians and medical trainees. (Continued on next page)
* Correspondence: [email protected] † U S H Gamage and Pasyodun Koralage Buddhika Mahesh are Joint first authors. Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie street, Melbourne 3053, Australia © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original auth
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