Quality comparison of electronic versus paper death certificates in France, 2010
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RESEARCH
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Quality comparison of electronic versus paper death certificates in France, 2010 Delphine Lefeuvre1,2, Gérard Pavillon1, Albertine Aouba1, Agathe Lamarche-Vadel1, Anne Fouillet3, Eric Jougla1 and Grégoire Rey1*
Abstract Background: Electronic death certification was established in France in 2007. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates. Methods: All death certificates from the 2010 French mortality database were included. Three specific quality indicators were considered: (i) amount of information, measured by the number of causes of death coded on the death certificate; (ii) intrinsic consistency, explored by application of the International Classification of Disease (ICD) General Principle, using an international automatic coding system (Iris); (iii) imprecision, measured by proportion of death certificates where the selected underlying cause of death was imprecise. Multivariate models were considered: a truncated Poisson model for indicator (i) and binomial models for indicators (ii) and (iii). Adjustment variables were age, gender, and cause, place, and region of death. Results: 533,977death certificates were analyzed. After adjustment, electronic death certificates contained 19% [17%-20%] more codes than paper death certificates for people deceased under 65 years, and 12% [11%-13%] more codes for people deceased over 65 years. Regarding deceased under and over 65 respectively, the ICD General Principle could be applied 2% [0%-4%] and 6% [5%-7%] more to electronic than to paper death certificates. The proportion of imprecise death certificates was 51% [46%-56%] lower for electronic than for paper death certificates. Conclusion: The method proposed to evaluate the quality of death certificates is easily reproducible in countries using an automatic coding system. According to our criteria, electronic death certificates are better completed than paper death certificates. The transition to electronic death certificates is positive in many aspects and should be promoted. Keywords: Death certificate, Causes of death, Electronic certification, Quality
Introduction Causes of death statistics are essential data to monitor population health, undertake epidemiological studies, and international comparisons. High-quality mortality data are needed in this respect, and the European Commission has expressed the importance of producing recommendations on methods that improve the quality and international comparability of cause of death statistics [1]. French death certificates, in compliance with the World Health Organization (WHO) international standards, are composed of two parts: Part I is dedicated to the reporting of diseases related to the train of events leading directly to death, and Part II is dedicated to the reporting * Correspondence: [email protected] 1 INSERM, CépiDc, Le Kremlin-Bicêtre, France Full list of author information is available at the end of the article
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