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首页> 外文期刊>BMC Health Services Research >The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the International Form of Medical Certificate of Cause of Death
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The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the International Form of Medical Certificate of Cause of Death

机译：孟加拉国农村地区医院死亡原因医疗死亡证明的质量：引入国际死亡原因医疗证明形式的影响

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Background Accurate and timely data on cause of death are critically important for guiding health programs and policies. Deaths certified by doctors are implicitly considered to be reliable and accurate, yet the quality of information provided in the international Medical Certificate of Cause of Death (MCCD) usually varies according to the personnel involved in certification, the diagnostic capacity of the hospital, and the category of hospitals. There are no published studies that have analysed how certifying doctors in Bangladesh adhere to international rules when completing the MCCD or have assessed the quality of clinical record keeping. Methods The study took place between January 2011 and April 2014 in the Chandpur and Comilla districts of Bangladesh. We introduced the international MCCD to all study hospitals. Trained project physicians assigned an underlying cause of death, assessed the quality of the death certificate, and reported the degree of certainty of the medical records provided for a given cause. We examined the frequency of common errors in completing the MCCD, the leading causes of in-hospital deaths, and the degree of certainty in the cause of death data. Results The study included 4914 death certificates. 72.9% of medical records were of too poor quality to assign a cause of death, with little difference by age, hospital, and cause of death. 95.6% of death certificates did not indicate the time interval between onset and death, 31.6% required a change in sequence, 13.9% required to include a new diagnosis, 50.7% used abbreviations, 41.5% used multiple causes per line, and 33.2% used an ill-defined condition as the underlying cause of death. 99.1% of death certificates had at least one error. The leading cause of death among adults was stroke (15.8%), among children was pneumonia (31.7%), and among neonates was birth asphyxia (52.8%). Conclusion Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death certification practices and medical record quality was poor. There is an urgent need to improve death certification practices and the quality of hospital data in Bangladesh if these data are to be useful for policy.
机译：背景技术关于死亡原因的准确，及时的数据对于指导卫生计划和政策至关重要。医生认定的死亡被暗中认为是可靠和准确的，但是国际死亡原因医疗证明（MCCD）中提供的信息质量通常会根据参与认证的人员，医院的诊断能力和诊断方法而有所不同。医院类别。没有发表的研究分析孟加拉国的认证医生在完成MCCD时如何遵守国际规则或评估临床记录的保存质量。方法该研究于2011年1月至2014年4月在孟加拉国的钱德布尔和科米利亚地区进行。我们向所有研究医院介绍了国际MCCD。受过训练的项目医生确定了潜在的死亡原因，评估了死亡证明的质量，并报告了针对特定原因提供的医疗记录的确定性程度。我们检查了完成MCCD时常见错误的发生率，院内死亡的主要原因以及死亡原因数据的确定程度。结果研究包括4914份死亡证明。 72.9％的医疗记录质量太差，无法确定死因，而且在年龄，医院和死因方面差异不大。 95.6％的死亡证明书未标明发病与死亡之间的时间间隔，31.6％的人需要改变顺序，13.9％的人需要包括新的诊断，50.7％的人的缩写，41.5％的人为每行的多个原因，以及33.2％的人一种不确定的状况是潜在的死亡原因。 99.1％的死亡证明书至少有一个错误。成人的主要死亡原因是中风（15.8％），儿童是肺炎（31.7％），新生儿是出生窒息（52.8％）。结论孟加拉国医院的医师难以正确完成MCCD。医师通常会在死亡证明操作中犯错误，并且病历质量很差。如果这些数据对政策有用，那么迫切需要改进孟加拉国的死亡证明做法和医院数据的质量。

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