中山醫學大學機構典藏 CSMUIR:Item 310902500/10367
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    题名: Diversity in death certification: A case vignette approach
    作者: Lu, Tsung-Hsueh
    Shih, Tai-Ping
    Lee, Meng-Chih
    Chou, Ming-Chih
    Linc, Chen-Kun
    贡献者: 中山醫學大學
    关键词: Death certificate;Cause of death;Diagnosis;Medical education;Clinical competence
    日期: 2001
    上传时间: 2015-03-03T07:33:59Z (UTC)
    摘要: Abstract
    Previous studies have revealed high rates of errors in death certification, but few have discussed the nature of these errors. To explore the diversity among physicians in death certification and its relationship with the complexity of the causal sequence of death, we asked 145 physicians attending a continuing medical education course to complete the cause-of-death section on dummy death certificates of four case vignettes. The difficulty in determining the causal sequence of death varied from relatively simple to complex. Variations in death certification were classified according to wording, diagnostic semantics, combinations of expressions, correctness of certification format, and concordance with the referent underlying cause of death (UCOD). Given the same case history information, physicians showed great variation in wording and diagnostic semantics in death certification. The rates of correct certification format and concordance with referent UCOD varied with the level of complexity of the causal sequence of death. The greatest source of diversity was choosing between an acute condition of a chronic disease and the chronic disease itself, and between competing prominent comorbidities. Experience in death certification was significantly associated with correct certification format but not with concordance with referent UCOD. Knowledge of death certification was not associated with correct certification format or concordance with referent UCOD. Our findings indicate that the traditional concept of UCOD tabulation and using a single standard ICD code in evaluating the quality of death certification oversimplifies a complex situation. Variations in death certification, especially the selection of UCOD, were due to differences in interpreting the information rather than differences in knowledge of death certification.
    URI: https://ir.csmu.edu.tw:8080/ir/handle/310902500/10367
    關聯: Volume 54, Issue 11, November 2001, Pages 1086–1093
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