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This article discusses the training process for certifiers in the United States, including workshops, recommendations, materials, and initiatives to improve cause-of-death statistics. It also highlights the importance of accurate cause-of-death certification and provides resources for training.
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Training of Certifiers in the United States Donna L. Hoyert Robert N. Anderson National Center for Health Statistics (NCHS)
US Vital Statistics System • Decentralized system • State vital statistics laws and regulations • 57 registration areas • Funeral directors, physicians, medical examiners or coroners 2
Scale • 2.4 million deaths annually • 700,000-800,000 practicing physicians, medical examiners, and coroners • Skewed distribution of certification 3
Training in Decentralized System • Not NCHS’ responsibility to train certifiers • NCHS helps facilitate training but does more 4
Workshops on Improving Cause-of-Death Statistics • Sponsors: NCHS & National Committee on Vital and Health Statistics • Attendees: • Federal vital statistics staff • State vital statistics staff • Professional organization representatives 5
Workshop Recommendations • Need broad-based educational training of certifiers • Multiple approaches • Multiple encounters 6
Workshop Recommendations • Training message: • Importance of cause-of-death statistics • Value of statistics in improving the practice of medicine • Mechanics of completing the death certificate 7
Workshop Recommendations Training Timing: • Medical school- Minimal orientation to process but emphasis on importance of statistics and physician contribution • Internship and residency- key time to begin training physicians 8
Follow through on Workshop Recommendations Recommendations concerning training &: • Medical school • Internship & residency • Licensure & board certification • Practicing physicians • Medical examiners and coroners • Hospitals • Information dissemination and software • Other areas 9
Workshop Results • Workshop reports widely distributed • Resolutions of support • Notices of initiative in variety of publications • NCHS produced additional training material • States may have increased efforts • Other promising developments withered 10
Training Materials • Instructions on death certificate • Laminated instructions • Handbooks etc. • Exhibits • Presentations • Web page 11
Instructions on death certificate • Examples and some instructions • Purpose: To make sure instructions are available to every certifier who is completing a death certificate 12
Instructions in an electronic death registration system • NCHS recommendations for help screens, prompts, and queries on an electronic death certificate developed in 1999 • Above recommendations were incorporated into the Death edit specifications for 2003 revision (http://www.cdc.gov/nchs/data/dvs/FinalDeathSpecs2-22-05.pdf) 13
Laminated instructions • 2 separate pages of instructions • Purpose: To provide certifiers with a quick and handy reference 14
Handbooks and other publications • NCHS handbooks • Series report • CAP manuals • Journal articles 15
Handbooks • Text, instructions, examples • Purpose: To provide more detailed instructions tailored to physician or medical examiner and coroner 16
Other publications • Text, instructions, examples • Purpose: To distribute instructions and examples in medical professional’s own language differently
Exhibit • Main panel, 4 table top panels, variety of educational handouts • Purpose: To bring and distribute training materials directly to certifiers and to educate them about the importance of accurate cause-of-death certification 18
Some Exhibit Locations • American College of Physicians • American Academy of Physicians • American Society of Internal Medicine • American Public Health Association • American College of Cardiology • American Society of Clinical Oncology • National Medical Association • National Association of Medical Examiners • National Association for Public Health Statistics and Information Systems • American Geriatrics Society • American Academy of Family Physicians • National Funeral Directors Association 22
Training Presentations • Tailored instructional presentation and power point • Purpose: To train certifiers 23
Web Page • Links to training resources • Purpose: To help disseminate information URL: http://www.cdc.gov/nchs/about/major/dvs/handbk.htm