A method of macro-auditing and assessing the preventability of infant mortality using large volume computerized files.
We present a method for auditing and evaluating infant mortality with the aid of a preventability grading system, based on national computerized files of livebirths and infant deaths. Diagnostic categories and specific causes of deaths were classified into one of the following three preventability grades: Preventable (P), Possibly Preventable (PP) and Non Preventable (NP). This classification was then applied to two different scales: Preventability of Condition (PC) and Preventability of Death (PD) from which a third scale--Preventability of Mortality (PM)--was derived. The method was then applied to matched records of 39,786 livebirth and 452 infant death certificates between 1977 and 1984, in a semi-urban region in Israel encompassing 220,000 inhabitants. Comparison of mortality rates, according to the proposed preventability scores, demonstrated that higher infant mortality rate in non-Jewish population, or in Jewish mothers with a lower educational, was present only in the preventable categories (P or PP), while death rates due to non preventable causes were identical for all groups. The suggested macro-auditing method facilitates the assessment of large scale infant mortality rates in terms of preventability.
Herman
A
A
Department of Clinical Epidemiology, Chaim Sheba Medical Center, Tel Hasomer, Israel.
Modan
B
B
Barell
V
V
Caspi
E
E
Barzilay
Z
Z
D000013:Congenital Abnormalities / Q000401:mortality; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007239:Infections / Q000401:mortality; D007557:Israel; D008297:Male; D008485:Medical Audit / Q000379:methods*; D007744:Obstetric Labor Complications / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D011787:Quality of Health Care