Is it possible and worth keeping track of deaths within general practice? Results of a 15 year observational study.
OBJECTIVE
To assess the value of maintaining a death register in a general practice with particular reference to monitoring quality of care.


METHODS
Observational study.


METHODS
Inner London general practice.


METHODS
The practice maintained a manual death register, retained medical records of all deceased patients, and requested information on cause of death from health authorities and coroners for 15 years.


METHODS
Number and causes of deaths; 3 yearly age standardised death rates; proportion of deaths formally notified to the practice; place of death; source of cause of death information.


RESULTS
During the study period 578 patients died. Practice age standardised death rates fell significantly from 35.59 to 27.12/1000. 498 (86.2%) deaths were formally notified to the practice, 392 within 7 days of death. Of 143 deaths reported to the coroner, only 45 coroners' reports were received. 360 (64.1%) died in hospital, 139 (24.8%) at home, and 38 (6.8%) in a hospice. Death certificate cause of death information was obtained from patients' records in 33.6% (n=194) of cases and from health authority sources for 50% (n=289). The pattern of ascertained causes of deaths was similar to the national pattern.


CONCLUSIONS
A death register can examine trends in practice deaths by age and place of death and comparisons undertaken with nationally published mortality data. An accurate picture of cause of death cannot be generated from routine data flows alone. There is delay in informing GPs of patient deaths. Meaningful and timely monitoring of deaths cannot be undertaken by individual practices. National Statistics should provide routine analysis of GP death certificate information.
Beaumont
B
B
Primary Care Research Group, Health Promotion Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. bbeaumont@doctors.org.uk
Hurwitz
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004282:Documentation; D005194:Family Practice / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London; D008137:Longitudinal Studies; D008875:Middle Aged; D009026:Mortality; D011785:Quality Assurance, Health Care; D012042:Registries