Assessing the quality of tuberculosis-related underlying cause of death assignment in Taiwan, 2001-2005.
OBJECTIVE
Assignment of underlying cause of death (UCOD) might be inconsistent among coders if physicians do not properly record cause of death on death certificates. This study aimed to assess the changes in the quality of tuberculosis-related UCOD assignment in Taiwan after interventions by the Center for Disease Control (CDC).


METHODS
The reference (gold standard) we used to assess the quality of UCOD assignment by coders was the UCOD selected by the Automated Classification of Medical Entities (ACME) computer program. The agreement, over- and under-coding rates between coders and the reference were calculated by years before and after the CDC interventions.


RESULTS
An abrupt decrease in tuberculosis death rates according to the UCOD assigned by coders was noted from 2003 to 2004, but no such decrease was noted according to the reference. The agreement in UCOD assignments between coders and ACME decreased from 0.75 in 2001 to 0.67 in 2005. We found a significant decrease in the over-coding rate from 0.21 in 2003 to 0.11 in 2004, and a prominent increase in under-coding rates from 0.08 in 2003 to 0.24 in 2004.


CONCLUSIONS
The abrupt decrease in the official published tuberculosis mortality rate from 2003 to 2004 was due to significant changes in the practice of UCOD assignment of official coders, which might have been a response to interventions initiated by the CDC.
Wu
Yi-Chun
YC
The Fourth Branch Office, Center for Disease Control, Taipei, Taiwan.
Lin
Ruey-Shiung
RS
Yang
Shiang-Lin
SL
Lu
Tsung-Hsueh
TH
D000328:Adult; D000368:Aged; D002423:Cause of Death; D002487:Centers for Disease Control and Prevention, U.S.; D003644:Death Certificates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000401:mortality*; D014481:United States