An intervention to improve cause-of-death reporting in New York City hospitals, 2009-2010.
BACKGROUND
Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC's health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting.


METHODS
From June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals.


RESULTS
At intervention hospitals, the proportion of death certificates that reported heart disease  as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period.


CONCLUSIONS
This NYC health department's hospital-level intervention led to durable changes in COD reporting.
New York City Department of Health and Mental Hygiene, 125 Worth St, Rm 204, CN-7, New York, NY 10013, USA. amadsenstraight@health.nyc.gov
Ann
A
Madsen
Sayone
S
Thihalolipavan
Gil
G
Maduro
Regina
R
Zimmerman
Ram
R
Koppaka
Wenhui
W
Li
Victoria
V
Foster
Elizabeth
E
Begier
D000465:Algorithms; D002423:Cause of Death; D059019:Clinical Coding / Q000592:standards; D003644:Death Certificates; D006331:Heart Diseases / Q000145:classification / Q000453:epidemiology / Q000401:mortality*; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007318:Inservice Training; D038801:International Classification of Diseases; D008505:Medical Staff, Hospital / Q000193:education; D009519:New York City / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011314:Preventive Health Services; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D012044:Regression Analysis