title: The quality of death certification practice in Greece.
abstract: BACKGROUND
  Death certification represents an excellent source for mortality statistics and appropriate public health surveillance. Errors in reporting the cause of death impede the development of national health policies and, accordingly, allocation of resources. The aim of this study was to determine the frequency of errors in the cause of death and to identify factors that may be associated with inaccuracies in death certificates.
  
  
  METHODS
  A cross-sectional study of all natural death certifications in a defined Greek region was conducted over the period 2006-2010. Specific criteria for major and minor errors were adopted for the evaluation of death certificates.
  
  
  RESULTS
  A total of 5,828 death certificates due to natural causes were identified. Major errors were found in 64.6 % of them with almost every death certificate having a minor error. Major error rate did not differ per year (p =0.65). Most commonly encountered major errors were a non-acceptable cause of death (31.2 %) and an incorrect sequencing (16.8 %). Factors affecting their frequency were the age of the deceased (older than 80 years, p =0.025), the area of certificate completion (rural and semi-urban, p <0.001) and doctor's grade (consultant, p <0.026).
  
  
  CONCLUSIONS
  High rate of recording errors at death certification influences the accuracy of the cause of death in a defined region in Southern Greece. Due to their impact on mortality statistics and health policies, standard practices of death certification should be established. Coordinated educational interventions are expected to play a significant role on this. Hippokratia 2016, 20(1): 19-25.
authors.affiliation: Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese,Sparta, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese,Sparta, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Andriopoulos
authors.affiliation: Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese,Sparta, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Panoutsopoulos
authors.affiliation: Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese,Sparta, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Zyga
authors.affiliation: Department of Social and Education Policy, Faculty of Social Sciences, University of Peloponnese, Corinth, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Souliotis
authors.affiliation: Microbiology Department, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Gennimata
authors.affiliation: Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese,Sparta, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Tsironi
keywords: Death certificate; errors; health policy; mortality; public health