Understanding Mortality Statistics: The Importance of Cause-of-Death Certification and Coding

Transcription

1 Understanding Mortality Statistics: The Importance of Cause-of-Death Certification and Coding Robert N. Anderson, PhD Arialdi M. Miniño, MPH Mortality Statistics Branch Division of Vital Statistics Centers for Disease Control and Prevention National Center for Health Statistics

2 Cause of death certification Physicians Deaths due to natural causes Medical examiners/coroners Injury deaths Deaths occurring under suspicious circumstances Sudden, unattended deaths

3 Evaluating Cause of Death Statistics Accuracy of diagnosis vs Accuracy of certification

4 Standard format for reporting cause of death Part I. Diseases, injuries, or complications that caused the death

7 Underlying Cause of Death The disease that initiated the train of morbid events leading directly to death or The circumstances of the accident or violence that produced the fatal injury

9 General Instructions Events and conditions should be logically linked in terms of time, etiology and pathology Underlying cause should be on the last used line in Part I One cause on each line in Part I

10 General Approach Condition which directly preceded death Antecedent condition Underlying cause

11 A 60-year-old male with a long history of chronic alcoholism developed cirrhosis. Terminally, the patient had hepatic encephalopathy, which dominated the clinical picture, but there was also some gastrointestinal bleeding (varices) and pneumonia, which complicated clinical management and were also thought to have contributed to death.

12 Immediate cause of death Part I, line (a) The disease or complication which directly preceded death There must always be an entry on line I(a) Avoid writing cardiac arrest or cardiopulmonary arrest

13 Example 1 Immediate cause Hepatic encephalopathy 15 days

14 Antecedent causes Part I, lines (b), (c) and (d) Reported conditions should be in a logical sequence in terms of time, etiology and/or pathology Terminate the sequence with the underlying cause of death leave unused lines blank

15 Example 1 Antecedent causes Hepatic encephalopathy 15 days Cirrhosis of liver 5 years

16 Example 1 Antecedent causes Hepatic encephalopathy 15 days antecedent causes, if any, leading to the immediate cause with underlying cause last Cirrhosis of liver Chronic alcoholism 5 years years

17 Other significant conditions Part II Other important diseases or conditions that were present at the time of death and that may have contributed to death, but were not directly related to the underlying cause of death should be reported in Part II

18 Example 1 Other significant conditions Hepatic encephalopathy 15 days Cirrhosis of liver Chronic alcoholism Bleeding esophageal varices, pneumonia 5 years years

19 Example 2 Acute renal failure 5 days Hyperosmolar nonketotic coma 8 days Diabetes mellitus, non-insulin dependent 15 years

20 A 80-year-old male with congestive heart failure is hospitalized with leg pain and edema and is subsequently diagnosed with deep venous thrombosis. Death occurred as the result of a pulmonary embolism. The patient had a history of poorly-controlled hypertension, prostate cancer and a previous myocardial infarction.

21 Example 3 Pulmonary embolism 30 min Acute iliofemoral deep venous thrombosis? 5 days

22 Example 3a Pulmonary embolism 30 min Acute iliofemoral deep venous thrombosis Congestive heart failure Hypertension 5 days 4 yrs years Poorly differentiated adenocarcinoma of the prostate, old myocardial infarction

23 Example 3b Pulmonary embolism 30 min Acute iliofemoral deep venous thrombosis Congestive heart failure Old myocardial infarction 5 days 4 years years Poorly differentiated adenocarcinoma of the prostate, hypertension

24 Example 3c Pulmonary embolism 30 min Acute iliofemoral deep venous thrombosis Poorly differentiated adenocarcinoma of the prostate 5 days years Congestive heart failure, old myocardial infarction, hypertension

25 Example 4 Metabolic derangement 2 days Diabetic ketoacidosis (new onset diabetes) Probable pancreatitis Possibly due to hypertriglyceridemia from low carbohydrate diet - speculative Hypertension 2 days 2 wk 4 wk

26 General Approach for Injury Fatal derangement Bodily trauma Injury event

27 Describe how injury occurred Ran over by farm tractor Deceased was experiencing dizziness from new medication. Apparently fell, struck head, suffocated face down in carpet. Decedent was eating and a piece of meat became lodged in throat Victim was overcome by carbon monoxide poison, which was produced by a portable generator Assaulted with a baseball bat and knife resulting in fatal injuries to head

28 Example 5 Left intrathoracic hemhorrage 20 min Transection of left subclavian vein Stab wound of left shoulder 20 min 20 min

29 Example 6 Methicillin-resistant staph aureus sepsis 2 days MRSA pneumonia Cutaneous burn wound infection 5 days 10 days 3 rd degree thermal burns 14 days

30 Example 7 Asphyxia unknown Drowning unknown Alcohol intoxication at 0.31 grams percent

31 Some Common Problems Mechanisms or modes of dying Cardiac or respiratory arrest Cardiopulmonary arrest Asystole Reporting symptoms, ill-defined conditions or lab findings Lack of specificity

32 Some common problems (cont.) Multiple conditions on one line Incorrect causal sequences Reporting terminal conditions (e.g., heart failure, renal failure, septicemia, pneumonia, pulmonary embolism, prematurity, et) that have more than one possible cause as the underlying cause

33 Example (bad) 8 Cardiac/pulmonary arrest, advance dementia Diphtheria, aortic stenosis, CVA, CAD Pacemaker

34 Example (bad) 9 Cardiac arrhythmia -> standstill immediate Tacky-brady mostly brady, syndrome Arteriosclerotic vascular disease with Hypothyroidism Chronic atrial fibrillation years years

35 Example (bad) 10 Respiratory failure/ards Septic shock Immunodeficiency

36 Example (bad) 11 Acute myocardial infarction Coronary arteriosclerosis Diabetes mellitus type II Hypertension, essential High cholesterol, Hypercholesterolemia

37 Example (bad) 12 End stage COPD Hx CAD Anemia Elevated BUN

38 Example (bad) 13 Cardiopulmonary arrest none Inanition Multisystem failure Congestive heart failure, renal failure 2 mos 2 mos

39 Example (bad) 14 Cardiogenic shock 12 hours COPD Mania Lithium toxicity years years 5 days

40 Example (bad) 15 Complications of left hip FX

41 Example (bad) 16 Polypharmacy Cardiomegaly with left ventricular hypertrophy Pul Ed Remote FX of cervical vertebrae column

42 Example (bad?) 17 Gunshot wound, self-inflicted to head Terminal cancer of the lungs

43 How extensive are the problems? Mechanisms or modes of dying and ill-defined conditions as the underlying cause - 2% Reporting terminal conditions that have more than one possible cause as the underlying cause - 11% Multiple conditions per line (Part I) 10% Incorrect causal sequences - 25%

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45 out/major/dvs/handbk.htm Published by: The College of American Pathologists

46 Robert N. Anderson