Background
Methods
Sample size calculation and statistical analysis
Results
Medical records and DCs
Death certificate characteristics | All DCs (n = 563) | Correct DCs (n = 208) | Incorrect DCs (n = 355) |
---|---|---|---|
1. Age (yr), mean ± SD | 58.0 ± 21.5 | 60.2 ± 20.6 | 56.7 ± 22.0 |
2. Female gender: n (%) | 207 (45.7) | 84 (47.5) | 123 (44.6) |
3. Evaluation of events leading directly to COD, n (%) | 563 (100) | 321 (57.0) | 242 (43.0) |
4. Thai COD coding evaluation, n (%) | 563 (100) | 229 (40.7) | 333 (59.3) |
5. Hospital size: n (%) | |||
▪ > 1000 beds | 118 (21.0) | 43 (20.7) | 75 (21.1) |
▪ 701–1000 beds | 160 (28.4) | 67 (32.2) | 93 (26.2) |
▪ 401–700 beds | 285 (50.6) | 98 (47.1) | 187 (52.7) |
6. Hospital location by Thailand region, n (%) | |||
▪ Northeastern | 178 (31.6) | 61 (29.3) | 117 (33.0) |
▪ Northern | 105 (18.7) | 39 (18.8) | 66 (18.6) |
▪ Southern | 104 (18.5) | 44 (21.2) | 60 (16.9) |
▪ Eastern | 71 (12.6) | 25 (12.0) | 46 (13.0) |
▪ Central | 105 (18.7) | 39 (18.8) | 66 (18.6) |
7. Disease group, n (%) | |||
▪ Cardiovascular disease | 125 (22.2) | 66 (31.7)* | 59 (16.6)* |
▪ Infectious disease | 81 (14.4) | 16 (7.7)** | 65 (18.3)** |
▪ Cancer disease | 80 (14.2) | 51 (24.5)* | 29 (8.2)* |
▪ Gastrointestinal disease | 77 (13.7) | 27 (13.0) | 50 (14.1) |
▪ Pulmonary disease | 53 (9.4) | 22 (10.6) | 31 (8.7) |
▪ Endocrine disease | 43 (7.6) | 3 (1.4)* | 40 (11.3)* |
▪ External cause | 36 (64.0) | 9 (4.3) | 27 (7.6) |
▪ Nephrology disease | 18 (3.2) | 5 (2.4) | 13 (3.7) |
▪ Neurologic disease | 14 (2.5) | 3 (1.4) | 11 (3.1) |
▪ Musculoskeletal and rheumatologic disease | 10 (1.8) | 1 (0.5) | 9 (2.5) |
▪ Unknown cause of death | 8 (2.3) | 0 (0) | 8 (2.3) |
▪ Other | 18 (3.2) | 5 (2.4) | 13 (3.7) |
Questionnaire responses from first-year general practitioners
Characteristics | All general practitioners (n = 155) | Correct DC GP group (n = 47) | Incorrect DC GP group (n = 108) |
---|---|---|---|
1. Age (yr.), mean ± SD | 25.3 ± 0.8 | 25.2 ± 0.7 | 25.4 ± 0.8 |
2. Female gender, n (%) | 88 (56.8) | 23 (48.9) | 65 (60.2) |
3. GPA, mean ± SD | 3.2 ± 0.3 | 3.3 ± 0.4* | 3.2 ± 0.3* |
4. Hospital size (beds), mean ± SD | 820.5 ± 317.5 | 844.6 ± 342.1 | 810.0 ± 307.3 |
5. Workload, mean ± SD | |||
▪ Number of OPD patients/day | 37.2 ± 17.8 | 37.9 ± 19.5 | 36.9 ± 17.2 |
▪ Number of IPD patients/day | 32.9 ± 18.8 | 32.6 ± 14.2 | 33.0 ± 20.4 |
▪ Number of IPD patients on night duty/day | 17.9 ± 11.4 | 17.2 ± 10.6 | 18.2 ± 11.7 |
6. Size of medical school graduating class, n (%) | |||
▪ > 200 medical graduates | 56 (36.2) | 18 (38.3) | 38 (35.2) |
▪ 101–200 medical graduates | 62 (40.0) | 18 (38.3) | 44 (40.7) |
▪ 51–100 medical graduates | 21 (13.5) | 4 (8.5) | 17 (15.7) |
▪ < 50 medical graduates | 16 (10.3) | 7 (14.9) | 9 (8.3) |
7. Future plans for specialist training, n (%) | |||
▪ No future training plans | 30 (19.4) | 8 (17.0) | 22 (20.4) |
▪ Major field training (i.e. medicine, surgery, pediatrics, obstetrics and gynecology) | 88 (56.8) | 27 (57.4) | 61 (56.5) |
▪ Minor field training | 37 (23.9) | 12 (25.5) | 25 (23.1) |
Clinical parameters associated with accurately completed DCs
Clinical parameters | All general practitioners (n = 155) | Correct DC GP group (n = 47) | Incorrect DC GP group (n = 108) |
---|---|---|---|
1. Overall DC knowledge, n (%) | 65 (41.9) | 21 (44.7) | 44 (40.7) |
▪ Understands that DCs are used in public health research and policy, n (%) | 66 (42.6) | 23 (48.9) | 43 (39.8) |
▪ Can differentiate between COD and MOD, n (%) | 39 (25.2) | 14 (29.8) | 25 (23.1) |
2. High level of self-confidence in identifying correct underlying COD, n (%) | 41 (26.5) | 15 (31.9) | 26 (24.1) |
3. Factors influencing errors in COD, n (%) | |||
▪ Lack of appropriate knowledge | 51 (32.9) | 15 (31.9) | 36 (33.3) |
▪ Extenuating circumstancea | 17 (11.0) | 3 (6.4) | 14 (13.0) |
▪ High workload | 33 (21.3) | 7 (14.9) | 26 (24.1) |
▪ Lack of adequate data | 28 (18.1) | 10 (21.3) | 18 (16.7) |
▪ Other/non applicable | 26 (16.7) | 12 (25.5) | 14 (12.9) |
4. Time spent on COD determination and DC completion in medical curriculum (hr), mean ± SD | 2.1 ± 0.9 | 2.2 ± 0.7 | 1.8 ± 0.9 |
▪ Time spent on COD and DCs < 2 h, n (%) | 96 (73.8) | 29 (74.4) | 67 (73.6) |
5. COD coding experience, n (%) | |||
▪ Have experience completing DCs by themselves during medical school | 43 (27.7) | 17 (36.2) | 26 (24.1) |
▪ Have experience completing DCs by themselves > 5 cases/month after graduation | 105 (67.7) | 33 (70.2) | 72 (66.7) |
6. Established COD coding training program in work hospital, n (%) | 45 (29.0) | 13 (27.7) | 32 (29.6) |
7. Person responsible for completion of death certificates during office hours, n (%) | |||
▪ Primarily senior physicians | 16 (10.4) | 5 (10.6) | 11 (10.3) |
▪ Primarily general practitioners | 126 (81.8) | 38 (80.9) | 88 (82.2) |
▪ On-duty general practitioner | 3 (2.0) | 0 (0) | 3 (2.8) |
▪ Other | 9 (5.8) | 4 (8.5) | 5 (4.7) |
8. Person responsible for completion of death certificates during after hours, n (%) | |||
▪ Primary senior physicians | 3 (2.0) | 1 (2.1) | 2 (1.9) |
▪ Primary general practitioners | 31 (20.1) | 16 (34.0) | 15 (14.0) |
▪ On-duty general practitioner | 112 (72.7) | 27 (57.5) | 85 (79.4) |
▪ Other | 8 (5.2) | 3 (6.4) | 5 (4.7) |
Death certificate characteristics | Unadjusted OR (95% CI) | p value | GP characteristics and associated parameters. | Unadjusted OR (95% CI) | p value |
---|---|---|---|---|---|
Elderly (age ≥ 60 yr.) | 1.2 (0.8–1.8) | 0.2 | Age | 0.8 (0.5–1.3) | 0.3 |
Female | 1.1 (0.8–1.6) | 0.5 | Female | 0.6 (0.3–1.3) | 0.1 |
Hospital Sizes | Medical School Sizes | ||||
▪ 400–700 beds | Reference | ▪ > 200 graduates/ year | Reference | ||
▪ 701–1000 beds | 1.1 (0.7–1.7) | 0.6 | ▪ 101–200 graduates/ year | 0.9 (0.4–1.9) | 0.7 |
▪ More than 1000 | 1.4 (0.9–2.0) | 0.1 | ▪ 51–100 graduates/ year | 0.5 (0.2–1.7) | 0.2 |
COD disease groups | ▪ ≤ 50 graduates/ year | 1.6 (0.5–5.1) | 0.3 | ||
▪ Cardiovascular disease | 2.3 (1.6–3.5) | < 0.001 | Future plans for specialist training | ||
▪ Infectious disease | 0.4 (0.2–0.7) | 0.001 | ▪ Specialist training plans | 1.3 (0.5–3.1) | 0.6 |
▪ Cancer group | 3.7 (2.2–6.0) | < 0.001 | GPA Group | ||
▪ Gastrointestinal disease | 0.9 (0.6–1.5) | 0.7 | ▪ GPA ≥ 3.5 | 3.5 (1.5–7.9) | 0.003 |
▪ Pulmonary disease | 1.2 (0.7–2.2) | 0.4 | Time spent during medical curriculum | ||
▪ Endocrine disease | 0.1 (0.04–0.4) | < 0.001 | ▪ Time spent ≥2 h | 1.0 (0.4–2.3) | 0.9 |
▪ External cause | 0.6 (0.3–1.2) | 0.1 | COD coding experience | ||
▪ Nephrology disease | 0.7 (0.2–1.8) | 0.4 | ▪ Have experience in completing DCs by themselves during medical school | 1.8 (0.9–3.8) | 0.1 |
▪ Neurologic disease | 0.5 (0.1–1.7) | 0.2 | ▪ Have experience completing DCs by themselves >5cases/month after graduation | 1.2 (0.6–2.5) | 0.6 |
▪ Musculoskeletal and rheumatologic disease | 0.2 (0.02–1.5) | 0.07 | ▪ Established COD coding training program in work hospital | 0.9 (0.4–1.9) | 0.8 |
▪ Unknown cause of death/ Other | 0.4 (0.2–1.1) | 0.05 | Understands that DCs are used in public health research and policy | 1.5 (0.7–2.9) | 0.2 |