Preventing Chronic Disease | Test of an Electronic Program to Query Clinicians About Nonspecific Causes Reported for Pneumonia Deaths, New York City, 2012 - CDC
Test of an Electronic Program to Query Clinicians About Nonspecific Causes Reported for Pneumonia Deaths, New York City, 2012
Laura Korin, MD, MPH; Tara Das, PhD, MPH; Ann Madsen, PhD, MPH; Antonio Soto, BA; Elizabeth Begier, MD, MPH
Suggested citation for this article: Korin L, Das T, Madsen A, Soto A, Begier E. Test of an Electronic Program to Query Clinicians About Nonspecific Causes Reported for Pneumonia Deaths, New York City, 2012. Prev Chronic Dis 2014;11:140282. DOI:http://dx.doi.org/10.5888/pcd11.140282.
We tested an electronic cause-of-death query system at a hospital in New York City to evaluate clinicians’ reporting of cause of death. We used the system to query clinicians about all deaths assigned International Classification of Disease code J189 (pneumonia, unspecified) as the underlying cause of death. Of 29 death certificates that generated queries, 28 were updated with additional information, which led to revisions in the underlying cause of 27 deaths. The electronic system for querying reported cause of death was feasible and enabled quicker than usual responses; however, follow-up with clinicians to ensure timely, accurate, and complete responses was labor-intensive. Educating clinicians and enforcing reporting standards would reduce the time and effort required to ensure accurate and timely cause-of-death reporting.
Cause-of-death reporting enables health departments determine program needs and effectiveness. Because clinicians often report cause of death incompletely or inaccurately, cardiovascular disease and pneumonia have been over-reported in some regions (1–5). The National Center for Health Statistics (NCHS) recommends that health departments query clinicians after death registration to obtain more detailed and accurate information (6,7). New York City’s Department of Health and Mental Hygiene (DOHMH) pilot-tested an electronic system for querying clinicians about cause of death and asking for more information when unspecified pneumonia, which is usually precipitated by a chronic condition, was reported as the underlying cause.
We selected a 519-bed acute tertiary-care facility that reported substantially more unspecified pneumonia deaths than other New York City hospitals. In 2010, 16% of deaths at this hospital were reported as due to pneumonia or influenza, compared with 6.8% citywide.
In New York City, 93% of 2012 deaths were entirely reported through the Electronic Vital Events Registration System (EVERS) (8). In EVERS, the text provided by certifying clinicians on each death certificate is used to determine the underlying cause of death and to assign the corresponding International Classification of Disease (ICD-10) code (9). A standardized international algorithm is used to apply these ICD-10 codes either automatically by NCHS-provided software or manually by our nosologist if automated coding fails or is unavailable (10).
Beginning March 1, 2012, we queried all deaths registered from January 1 through July 31, 2012, that were coded J189 (pneumonia, unspecified) as the underlying cause of death. Our DOHMH nosologist sent an email and system message via EVERS to certifying clinicians and copied the hospital administrative staff member responsible for death registration (Box). The message asked clinicians to submit electronically, through EVERS, either an amendment with a revised underlying cause of death or a comment within the death record stating that additional information was unavailable.
This research was funded in part by a Physician Training Award in Cancer Prevention (no. 124287-PTAPM-04-079-13-PTAPM) from the American Cancer Society while Dr. Korin was a public health/preventive medicine resident at New York City DOHMH.
Corresponding Author: Ann Madsen, PhD, MPH, New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics, 125 Worth Street, Room 204 CN-7, New York, NY 10013. Telephone: 212-788-4588. Email: firstname.lastname@example.org.
Author Affiliations: Laura Korin, Public Health/Preventive Medicine Residency Program, New York City Department of Health and Mental Hygiene, New York, New York; Tara Das, Ann Madsen, Antonio Soto, Elizabeth Begier, Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York