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  • 1. Training of Certifiers in the United States Donna L. Hoyert Robert N. Anderson National Center for Health Statistics (NCHS)
  • 2. US Vital Statistics System
    • Decentralized system
    • State vital statistics laws and regulations
    • 57 registration areas
    • Funeral directors, physicians, medical examiners or coroners
    2
  • 3. Scale
    • 2.4 million deaths annually
    • 700,000-800,000 practicing physicians, medical examiners, and coroners
    • Skewed distribution of certification
    3
  • 4. Training in Decentralized System
    • Not NCHS’ responsibility to train certifiers
    • NCHS helps facilitate training but does more
    4
  • 5. Workshops on Improving Cause-of-Death Statistics
    • Sponsors: NCHS & National Committee on Vital and Health Statistics
    • Attendees:
      • Federal vital statistics staff
      • State vital statistics staff
      • Professional organization representatives
    5
  • 6. Workshop Recommendations
    • Need broad-based educational training of certifiers
      • Multiple approaches
      • Multiple encounters
    6
  • 7. Workshop Recommendations
    • Training message:
      • Importance of cause-of-death statistics
      • Value of statistics in improving the practice of medicine
      • Mechanics of completing the death certificate
    7
  • 8. Workshop Recommendations
    • Training Timing:
    • Medical school- Minimal orientation to process but emphasis on importance of statistics and physician contribution
    • Internship and residency- key time to begin training physicians
    8
  • 9. Follow through on Workshop Recommendations
    • Recommendations concerning training &:
    • Medical school
    • Internship & residency
    • Licensure & board certification
    • Practicing physicians
    • Medical examiners and coroners
    • Hospitals
    • Information dissemination and software
    • Other areas
    9
  • 10. Workshop Results
    • Workshop reports widely distributed
    • Resolutions of support
    • Notices of initiative in variety of publications
    • NCHS produced additional training material
    • States may have increased efforts
    • Other promising developments withered
    10
  • 11. Training Materials
    • Instructions on death certificate
    • Laminated instructions
    • Handbooks etc.
    • Exhibits
    • Presentations
    • Web page
    11
  • 12. Instructions on death certificate
    • Examples and some instructions
    • Purpose: To make sure instructions are available to every certifier who is completing a death certificate
    12
  • 13. Instructions in an electronic death registration system
    • NCHS recommendations for help screens, prompts, and queries on an electronic death certificate developed in 1999
    • Above recommendations were incorporated into the Death edit specifications for 2003 revision ( http://www.cdc.gov/nchs/data/dvs/FinalDeathSpecs2-22-05.pdf )
    13
  • 14. Laminated instructions
    • 2 separate pages of instructions
    • Purpose: To provide certifiers with a quick and handy reference
    14
  • 15. Handbooks and other publications
    • NCHS handbooks
    • Series report
    • CAP manuals
    • Journal articles
    15
  • 16. Handbooks
    • Text, instructions, examples
    • Purpose: To provide more detailed instructions tailored to physician or medical examiner and coroner
    16
  • 17. Other publications
    • Text, instructions, examples
    • Purpose: To distribute instructions and examples in medical professional’s own language differently
  • 18. Exhibit
    • Main panel, 4 table top panels, variety of educational handouts
    • Purpose: To bring and distribute training materials directly to certifiers and to educate them about the importance of accurate cause-of-death certification
    18
  • 19. Illustration: Old Exhibit Display 19
  • 20.  
  • 21.  
  • 22. Some Exhibit Locations
    • American College of Physicians
    • American Academy of Physicians
    • American Society of Internal Medicine
    • American Public Health Association
    • American College of Cardiology
    • American Society of Clinical Oncology
    • National Medical Association
    • National Association of Medical Examiners
    • National Association for Public Health Statistics and Information Systems
    • American Geriatrics Society
    • American Academy of Family Physicians
    • National Funeral Directors Association
    22
  • 23. Training Presentations
    • Tailored instructional presentation and power point
    • Purpose: To train certifiers
    23
  • 24. Web Page
    • Links to training resources
    • Purpose: To help disseminate information
    URL: http://www.cdc.gov/nchs/about/major/dvs/handbk.htm
  • 25.
    • Thank you for your attention.