Inquiry Into Diagnostic Evidence Supporting Medical Certifications of Death

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Abstract
Results of a pilot study indicate that in the Pennsylvania sample of death certificates, about 43% of medical certifications appear to have been based on solidly established diagnoses, and an additional 36% seemed to be reasonable diagnoses. In 10% there was some question as to whether the cause-of-death statement was right or wrong, and in 8% of the death certificates, the cause as stated originally, was probably wrong. The quality of diagnostic evidence varied by cause of death. For malignant neoplasms the proportion of solidly established diagnosis was high, 65%. On the other hand, there was a much lower proportion (33%) of solidly established diagnoses in cardiovascular-renal diseases. However, this was compensated for by a higher proportion of reasonable diagnoses, 47%. The approach in this study differs from that taken previously in the assessment of quality of cause-of-death statistics. Clinical and pathological findings were secured from the certifying physician and evaluated by an internist in rather broad qualitative terms, taking into consideration the type and amount of supporting diagnostic information, consistency of medical certification with the diagnostic evidence, and the physician''s opinion of certitude of diagnosis.

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