Accuracy of cause-of-death statements on death certificates; before and after a training program in Kuwait

Population-based mortality statistics are derived from the information recorded on death 1ertificates. Many physicians did not receive adequate training in completing death certulcates resulting in undermining the quality of the data derived from death certificates. A training program for all certifier physicians in Kuwait has been conducted. The objective of this study was to examine improving the accuracy of death certificates for coding and the results of an audit of death certificate accuracy before and after this training program. An educational intervention was designed and implemented to improve accuracy in death certificate completion. A total of 2020 death certificates [986 completed before and 1034 completed after the intervention] were audited for major and minor errors, and the proportion of errors before and after the intervention was compared. Major errors were identified in 69.1% of the death certificates completed before the intervention. Following the intervention the major error proportion decreased to 34.6% [P=0.001]. The reduction in the major error proportion was accounted for by significant reductions in the proportion of listing of mechanism of death whiteout a legitimate underlying cause of death [27.0% v. 18.4%, P=0.001] and the proportion of improper sequencing of death certificate information [41.8% v. 15.9% P=0.001]. No improvement in minor errors or demographic errors. Errors are common in the completion of death certificates in Kuwait. The accuracy of death certification can be improved with the implementation of a simple educational intervention