Using National Inpatient Death Rates as a Benchmark to Identify Hospitals with Inaccurate Cause of Death Reporting - Missouri, 2009-2012.

Reporting causes of death accurately is essential to public health and hospital-based programs; however, some U.S. studies have identified substantial inaccuracies in cause of death reporting. Using CDC's national inpatient hospital death rates as a benchmark, the Missouri Department of Health and Senior Services (DHSS) analyzed inpatient death rates reported by hospitals with high inpatient death rates in St. Louis and Kansas City metro areas. Among the selected hospitals with high inpatient death rates, 45.8% of death certificates indicated an underlying cause of death that was inconsistent with CDC's Guidelines for Death Certificate completion. Selected hospitals with high inpatient death rates were more likely to overreport heart disease and renal disease, and underreport cancer as an underlying cause of death. Based on these findings, the Missouri DHSS initiated a new web-based training module for death certificate completion based on the CDC guidelines in an effort to improve accuracy in cause of death reporting.

Coccidioidomycosis in a State Where It Is Not Known To Be Endemic - Missouri, 2004-2013.

During 1998‒2012, coccidioidomycosis cases increased nationally nearly eightfold. To describe the epidemiology of coccidioidomycosis in Missouri, a state without endemic coccidioidomycosis, coccidioidomycosis surveillance data during 2004-2013 at the Missouri Department of Health and Senior Services were retrospectively reviewed. The incidence of reported coccidioidomycosis increased from 0.05 per 100,000 population in 2004 to 0.28 per 100,000 in 2013, with cases distributed throughout all regions of Missouri. Persons aged >60 years were most affected. In cases in which patients had disease manifestations, the most common were pneumonia (37%) and influenza-like illness (31%). Nearly half (48%) of patients had traveled to an area where coccidioidomycosis is endemic, whereas approximately one-quarter (26%) of patients did not report such travel. Those with history of travel to endemic areas were significantly more likely to receive a diagnosis by positive culture or polymerase chain reaction (PCR) testing, compared with those without a history of travel to endemic areas, who were more likely to receive a diagnosis by serological tests. Additional studies will be required to ascertain whether truly endemic cases exist in Missouri.