AMA Resolutions

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution: __(A-02)

Introduced by:   American College of Preventive Medicine

Subject:            Improving the Accuracy of Cause of Death
                        Certification

Referred to:       Reference Committee __

Whereas, Our American Medical Association acknowledges that the reporting of vital events is an integral part of patient care (H-85.996); and

Whereas, the death certificate is an important source of disease-related data, providing information on the immediate cause of death (i.e., the disease or injury that directly causes death) as well as the underlying cause of death (i.e., disease or injury that initiated the train of morbid events leading to death); and

Whereas, data on state vital records plays an important role in determining resource allocation, with millions of dollars in health-related resources allocated each year on the basis of information provided on cause of death alone; and

Whereas, in most states physicians are responsible for accurately certifying to the cause of death, as they are best able to decide which of several conditions was responsible for death and to describe the complete pathophysiologic sequence ending in death; and

Whereas, the physician’s role as certifier to the cause of death is an important contributor to the uniformity and comprehensiveness of our national vital statistics system and serves as the basis for uniformity within the global vital statistics system as defined by the World Health Organization; and

Whereas, while physicians have the clinical expertise needed to accurately certify cause of death, the literature has shown that many physicians are not well-trained on how to accurately complete death certificates, and inaccurate completion of death certificates is commonplace;^, and

Whereas, in 2000 the state of Washington and in 2001 the states of Montana and Oregon passed laws allowing certified advanced practice registered nurses to provide medical certification of cause of death on the death certificate without consideration of the need for uniformity in death statistics or consultation from the National Center for Health Statistics (NCHS), the World Health Organization or state medical societies.

RESOLVED, That our American Medical Association reaffirm the reporting of vital events as an integral part of patient care and the role physicians play in certifying to the cause of death; and be it further

RESOLVED, That our AMA advocate for an appropriate federal agency (e.g., the National Center for Health Statistics/CDC) to fund a study to explore the current accuracy and reliability of death certificate coding and alternative approaches to improving it; and be it further

RESOLVED, That our AMA work with the federal government, the Federation, and state medical societies to educate lawmakers of the need for uniformity in cause of death statistics and to require all persons who certify cause of death to undergo adequate training on how to do it accurately.

H-85.996 Improvement in Accuracy of Death Certificates

Our AMA: (1) acknowledges that the reporting of vital events is an integral part of patient care; (2) urges physicians to ensure completion of all state vital records carefully and thoroughly with special attention to the use of standard nomenclature; and (3) supports notifying state medical societies and state departments of vital statistics of this policy and encouraging their assistance and cooperation in implementing it. (Sub. Res. 8, I-80; Reaffirmed: CLRPD Rep. B, I-90; Reaffirmed: Sunset Report I-00; Modified: CSA Rep. 6, I-00)

H-85.974 Improving Death Certificate Completion

The AMA (1) supports the position that efforts to improve cause of death statistics are indicated as necessary; (2) endorses the concept that educational efforts to improve death certificates should be focused on physicians, particularly those who take care of patients in facilities where patients are likely to die, namely in acute hospitals, nursing homes, and hospices; and (3) endorses the concept that training sessions in the completion of death certificates should be (a) included in hospital house orientation sessions and clinical pathologic conferences; (b) integrated into continuing medical education presentations; (c) mandatory in mortality conferences; and (d) included as part of in-service training programs for nursing homes, hospices, and geriatric physicians. (Res. 305, I-91)

H-85.986 Accurate Completion of Death Certificates

The AMA encourages legible writing and accurate diagnosis on death certificates and supports taking steps, including special emphasis in its educational programs, to make certain that physicians fill out death certificates carefully, accurately and legibly. (Res. 3, A-87; Reaffirmed Sunset Report I-97).

H-85.981 Improving the Accuracy of Death Certificates

Our AMA (1) in cooperation with other organizations, supports developing a program to improve the accuracy of death certificates; (2) supports evaluating the advisability and feasibility of having quality assurance programs review the accuracy of death certificate; (3) supports developing recommendations to encourage documentation of risk factors such as poverty, smoking and alcoholism; and (4) encourages the practice of amending the completed death certificate to enhance accuracy and effectiveness. (Sub. Res. 76, I-89; Reaffirmed: Sunset Report, A-00)

H-85.961 Accuracy, Importance, and Application of Data from the U.S. Vital Statistics System

(1) Our AMA supports the integration into undergraduate, graduate, and continuing medical education of instruction on the use and proper completion of vital records of birth, fetal death, and death. The presence and effectiveness of this education could be monitored through the Liaison Committee on Medical Education (LCME) annual questionnaire to medical schools, the joint AMA/Association of American Medical Colleges survey of residency programs, questions on the United States Medical Licensing Examinations, and questions on certifying examinations in the individual specialties. (2) Our AMA encourages physicians to provide complete and accurate information on prenatal care and hospital patient records of the mother and infant, as this information is the basis for the health and medical information on birth certificates. (CSA Rep. 6, I-00)