死因监测中根本死因填报存在问题及解决途径

Filling-in of underlying causes of death in death surveillance:problems and solutions

目的提高根本死因填报准确性,准确定量死因构成,确定重点防制的重大疾病,为制定疾病预防与控制策略提供依据。方法数据来源于太原市区县疾控中心上报死亡个案,MicroAccess建库、清洗、统计。结果2005年报告死亡病例数为5554例,根本死因填报正确率为74.97%,根本死因填报错误率为25.03%。其中,错误项中症状或体征构成比最高,为47.08%,其次为各种衰竭,构成比为31.97%。造成根本死因填报错误的主要原因是:个别医生对根本死因概念不清《:居民死亡医学证明书》中死因链填写不规范。2006年监测数据表明,培训前后,死因链正确率由64.26%上升到70.98%,根本死因正确率由74.50%上升为82.44%。结论死因监测中根本死因判定不准确的问题,是影响监测质量的关键因素,通过探讨有效的死因监测系统管理模式,增强死因监测人才的能力建设,可有效的解决根本死因判定不准确的问题,使死因监测系统得以健康发展。

Objective The present study was designed to gain insight into the problems and solutions for the improvement of the accuracy of filling in underlying causes of death, exactly quantifying the proportion of deaths, and determining the severe diseases which should be prevented and controlled principally, providing basis for the establishment of the strategies for their control and prevention. Methods Data of the dead cases reported by Centers for Disease Control and Prevention at district or county level in Taiyuan City was cleaned and taken statistical analysis after the database was created with MicroAccess. Results Of the 5554 dead cases reported in 2005, the accuracy rate and the error rate of the filling-in of underlying causes of death were 74.97% and 25.03%, respectively. Among these false items, the proportion of symptoms or signs was 47.08%, the highest. Various failures were in the second place with the proportion of 31.97%. There were two main reasons for the mistakes in filling in underlying causes of death： some doctors did not clearly understand the conception of underlying causes of death, and filling-in of multiple causes of death in Medical Certificates of Death did not observe the standard procedures. Surveillance data in 2006 showed that the accuracy rate of filling in the multiple causes of death increased from 64.26% to 70.98% and the accuracy rate of the filling of underlying causes of death from 74.50% to 82.44% after training, Conclusion The accurate judgment of underlying causes in death surveillance is a key factor affecting the surveillance quality . By exploring effective management mode of the surveillance system for cause of death and strengthening the construction of capacity of talented persons engaged in the surveillance on cause of death, the problems on inaccurate judgment of underlying causes of death may be resolved and healthy development of the surveillance system for cause of death can be achieved.