Online Program

Exploring inaccuracies in fetal and infant death certificates

Tuesday, November 5, 2013

Grace Murphy, MSN/MPH, RN, Community Public Health Nursing, Johns Hopkins School of Nursing, Baltimore, MD
Cathy Costa, MSW, MPH, Bureau of Maternal and Child Health, Baltimore City Health Department, Baltimore, MD
Jana Goins, MHS, Bureau of Maternal and Child Health, Baltimore City Health Department, Baltimore, MD
Background. In 2011, Baltimore City had a fetal-infant mortality rate of 21.3 per 1000 live births, which was 1.5 times higher than Maryland's rate. Fetal–Infant Mortality Review (FIMR) programs in the US rely on birth and death records to identify trends in fetal/infant mortality and make recommendations to improve birth outcomes. Baltimore City FIMR routinely encounters records with missing data or data that are discrepant with medical records; poor data impairs the FIMR team's ability to analyze fetal/infant death trends. This study aimed to identify the prevalence of inaccuracies in fetal/infant death certificates. Methods. A convenience sample of fetal and infant death certificates (N=29) from Baltimore City birthing hospitals (2011-2012) were compared to medical records to identify inconsistencies and missing data. Six key informant interviews were conducted to identify contributors to inaccurate death certificate data. Thirty additional cases were abstracted and will be added to the sample. Results. Twenty-five (86%) death certificates had at least one inaccuracy. Inaccuracies included missing/unknown data (60%) or medical record discrepancies (60%). Eleven (37%) death certificates had inaccurate data related to prenatal care and/or previous birth outcomes. Key informant interviews revealed contributing factors to be inadequate training in certificate completion and absence of monitoring. Conclusions. Most certificates had inaccurate data, including important variables. Since death certificate data drive processes such as FIMR, it is vital to further explore, and prevent, poor certificate completion. Improving death certificate data accuracy is critical for developing targeted recommendations to further reduce fetal/infant mortality in cities such as Baltimore.

Learning Areas:

Public health or related research

Learning Objectives:
Identify ways in which the accuracy and completeness of fetal/infant death certificates impact public health processes such as FIMR. Discuss system-level strategies to improve the accuracy and completeness of fetal /infant death reports and death certificates.

Keyword(s): Data/Surveillance, Infant Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I abstract the medical record for Baltimore City Fetal and Infant Mortality Review cases. Based on my experience as an acute care nurse and as an advanced public health nurse, I understand the challenges associated with death certificate completion from both the individual care and systems level perspectives.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.