Abstract

Death Certification Trainings to Improve the Quality of Disaster-Related Mortality Data

Tesfaye Bayleyegn, MD, MPH¹, Aileen Artus, MPH², Carter Elizabeth, MPH¹, Marcy Barnett³, Lorraine Bnjamin-Matthew⁴, Sarah Chughtai⁵, Radmur Downing⁴, Kent E. Harshbarger⁶, Amy Hawes⁷, MaryGrace C. Joyce⁸, Maria M. Juiz Gallego Juiz Gallego⁹, Mike McNutt¹⁰, Christine Ortiz Gumina³, Lee Anne Flagg¹¹ (1)Center for Disease Control and Prevention, (2)Tanaq Government Services, LLC, Atlanta, GA, (3)National Network of Public Health Institutes, Washington, DC, (4)Virgin Islands Department of Health, St. Croix, VI, (5)National Association of County and City Health Officials, Washington, DC, (6)Montgomery County Coroner Office, Dayton, OH, (7)Office of the State Chief Medical Examiner, Nashville, TN, (8)National Nurse-Led Care Consortium, Philadelphia, PA, (9)Puerto Rico Department of Health, San Juan, PR, (10)Texas Department of State Health Services, Austin, TX, (11)National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA

APHA 2022 Annual Meeting and Expo

Background
Three consecutive and powerful hurricanes made landfall in the southeastern continental United States and the Caribbean including U.S. territories, Puerto Rico and U.S. Virgin Islands (USVI), in August and September 2017, causing massive devastation and numerous deaths. Obtaining an accurate count of disaster-related deaths is typically challenging but is important for disaster response, recovery, and preparedness. In 2018, the Centers for Disease Control and Prevention (CDC) received supplemental funds to improve the accuracy of death counts in the affected jurisdictions. In 2019, CDC expanded the project to additional states to improve mortality surveillance in local and state health departments. The project aims to improve the quality of mortality data by equipping death certifiers with the knowledge to accurately record and report deaths, especially disaster-related deaths.

Methods
CDC’s National Center for Environmental Health and National Center for Health Statistics partnered with public health agencies, state and territory health departments, and nonprofit organizations to develop and implement death certification trainings including disaster-related deaths in selected U.S. states and territories. Puerto Rico, the U.S. Virgin Islands, and Texas were initially selected while Pennsylvania, Tennessee, and Ohio were included a year later. To inform training course agendas, an assessment was performed to determine the current death certifier workforce and evaluate their knowledge of the death certification process. Each jurisdiction established a training goal based on assessment findings. CDC conducted initial training-of-trainers (ToT) sessions. Subsequent trainings were conducted by trained trainers in each jurisdiction.

Results
Between March 2019 to June 30, 2021, CDC and project partners conducted 349 (52 in-person and 297 virtual) trainings and trained a total of 2,257 persons, of which 72% (1,625) were death certifiers. Of the trained death certifiers, 40% (656) were from Texas, 21% (337) from Puerto Rico, 14% (227) from Tennessee, 14% (226) from Ohio, 9% (151) from Pennsylvania, and 2% (28) from USVI. Furthermore, Puerto Rico established the death certification training course in medical schools to prepare future death certifiers while most partner jurisdictions prepared on-demand videos to sustain trainings efforts and continue to improve the quality of mortality data.

Conclusion
CDC and public health partners in the United States and U.S. territories implemented death certification training courses aimed at progressively improving the quality of mortality data. This may help to improve public health surveillance and inform disaster preparedness, response, and recovery efforts.