Factors Related to Record Ill-defined Cause of Death in the Death Summary
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Abstract
Background: The cause of death (COD) can provide valuable information for national health policy. The World Health Organization (WHO) recommended avoiding ill-defined CODs as they do not give any utility. Thai Ministry of Public Health (MoPH) sets the goal that ill-defined CODs should not exceed 25%. However, there is still a high proportion of ill-defined CODs. Objective: To analyze the quality of the CODs recorded by doctors using WHO criteria. Method: A cross-sectional study was conducted in a community hospital in Lopburi province using data retrieved between October 1, 2018, and September 30, 2023. The medical records were reviewed to determine the CODs according to WHO criteria. Then descriptive statistics, chi-square tests, and logistic regression analyses were used at the 0.05 level of significance. Lastly, in-depth interviews were conducted to identify the root of problems. Results: Of 519 records, 73 records (14.1%) were ill-defined; there were 56.6% in outpatients and 6.8% in inpatients. Most of ill-defined CODs were cardiac arrest (21.9%), congestive heart failure (19.2%), and unattended death (16.4%). Being over 80 of age (aOR=2.55, 95%CI 1.28-5.08), being in 2020 (aOR=2.53, 95%CI 1.03-6.23), and being an outpatient (aOR=27.67, 95%CI 13.55-56.49) were the associated factors of ill-defined CODs. The interviews revealed that most of these cases arrived with an unknown medical history and refused an autopsy, except when they encountered some legal or insurance issues. Additionally, the study discovered some misunderstandings about defined CODs. Conclusion: This community hospital’s quality of CODs is good. However, ill-defined CODs in outpatient departments were still high; this was caused by unclear medical history and the refusal to autopsy from relatives. Therefore, it is necessary to develop a central medical database, making it possible to request medical records between hospitals, and raising the awareness of writing defined CODs.
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