1. Training of Certifiers in the United States Donna L. Hoyert Robert N. Anderson National Center for Health Statistics (NCHS)

2. US Vital Statistics System Decentralized system State vital statistics laws and regulations 57 registration areas Funeral directors, physicians, medical examiners or coroners 2

3. Scale 2.4 million deaths annually 700,000-800,000 practicing physicians, medical examiners, and coroners Skewed distribution of certification 3

4. Training in Decentralized System Not NCHS’ responsibility to train certifiers NCHS helps facilitate training but does more 4

5. Workshops on Improving Cause-of-Death Statistics Sponsors: NCHS & National Committee on Vital and Health Statistics Attendees: Federal vital statistics staff State vital statistics staff Professional organization representatives 5

6. Workshop Recommendations Need broad-based educational training of certifiers Multiple approaches Multiple encounters 6

7. Workshop Recommendations Training message: Importance of cause-of-death statistics Value of statistics in improving the practice of medicine Mechanics of completing the death certificate 7

8. Workshop Recommendations Training Timing: Medical school- Minimal orientation to process but emphasis on importance of statistics and physician contribution Internship and residency- key time to begin training physicians 8

9. Follow through on Workshop Recommendations Recommendations concerning training &: Medical school Internship & residency Licensure & board certification Practicing physicians Medical examiners and coroners Hospitals Information dissemination and software Other areas 9

10. Workshop Results Workshop reports widely distributed Resolutions of support Notices of initiative in variety of publications NCHS produced additional training material States may have increased efforts Other promising developments withered 10

11. Training Materials Instructions on death certificate Laminated instructions Handbooks etc. Exhibits Presentations Web page 11

12. Instructions on death certificate Examples and some instructions Purpose: To make sure instructions are available to every certifier who is completing a death certificate 12

13. Instructions in an electronic death registration system NCHS recommendations for help screens, prompts, and queries on an electronic death certificate developed in 1999 Above recommendations were incorporated into the Death edit specifications for 2003 revision ( http://www.cdc.gov/nchs/data/dvs/FinalDeathSpecs2-22-05.pdf ) 13

14. Laminated instructions 2 separate pages of instructions Purpose: To provide certifiers with a quick and handy reference 14

15. Handbooks and other publications NCHS handbooks Series report CAP manuals Journal articles 15

16. Handbooks Text, instructions, examples Purpose: To provide more detailed instructions tailored to physician or medical examiner and coroner 16

17. Other publications Text, instructions, examples Purpose: To distribute instructions and examples in medical professional’s own language differently

18. Exhibit Main panel, 4 table top panels, variety of educational handouts Purpose: To bring and distribute training materials directly to certifiers and to educate them about the importance of accurate cause-of-death certification 18

19. Illustration: Old Exhibit Display 19

22. Some Exhibit Locations American College of Physicians American Academy of Physicians American Society of Internal Medicine American Public Health Association American College of Cardiology American Society of Clinical Oncology National Medical Association National Association of Medical Examiners National Association for Public Health Statistics and Information Systems American Geriatrics Society American Academy of Family Physicians National Funeral Directors Association 22

23. Training Presentations Tailored instructional presentation and power point Purpose: To train certifiers 23

24. Web Page Links to training resources Purpose: To help disseminate information URL: http://www.cdc.gov/nchs/ about/major/dvs/handbk. htm

25. Thank you for your attention.