Effectiveness of the DOH online medical certification of cause of death for licensed physicians on death certificate issued in Philippines Children&#039;s Medical Center from year 2021 - 2024

Robie Angelo  M. Ariola,; Jasmin  A. Castillo,

Effectiveness of the DOH online medical certification of cause of death for licensed physicians on death certificate issued in Philippines Children's Medical Center from year 2021 - 2024

Robie Angelo M. Ariola | Jasmin A. Castillo

Abstract:

OBJECTIVE: This study assessed the effectiveness of the DOH online Medical Certification of Cause of Death (MCCOD) course in improving the accuracy of death certificates prepared by pediatric residents at the Philippine Children's Medical Center (PCMC) from 2021 to 2024. MATERIALS AND METHODS: A total of 976 death certificates (488 pre - and 488 post-training) were reviewed using random sampling. Errors were classified using a modified Myers and Farquhar method. Returned certificates from the Quezon City Civil Registry were analyzed. Chi-square tests and odds ratios were used for analysis. RESULTS: Error rates significantly increased post-intervention (15.98%) compared to pre-intervention (5.94%) (χ2 = 24.077, p < 0.001; OR = 0.333, 95% CI: 0.213-0.520). Major errors were more common post-training. The most error-prone sections were "Immediate Cause" and "Underlying Cause." Common revision reasons included vague diagnoses and improper sequencing. CONCLUSION: Despite training availability, documentation quality declined. More interactive, skills-based training is recommended.

References:

1. Zaki MK, Sobh ZK. Optimum standardization of cause-of-death certification procedures in healthcare facilities: A medicolegal initiative. Forensic Sci Int Rep [Internet]. 2023 [cited 2025 Oct 4];8:100329. Available from: https://doi.org/10.1016/j.fsir.2023.100329

2. Gamage USH, Adair T, Mikkelsen L, Mahesh PKB, Hart J, Chowdhury H, et al. The impact of errors in medical certification on the accuracy of the underlying cause of death. PLoS One [Internet]. 2021 [cited 2025 Oct 4];16(11):e0259667. Available from: https://doi.org/10.1371/journal.pone.0259667

3. Schuppener LM, Olson K, Brooks EG. Death Certification: Errors and Interventions. Clin Med Res [Internet]. 2020 [cited 2025 Oct 4];18(1):21–6. Available from: https://doi.org/10.3121/cmr.2019.1496

4. McGivern L, Shulman L, Carney JK, Shapiro S, Bundock E. Death Certification Errors and the Effect on Mortality Statistics. Public Health Rep [Internet]. 2017 [cited 2025 Oct 4];132(6):669–75. Available from: https://doi.org/10.1177/0033354917736514

5. Azim A, Singh P, Bhatia P, Baronia AK. Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital. J Anaesthesiol Clin Pharmacol [Internet]. 2014 [cited 2025 Oct 4];30(1):78–81. Available from: https://doi.org/10.4103/0970-9185.125708

6. Singh P, Khanna D, Sharma P, Vaza Y, Anand A, Budukh AM, et al. A scoping review on the errors in medical certification of the cause of death in India. Indian J Med Res [Internet]. 2024 [cited 2025 Oct 4];160(1):11–21. Available from: https://doi.org/10.25259/IJMR_498_23

7. Gamage USH, Mahesh PKB, Schnall J, Mikkelsen L, Hart JD, Chowdhury H, et al. Effectiveness of training interventions to improve quality of medical certification of cause of death: systematic review and meta-analysis. BMC Med [Internet]. 2020 [cited 2025 Oct 4];18(1):384. Available from: https://doi.org/10.1186/s12916-020-01840-2

8. Del Mundo MPFA, Dela Luna NYO, Amoranto AJ, Gaspar MJPO, Sumalo JO, Angeles KAT, et al. A PRECEDE-PROCEED Approach in the Advocacy for Computer-based Education on Correct Medical Certification of Cause of Death among Physician-Learners. Acta Med Philipp [Internet]. 2023 [cited 2025 Oct 4];57(8):25–37. Available from: https://doi.org/10.47895/amp.vi0.4639

9. Hart JD, Sorchik R, Bo KS, Chowdhury HR, Gamage S, Joshi R, et al. Improving medical certification of cause of death: Effective strategies and approaches based on experiences from the Data for Health Initiative. BMC Med [Internet]. 2020 [cited 2025 Oct 4];18:74. Available from: https://doi.org/10.1186/s12916-020-01519-8

10. El-Gibaly O, Elela MGMA, Rizk YFA, Mahmoud SHH. Improving medical certification of cause of death in Assiut University Children Hospital: an intervention study. BMC Health Serv Res [Internet]. 2024 [cited 2025 Oct 4];24(1):1506. Available from: https://doi.org/10.1186/s12913-024-11804-4

11. Kasule OHK. Outstanding ethico-legal-fiqhi issues. J Taibah Univ Med Sci [Internet]. 2012 Aug [cited 2025 Oct 4];7(1):5–12. Available from: https://doi.org/10.1016/j.jtumed.2012.07.003