Scientific Substantiation for the Development and Implementation of an Automated System for Registering Mortality (Using Tula Oblast as an Example)

The study is devoted to the development, adaptation, and implementation of an automated mortality-registration system for long-term monitoring and improving the reliability of statistical information on causes of death. It addresses international and Russian experience, the materials and methods of mortality registration, mortality dynamics and life expectancy in Tula Oblast, main causes of death, and organizational and methodological aspects of system operation.

Special attention is paid to automated coding, selection of the initial cause of death, analysis of multiple causes, assessment of the quality of antemortem and postmortem diagnosis, specialist training, and a model of multilevel interaction among organizations. The practical result is a mortality register and a system that relieves physicians of part of these functions and expands the possibilities for data analysis.

Relevance of the Problem

In recent years, the reform of the economy in our country has, regrettably, been accompanied by unfavorable trends in the indicators of population reproduction and, above all, by a decline in the population—depopulation.

Since 1992, when the mortality level in Russia exceeded the birth rate, an acute demographic crisis began that continues to the present day. It is characterized by low birth rates and high mortality. Many studies have addressed the demographic situation in Russia, including the study of mortality (Бедный М. С., 1979; Хальфин Р. А., 1995; Ермаков С. П., 1996; Каманин Е. И., Гринев А. В., Микулич В. Е., 2000; Стародубов В. И., Иванова А. Е., Семенова В. Г., 2003; Стародубов В. И., Михайлова Ю. В., 2003; Медков В. М., 2004 и др.).

In the context of the demographic crisis, one of the important priority tasks for the economy is the study of medical-demographic processes and, above all, mortality, as one of the most reliable indicators of the state of population health.

In contemporary conditions, the mortality-registration system and mortality statistics cannot be regarded as satisfactory and reliable: “Medical Certificates of Death” are completed manually; numerous errors occur in coding and in selecting the initial, or primary, cause of death, which are associated with the transfer of this function to physicians; and a system for training physicians in the correct completion of “Medical Certificates of Death” has not been established.

Unreliable information about mortality, in turn, does not make it possible to assess the situation correctly, plan health care resources, and take appropriate management decisions.

Under the conditions that have arisen, a fundamental change in the situation cannot be imagined without the use of new computer technologies capable of ensuring mortality monitoring, reducing costs, and improving the quality, timeliness, and reliability of statistical information.

The task of developing monitoring systems related to population health was defined by the Government of the Russian Federation Resolution of 06.10.1994 No. 1146, “On the Approval of the Regulation on Social and Hygienic Monitoring,” and by the Concept for the Creation of the State System for Monitoring the Health of the Population of Russia, approved in 1996 by the Russian Ministry of Health and the Committee under the President of the Russian Federation for Informatization Policy. Many studies have been devoted to the creation of monitoring systems (Леонов С. А., 1991; Гапарян С. А., 1991; Киселев А. С., 1996; Кричагин В. И., Вельская О. Б., 1996; Хальфин Р. А., 1997; Соломонов А. Д., 1998 и др.).

An automated information system for monitoring medical-demographic processes is a key stage in the informatization of health care. The need has long been overdue to generalize existing world experience and create an automated mortality-registration system that includes automated coding and automated selection of the initial, or primary, cause of death, thereby freeing physicians from these functions and improving the reliability of statistical information. A promising direction is analysis based on multiple causes of death, analysis of the quality of antemortem and postmortem diagnosis, and modern methods of assessing the state of population health.

The aim of the present study is to develop an organizational and informational system for automated mortality registration that can increase the reliability of population mortality indicators at the level of a constituent entity of the Russian Federation.

Research Tasks

1. Study and analyze the trends in the demographic situation in Tula Oblast.

2. Develop, carry out the adaptation of, and practically test an automated system aimed at improving the quality of completion of death certificates, the quality of antemortem and postmortem diagnosis, and the possibility of analyzing mortality indicators at a modern methodological level.

3. Conduct an additional analysis of mortality according to multiple causes and of losses from premature mortality among the population of Tula Oblast for subsequent development of proposals for adjusting preventive programs.

4. Develop and implement a system for preparing and retraining specialists in the use of the automated mortality-registration system, and prepare instructions and methodological guidelines for working with it.

5. Create a model of multilevel interaction among various organizations and structures in death registration.

Scientific Novelty of the Study

For the first time:

1. At the level of a constituent entity of the Russian Federation, a long-term monitoring system based on automated registration of all cases of death among the population was developed.

2. The use of the automated system made it possible to assess the logical sequence of entries and to select the initial cause of death correctly.

3. Reliable data on causes of death were obtained, enabling the plans of measures directed at reducing them to be specified.

4. The significance of multiple causes of death for assessing the quality of antemortem and postmortem diagnosis of diseases has been demonstrated.

5. A model of multilevel interaction among various organizations and structures in death registration was developed.

Scientific and Practical Significance

The developed and tested automated mortality-registration system made it possible to:

- create a mortality register to support long-term monitoring;

- free physicians from the function of coding and selecting the initial cause of death;

- increase the capabilities of the automated system for improving the reliability of processing up to 99% of records in the database by applying the training system and the “row replacement” block;

- make it possible to assess the state of population health on the basis of reliable statistical information at a modern methodological level, including analysis based on multiple causes of death;

- make it possible to influence improvement in the quality of antemortem and postmortem diagnosis by 27.9%.

Presentation of the Study Results

The main provisions of the dissertation were presented and demonstrated at:

- the International Seminar “Monitoring the State of Population Health and Control of Morbidity,” organized by the Ministry of Health of the Russian Federation in cooperation with the World Health Organization (WHO), the United States Agency for International Development, the United Kingdom Department for International Development, and the World Bank on March 25–26, 2002, in Moscow, at the N. A. Semashko Research Institute of Social Hygiene, Economics, and Health Care Management.

- the Third International Meeting on Issues of Automation of Mortality Statistics (International Collaborative Effort on Automating Mortality Statistics: Third Meeting), organized by the U.S. Department of Health and Human Services, the U.S. Centers for Disease Control and Prevention (CDC), and the U.S. National Center for Health Statistics (NCHS) from April 7–10, 2003, in Washington (United States).

- the International Conference “Automated Systems for Coding Data on Mortality: A Review of the Features of System Design, Implementation, and the Benefits of Automation,” organized by the Open Society Institute (Soros Fund) and the U.S. National Center for Health Statistics (NCHS) in June 2004 in Prague (Czech Republic).

- the Fourth Summer School devoted to public health issues, organized by the Open Institute of Population Health with support from the Open Society Institute and the World Health Organization in July 2004 in the settlement of Kolontaievo, Moscow Oblast.

- the Conference of the Volga-Ural Association of Forensic Medical Experts in September 2004 in Perm.

Main Provisions Presented for Defense

1. A negative trend in the increase in mortality indicators in Tula Oblast that substantially exceeds the mortality indicators in the Russian Federation.

2. Development, adaptation, and practical testing of a system for automated registration of population mortality to create a long-term monitoring system.

3. A model of multilevel interaction among various organizations and structures in mortality registration.