Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification. The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne. The TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles. The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.

中文翻译：

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改善死亡原因的医学证明：基于“健康数据倡议”的经验的有效策略和方法。

准确及时的死亡原因（COD）数据对于制定明智的公共卫生政策至关重要。通常，COD的医学认证可提供人口中大部分的COD数据，并且是民事登记和生命统计（CRVS）系统的重要组成部分。对于医生来说，正确填写死亡原因医疗证明（MCCOD）应该是一个相对简单的过程，但是错误很常见。在这里，我们介绍了在墨尔本大学（UoM）的彭博慈善数据为健康（D4H）计划支持下在五个国家实施的三种培训策略，并评估了对认证质量的影响。评估的三种培训策略是：（1）在菲律宾，缅甸和斯里兰卡的培训师（TOT）培训；（2）在巴布亚新几内亚（PNG）由UoM D4H直接培训医师；（3）在秘鲁实施在线基础培训策略。该评估涉及在培训前后使用墨尔本大学开发的评估工具对MCCOD进行评估。TOT策略使斯里兰卡错误填写的证书减少了28％，菲律宾减少了40％。在对医生进行了PNG的直接培训之后，错误填写的证书减少了30％。在秘鲁，仅在在线系统上实施和培训后，不正确证书的减少率为30％，而在在线系统和基本医学认证原则方面的培训后，错误证书的减少率为43％。这项研究的结果表明，各种培训策略可以对认证质量产生好处，但是可能会进一步改进。D4H的经验表明，应进一步制定策略以改善结果，特别是从干预初期和当地委员会开始，主要利益相关者的参与，以监督活动并支持医院的改善文化，以支持更好的诊断技能和实践。