Death Certificate Surveillance in New Hampshire

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Death Certificate Surveillance in New Hampshire

• Christopher S. Taylor
• International Society for Disease Surveillance
• Indianapolis, Indiana
• 10 October 2007

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Why Death Certificate Surveillance?

• Death is the most serious outcome of disease

• Clinical causes of death are known

• Enhanced monitoring of Influenza-related illness

• Disease control measures can be quickly initiated

• Medical provider contact information known
• Family / Informant reported

-Public Health Emergency Preparedness Grant (USA)

• Appendix 11 Surveillance/Laboratory Level I
  III
• Appendix 12 Surveillance/Lab Exercise
  Objectives

Ensure that the most serious disease threats are
investigated
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Death Surveillance System

• Logic Model and Data Flow

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Logic Model
Does death suggest a communicable disease threat?
Weekly Surveillance Meeting
Outbreak Team Meeting
No further investigation required
No
Initiate Disease Control investigation
Is there a significant health risk?
Yes
Yes
No
Yes
Do several deaths suggest a cluster?
Yes
Unexpected activity ?
Common pattern?
Yes
No
No
No
No further investigation required
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Data Flow
Death
Pronouncer
New Hampshire Department of State
New Hampshire Department of Health and Human
Services
Certifier
Data Warehouse
Disease Surveillance
Funeral Home
Bureau of Vital Records
Disease Control
Burial
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Important Facts to Remember

• Death certificates are filed electronically by
  funeral home directors

• Electronic tools are used monitor for
  communicable disease and other public health
  threats

• Deaths are reviewed in aggregate, and individually

• Death certificates are filed within days of the
  death

• Data is available for surveillance within 24
  hours of filing

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Death Surveillance Software

• New Hampshires Solution

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Keywords and Conditions

• Keywords and conditions form the core to New
  Hampshires Death Certificate Surveillance efforts

KEYWORDS specific words, or word combinations
found on a death certificate
CONDITIONS Groupings of related words (e.g.
sepsis, septicemia, bacteremia, viremia, blood
poisoning)
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Death Surveillance Conditions

• Related keywords
• Alternate spellings

• 84 Conditions
• 500 Keywords

10
Simple Navigation
All features are accessed from a single screen
11
Customizable

• Introduce new conditions when needed
• Maintain keywords with ease
• Clinical terminology
• Misspellings

12
Detection
13
Modified Shewhart Control Chart Alerts
Alert Levels 3 Sigma, 95 Confidence
Interval Alert Time Intervals Daily, Weekly,
Monthly Geography Levels Residence Town, Death
Town, Death Location, Residence County, Death
County Counts Actual Expected Drill Down
Capacity
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Manual Review of Select Deaths

• Rule out Communicable Disease threats
• Embedded Google search capability reduces review
  time for unusual medical terminology

15
Complete Death Certificate Access
Review Death Certificates instantly

• Causes of death
• Geography
• Informant (often next of kin)
• Certifier name, license number, and address
• Occupation, and Employer
• Disposition place and method
• Medical examiner status and indication of autopsy
  findings
• Personal information (ethnicity, residence
  address, parents names, etc.)

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Ad Hoc Analysis

• Custom investigation and analysis made easy

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Ad Hoc Analysis
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Ad Hoc Analysis

• Features
• Filter by category
• Filter by geography
• Filter by date range
• Optionally exclude rule-out cases
• Export to MS Excel for additional analysis

• Enhance
• Investigations
• Situation monitoring
• Ad hoc analysis
• Report Types
• Summary statistics
• Line listings

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Reports
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Custom Reports
21
Influenza and Pneumonia Reporting

• Rapidly compare NH influenza and pneumonia
  activity to national levels
• Automated analysis organized by MMWR weeks
• Utilization of MMWR Influenza and Pneumonia
  standards
• Electronic report creation and distribution from
  a single mouse click

22
Results

• How Death Certificate Surveillance has helped New
  Hampshire

23
Efficiency
24
Detections Since 1/1/2003
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Acknowledgements

• Kim Fallon
• Conceptualizing electronic Death Certificate
  Surveillance
• Stephanie Miller
• Negotiating data access with the Bureau of Vital
  Records
• Kenneth Dufault
• Analysis and review of Death Certificates