Crisis Cooperative Agreement from Centers for Disease Control and Prevention

93.391 - Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises

Project Name: NNPHI Emergency Technical Assistance and Coordinated Hub Services (TACHS)

We would like to express our gratitude by acknowledging the contributions of the Puerto Rico Death Certification Working Group who developed this curriculum:

María M. Juiz Gallego, MPHE, CHES (1), Jessenia D. Zayas-Rios, DBH, MPHE, CHES (1), Ishi Maldonado Fonseca, BA (1), José A. López Rodríguez, MS (1) Lyvia A. Álvarez, MD, MRO (2), Tesfaye Bayleyegn, MD (3), Elizabeth Carter, MPH (4), Lee Anne Flagg, PhD (5), Ginel Rodriguez, MD (6), Olga Rodriguez de Arzola, MD (7), Ana-Luisa Davila, PhD (8), Veronica Rodríguez, MD (9), Waleska Crespo, PhD (10), Jorge Acevedo Canabal, MD (11), Isabela Kaser, MPH (12), Marcy A. Barnett, CEM, REHS, MEP (12), Melanie Rodríguez, MHSN (13), Lizmariel Tirado, MS (13), Sara Miller, MPH (13), Martín Montoya-Zavala, PhD (13), José Rodríguez Orengo, PhD (13), and Leslie Maas Cortés, MHS (13).

1) Quality and Vital Statistics Division, Puerto Rico Department of Health

2) Anatomical and Forensic Pathology, Office of the Medical Review Officer and Consultant

3) National Center for Environmental Health, Centers for Disease Control and Prevention

4) Tanaq Government Services, LLC

5) National Center for Health Statistics, Centers for Disease Control and Prevention

6) San Juan Bautista, School of Medicine

7) Ponce Health Sciences University, School of Medicine

8) Program of Demography, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico

9) Puerto Rico Board of Licensure and Medical Disciplines

10) University Central del Caribe School of Medicine

11) University of Puerto Rico School of Medicine

12) National Network of Public Health Institutes

13) Puerto Rico Hurricane Response Hub Technical Assistance Center, program of the Puerto Rico Public Health Trust at the Puerto Rico Science, Technology and Research Trust

Suggested Citation:

Puerto Rico Death Certification Working Group. Certification of Death with an Emphasis on Disaster-Related Deaths: A Curriculum developed for the Jurisdiction of Puerto Rico. August 25, 2020; Material intended for training and capacity building use in the Public Domain

Development and Training of Death Certificate Working Group for the training of Medical Professionals in Puerto Rico:

It is important that the information on the death certificate is communicated on time, complete and accurately. This information is vital for grieving families, clinical practice, and public health. Tracking disaster-related deaths is critical to inform the public health answer and allow surviving family members to obtain benefits. As Puerto Rico is now facing the COVID-19 pandemic, recovering from a series of earthquakes, as it prepares for hurricane season, accurate and timely notification of deaths will be even more crucial.

Recognizing the importance and need to provide official training to medical certifiers to improve the quality of mortality data, in early 2019 the Demographic Registry of Puerto Rico Department of Health held a series of training sessions for Doctors on how to correctly complete the cause of death section on a Death Certificate. In order to extend the scope of this educational effort, the Death Certificate Development and Training Work Group was created, as a collaborative effort led by the Technical Assistance Center of the Puerto Rico Hurricane Hub, a program of Puerto Rico Public Health Trust (PRPHT); both part of Puerto Rico Science, Technology and Research Trust (FCTIPR).

The group is consolidated by the Demographic Registry of the Puerto Rico Department of Health, the U.S. Demographic Registry, the Virgin Islands Health Department, the Puerto Rico College of Doctors and Surgeons, the Puerto Rico Medical Licensing and Disciplines Board, The School of Nursing of the University of Puerto Rico, Institute of Forensic Sciences of Puerto Rico, Professional Association of Funeral Directors, Regional Schools of Medicine, School of Medicine of San Juan Bautista, University of Health Sciences of Ponce, School of Medicine from the University of Puerto Rico and the Central University of the Caribbean, among others.

The role of this Work group is to address capacity building needs and the development of an online course to train doctors with the goal of accurately and consistently completing a death certificate in Puerto Rico. This initiative is funded by the Centers for Disease Control and Prevention (CDC) through the National Network of Public Health Institutes (NNPHI) and it is closely aligned with the existing training and tools of the National Center for Health Statistics of Puerto Rico. This project is designed to help medical certifiers to complete an accurate death certificate and is intended to fill gap by offering content in Spanish.

Why is it important for doctors to consider the causes of death?

The more accurate and detailed the information on death certificates, the better our ability to understand, prevent, and treat disease. Here are the three reasons why doctors should consider how to report the causes of death:

1) To honor the deceased patient and help the patient's family to understand death better and find closure. It also allows survivors to obtain their life insurance or funeral benefits.

2) Death certificates are one of the main sources of public health surveillance data. This information is often our first alert to big threats like the opioid overdose epidemic.

3) Accurate and specific cause of death information helps to direct the funding for clinical and biomedical research and public health programs to the right places, wth impact in the diseases we study and how we can best prevent or treat them.

Impact and need for this Course of Death Certificate for Puerto Rico.

The Work group is developing a death certification training curriculum in Spanish and incorporating it into medical, nursing and funeral director education programs. Work is also being done to make the course a requirement for the licensing of the respective professional boards. This training curriculum will be offered as an online course as part of the Virtual Learning Academy of the “Puerto Rico Hurricane Hub” and the user will be able to have access at their convenience. In addition, it will include a series of additional virtual and in-person training sessions (when allowed in the current COVID-19 situation), which will complement the content of the online courses. The aim of this initiative is to improve the understanding of causes of death after emerging events to develop more effective risk mitigation plans for areas that frequently experience disasters, as well as to improve reporting of causes of death in general.

References

Flagg, LA, Braun PA, Alexander JL, Anderson RN. Certificados de defunción: Las nuevas herramientas facilitan la tarea difícil.Medscape. 8 de noviembre de 2019. Disponible en:https://www.medscape.com/viewa....

This project is funded by the National Network of Public Health Institutes (NNPHI) through a collaborative agreement with the Centers for Disease Control and Prevention (CDC). Grant 3 6 NU1ROT000004-01-05. Crisis Cooperation Agreement 93.391 - Activities to Support the response of the State, Tribal, Local and Territorial Health Department (STLT), to Public Health or Health Care Crisis: NNPHI Emergency Technical Assistance and Central Coordinated Services (TACHS).

General Goals

At the end of the course, participants will be able to:

• Recognize the importance of the correct and accurate report of death causes and list the uses of mortality data obtained from Death Certificates.
• Gain knowledge of best practices to complete the cause of death section of the Death Certificate.
• Understand the difference between the immediate cause of death and the basic or underlying cause (UCOD - Underlying Cause of Death).
• Determine the most effective practices for documenting the clinical details of death.
• Demonstrate how to properly report causes of death.