John W. Oswald

Factors associated with reporting multiple causes of death

BackgroundThere is analytical potential for multiple cause of death data collected from death certificates. This study examines relationships of multiple causes of death as a function of factors available on the death certificate (demographics of decedent, place of death, type of certifier, disposal method, whether an autopsy was performed, and year of death).MethodsData from 326,332 Minnesota death certificates from 1990–1998 are examined. Underlying and non-underlying causes of death are examined (based on record axis codes) as well as demographic and death-related covariates. Associations between covariates and prevalence of multiple causes of death and conditional probability of underlying compared to non-underlying causes of death are examined. The occurrence of ischemic heart disease or diabetes as underlying causes are specifically examined.ResultsBoth the probability of multiple causes of death and the proportion of underlying cause compared to non-underlying cause of death are associated with demographic characteristics of the deceased and other non-medical conditions related to filing death certificate such as place of death.ConclusionsMultiple cause of death data provide a potentially useful way of looking for inaccuracies in reporting of causes of death. Differences across demographics in the proportion of time a cause is selected as underlying compared to non-underlying exist and can potentially provide useful information about the overall impact of causes of death in different populations.

Prematurity prevention programs: An analysis of successes and failures

OBJECTIVE Our purpose was to assess the long-term results of established prematurity prevention programs. STUDY DESIGN A population cohort of pregnant women from two major urban health care organizations were examined. Rates and cost-benefit analysis of prematurity and patient, system, or physician failures were analyzed. During 1990 1143 pregnant women were prospectively reviewed. RESULTS A total of 11.8% of the mothers were high risk and responsible for 108 (50.2%) of the preterm deliveries. The preterm birth rate of all enrollees was 4.6%. One percent of the preterm neonates required level III care for complications. The average charge for a 35 week infant was 18 times, and a 36 week infant was five times more costly than a term infant. Patient, physician, and health care system failures occurred at different rates. CONCLUSIONS This preterm prevention program resulted in low preterm birth rates. Potentially preventable preterm births most often occurred as a result of patient and physician failures.

Linking birth certificates with Medicaid data to enhance population health assessment: methodological issues addressed.

This study linked birth certificates with Minnesota Medicaid deliveries in order to identify Medicaid births. This article describes the link between methodology and results. Medicaid claims from 1997 were used to identify women with a delivery code. Identifiers for these women were linked to birth certificate files, with a match rate of 93.2 percent. Womens match status did not differ by maternal age. Women in some border counties matched at much lower rates than the rest of the population. The methodology was effective in linking Medicaid and birth certificate data and will be implemented as a data linkage protocol for Minnesota.

Recommendations for addressing quality and health assessment initiatives in Minnesota.

A recent priority of the Assessment Initiative in Minnesota has been to develop recommendations for addressing quality and health assessment activities in the state. These recommendations consist of a comprehensive array of issues, most of which where there was fairly strong consensus and a few of which where there were differing perspectives among key stakeholders. There are some significant opportunities for advancing quality and health assessment activities in Minnesota in the context of state and national programs in health care and public health.