Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

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Abstract Background The majority of deaths read more in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial.MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death.We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.Method We conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse.

MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire.Auto-Analyse then presented the MHO with the three most likely causes of death.For the pilot, the intervention was scaled-up to 91 municipalities.We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.

Results Of the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%).For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative.When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the getpureroutine.com cause of death.Only 13% of the deaths under the intervention had an undetermined cause of death.

Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.Conclusion Standardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths.