1. A proposal for an evaluation for mortality coders Education Committee meeting May 2006 Cassia Maria Buchalla

2. Background Education Committee Meeting 2005 –exam Brazilian Center volunteer WHO-FIC Meeting 2005 – MRG volunteer to test the set December 2005 – Brazilian Center sent the set to MRG April 2006 – answers from 8 people/groups

3. Background 100 death certificates and –abbreviation list for selection rules –scale for classification of the DC (level) –proposal form for the applicants –answer form sheet Mortality Reference Group –answers and suggestions

4. Abbreviation list Notes NeoMalignant Neoplasms Notes OpOperations Notes for interpretation of entries of causes of death RFRule F RERule E RDRule D RCRule C RBRule B RARule A R3Rule 3 R2Rule 2 R1Rule 1 GPGeneral principle abbreviationsDescriptions

5. Scale for the level of difficulty 1 -for very easy 2 -for easy 3 -for medium difficult 4 -difficult 5 -very difficult

6. Answer Sheet

7. Method Analysis related to the UC Analysis for rules applied Suggestions for the forms (answer and applicant) Comments on the exam, the set, etc

8. Results All answers agree in 43% - in 3 the agreement was only at category level Rules used to select the UC were: –GP alone in almost 50% –Rule 1 and Rule C –Rule 2, malign neoplasm, rule 3 and notes on operation

9. Results There was a scale for the level of difficulty from this 43 Death certificates: N= 43 % 1 (very easy) and 2 (easy) 2558.1 > 2 to 3 (medium difficult) 1534.9 > 3 to 4 (difficult) 3 7.0 > 4 to 5 (very difficult) 0

10. Results From the 57 that were not completely agreed N= 57 % 1 (very easy) and 2 (easy) 1322.8 > 2 to 3 (medium difficult) 3459.6 > 3 to 4 (difficult) 10 17.5 > 4 to 5 (very difficult) 0

11. Results From the 57 cases we did not agree completely –suggestion to exclude 5 cases (# 13, 34, 8, 87, 100) –12 hours and 25 minutes to complete all set

12. Results Comments on the wording - a new file Comments on the answer sheet - it was only for the evaluation of the set. We have got many interesting suggestions for this form. Comments on the form for the candidates - new file (3apresentaçao formulario.doc)

13. Answer Sheet What ICD version do you use to fill this?...............

14. Suggestions The exam must refers to both UC and multiple cause coding; We will have to enlarge it to include examples of Rules B and E, more Neoplasm, include time information; Should it include abbreviations? More than one version of exam available People will have some time to answer and send to the group (how long?)

15. Next steps The rules used will be analyzed The set will be present regarding their level of difficulty and rules applied To include more DC in which rules not covered in this set are applied To repeat this trial to got a number of sets of DC

16. Final Comments Translation problems – the exam should be offered in many languages How to deal with the differences among the diseases panorama that differs from country to country? It is a challenger to make an international exam How the exam will be done (by internet, on line, by mail, etc) How many set of questions (versions of the exam) should we have?