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COPD: exacerbations, survival and end of life care
P218 Recording of COPD mortality must improve if it is to be a robust outcome measure
  1. S Ansari,
  2. M Ali,
  3. D J Powrie,
  4. K G Lingam,
  5. A G Davison
  1. Southend University Hospital, Southend on Sea, UK

Abstract

Statistics for chronic obstructive pulmonary disease (COPD) are dependant on local data collection and have an impact on understanding the morbidity and mortality. This can steer the resources and ought to be robust. Inaccuracies in coding can affect the hospital standardised mortality ratio. The Coalition government's “Outline Strategy for COPD and Asthma in England” published in 2011, emphasises the focus on outcomes. We examined in-patient mortality of COPD at Southend University Hospital to confirm the accuracy of the data. The coding department provided a list of patients coded with COPD who died in the hospital during the study period of 1 year (1 April 2009 and 31 March 2010). All death certificates for the same period were reviewed and those with cause of death recorded as COPD identified. The two lists were compared. Five consultant respiratory physicians reviewed the notes, independently recorded the cause of death and compared to death certificates. According to death certificates 77 patients died of COPD, whereas a total of 55 COPD related deaths were identified by the coding department. The later was compared with actual death certificates for corroboration: COPD as a disease directly leading to death (Ia) was recorded in 21, as a disease leading to 1a (Ib) in 11, as a disease leading to 1b (Ic) in none and as another significant condition contributing to death (II) in 8. Two were referred to the coroner, no data available for two and no COPD was recorded in the remaining 11. Of the available 41 notes (from the coding department's list) reviewed by respiratory consultants, COPD as a cause of death in their view was Ia in 13, Ib in 5, Ic in none and II in 10 cases and it was not the cause in the rest. Mortality data from coding, death certification and opinion of auditing senior clinicians exhibited multiple discrepancies. This raises doubts as to the robustness of mortality data. We have identified a need to review the practice including the accurate completion of death certificates.

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