台灣地區死因統計準確度評估(Ⅱ)：死亡證明書高頻率開具者特徵分析

Evaluating the Validity of Cause-Of-Death Statistics in Taiwan (Ⅱ): Characteristics of High Frequency Death Certificates Certifiers

呂宗學(Tsung-Hsueh Lu) ； 石台平(Tai-Ping Shih) ； 賴華山(Hwa-Shan Lai) ； 李麗雪(Li-Shu Lee) ； 李孟智(Meng-Chih Lee) ； 周明智(Ming-Chih Chou)

《中華公共衛生雜誌》 16卷3期 (1997/06) Pp. 273-279

https://doi.org/10.6288/CJPH1997-16-03-08

摘要

本研究分析死亡證明書高頻率開具者特徵及死因診斷品質，提供改善死因統計品質計畫擬定參考。本研究分析民國83年台灣地區的死亡證明書111,927張。研究結果發現一年開具一百張以上者共110位，佔總開具人數0.67%，但所開具的死亡診斷書總張數卻有28,796張，佔總張數22.47%，這些少數高頻率開具者對台灣死因統計品質有重要影響。高頻率開具者特徵為：年紀較長、較高比率為甄試特考出身、較多為一般科且大多數在非敎學醫院及診所服務。死因診斷形式錯誤率，高頻率開具者較高。之所以會出現少數超高頻率開具者，可能是因為台灣特殊的「行政相驗」制度所造成，本文也針對行政相驗的可能缺失提出檢討與改進建議。

關鍵字

死亡證明書 ； 死因 ； 生命統計 ； 醫師行為

並列摘要

This study describes the characteristics of high-frequency death certificate certifiers and the quality of their cause-of-death diagnoses in order to provide information for designing a program to improve the quality of cause-of-death statistics. In Taiwan, there were 111,927 death certificates issued in 1994 and the frequency of death certificates issued by one certifier a year was highly skewed. One hundred and ten doctors issued more than 100 death certificates a year. They comprised 0.67% of all certifiers, but the death certificates issued by them accounted for 22.47% of all death certificates. These certifiers had great influence on the quality of cause-of-death statistics in Taiwan. Most of these high frequency certifiers were: older in age, not graduated from medical schools, general practitioners and served in non-teaching hospitals or clinics. The percentage of formative errors on cause-of-death diagnoses was higher for high-frequency certifiers as compared to low-frequency certifiers. The special ”administrative certification” process in Taiwan is the reason for the large number of high-frequency death certifiers. The defects of this system are discussed and some proposals for improvements are raised in this study.

並列關鍵字

death certificate ； cause-of-death ； vital statistics ； physician behavior