Table 1 Key features of the Million Death Study
Feature | Purpose |
|---|---|
DESIGN | |
Random sample of deaths surveyed | Ensures results are representative of India (based on rural and urban strata for major states, and at the state level for smaller states) |
Continuous enumeration of deaths and births | Ensures follow-up of the same houses to enable prospective analyses of risk factors (such as education, smoking and alcohol), and familiarity by households to the SRS field staff |
FIELD PROCEDURES | |
3% to 5% random household resample of deaths by independent team | Quality check on the reliability of data, and is a disincentive for faulty field work |
Structured survey questions, half-page local language narrative, and guiding cardinal symptom lists | Guides surveyors to fully capture chronology of key symptoms by age group, so as to aid physician diagnosis |
Extraction of VA field data into web-based reports for coding | Concise reports increase speed and efficiency of coding, custom extraction of data retains confidentiality |
PHYSICIAN CODING PROCEDURES | |
Independent, anonymous and random physician double coding (stratified only by language) | Increases cross-state comparability (in particular for about half the records which are recorded in Hindi or English), and decreases local biases in coding |
Web-based centralized medical coding application, with logical checks, clinical guidelines, and differential diagnoses | Coding application with a user interface which includes searchable ICD-10 codes, standardised clinical guidelines and differential diagnoses, age/sex restrictions (for example, no cervical cancer in males, or senility before old age), and highlighting of keywords; increases the speed, repeatability, and quality of coding versus a paper-based system |
Reconciliation and adjudication stages for coding disagreements | Double coding with reconciliation and adjudication helps train new coders on correct use of coding, is a check on coding quality, and a disincentive for faulty coding |
Financial incentives for quality of coding | Payment is made per record that has cleared the reconciliation stage rather than per code assigned, thus decreasing incentives for random or faulty coding |
Online recruitment and e-training for physicians (http://www.cghr.org/index.php/training/training-centre/) | Physicians train remotely as their schedule allows and are evaluated before entering the system; increases efficiency and quality of coding |