Mortality Use Cases of ICD-10

in Thailand2000-2013

Wansa PaoinThai WHO-FIC CC

6th WHO-FIC APN Meeting, Bangkok, July 17-19, 2013

Implementation of ICD in Thailand

• 1950 ICD-7 for mortality statistics

• 1963 ICD-8• 1980 ICD-9• 1994 ICD-10

Pattern of death and preventions

Period Leading cause of death

Interventions

1950 to 1965

Infectious Diseases

Vaccination, Mosquito controls, Sanitation

1966 to 1980

Road Traffic Accidents

Helmet and seat belt wearing laws, Improvement of Road & Highway condition, Campaign for “No drink and drive”

1981 to 1999

Cardiovascular Diseases

Campaign for regular exercise, Diet and obesity control, Regular health check-up

Vital Registration in Thailand

• Birth and Death Registration–Ministry of Interior

• Mortality Statistics–Ministry of Public Health

• No problem in coverage rate (completeness) of registration (98-100%) since 1995

• Major problem was “quality of cause of death”

Evidence and Information for Policy WHO 1999

Proportion of ill-defined deathsTHAILAND

HAITIHONDURAS

DOMINICAN REPUBLIC

EL SAVADORSURINAMESRI LANKA

BRAZILEGYPT

NICARAGUAVENEZUELA

SOUTH AFRICAECUADOR

YUGOSLAVIAPANAMA

ALBANIASEYCHELLESGUATEMALA

PERUBAHRAIN

REPUBLIC OF KOREA

PORTUGALMAURITIUS

JAMAICATFYR Macedonia

COLOMBIAPHILIPPINES

FRANCE

0

0 0.1 0.2 0.3 0.4 0.5

Sources of cause of death data

Mortality data classified by place of death

Death outside hospitalDeath inside hospital70 %

Senility, Syn-cope, Fever …

Cardiac arrest, Respiratory

failure …

30%

Improvement of mortality data quality from hospital

1. Implementation of international form of medical death certificate - 1999-2001 AD.

2. Create manual for doctor to write death cert.

3. Retraining of medical doctors 1999-2004

4. Add “How to write good medical death certificate?” into medical school curriculum – success in 2000

5. Introduction of yearly orientation course for newly graduated medical doctor in every province

Improvement of mortality data quality from outside

hospital1. Pilot study on “possibility” to assign medical doctors in public hospital to write “cause of death” in death certificate from outside hospital – 2001-2002 (failed)

2. Researches on feasibility to use “verbal autopsy” for quality improvement of cause of death (outside hospital) 2003-2006

3. Pilot study to add verbal autopsy as a tools to improve quality of cause of death data 2007-2010 in sixteen provinces

System Change

• Old system–Direct death report to local

registration office• New system

–Cause of death verified by local health office before reporting to local registration office

–Pilot test in 16 provinces–Plan for fully implementation 2012-

2013

Proportion of ill defined death

Proportion of ill defined death0

10

20

30

40

50

60

70

80

90

100

199920052010

Change in pattern of causes of death

(non communicable disease)

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 20060

102030405060708090

6.2 5.6 6.1 6.4 5.65.8

5.3 7.74.9

5.55.4

28.121.4

13.118.9 21.4 20.8

21.5 20.4 19.8 17.8 16.7

50.543.4

48.7

58.663.9

68.473.3

78.9 81.3 81.4 83.1

10.5 9.97

10.8 13.4 18.2 21.4

29.126.7 25.3

20.6

77.471.1

63.5

49.9

31.9 30.3 24.627.7

30.8 28.228.3

5.13.4

3.3 4.9 5.56.3

5.1 5.44

3.9 3.8

HomicideTransport AccidentNeoplasm

Current Activity-2013

• Intra-hospital Death, Cause of Dead Verification and report–Web Service to verify causes of death

input into the dead certificate by doctor

• Intra-hospital Death, Cause of Dead report–Cause of death verified by local

registration officer using verbal autopsy (Thai version)

–Full implementation 2014

Lesson learned from 10+ years experiences

• 4 Key success factors• 1. Change management of all key-

persons involving in health information system–Executive groups in Ministry of Health

and Ministry of Interior–All medical doctors–All medical schools committee–Verbal autopsy team – public health

workers

Lesson learned from 10+ years experiences

• 4 Key success factors• 2.Co-operation with all

stakeholders organization in the country–Ministry of Health–Ministry of Interior–All Medical Schools–All Public and Private Hospitals–All Health Offices

Lesson learned from 10+ years experiences

• 4 Key success factors• 3. Creation of new leaders in all

level–Doctors as trainers for new doctors–Verbal autopsy leaders–Provincial health executives

Lesson learned from 10+ years experiences

• 4 Key success factors

• 4. Just Keep Going !