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it is in everyone's best interest to leverage resources to enable collection of information (Lois Fingerhut, Dan Sosin, Sam Groseclose, Kathleen Toomey).
Physicians are often unaware of the widespread use and value of death certificate data (Jonathan Arden, Lois Fingerhut). If their awareness were increased, they would have greater motivation to code certificates accurately; greater and more sustained training of medical students and residents in filling out death certificates correctly is needed (Robert Anderson, Kathleen Toomey, Steve Hargarten). Working through the Federation of State Medical Boards to mandate more training might be considered (Alan Trachtenberg, Garry Peterson).
The new death certificates issued by NCHS will reinstate coding to indicate whether an autopsy has been performed and whether it was used for the death investigation. Those data elements will be used to monitor trends in autopsy rates. The questions had been deleted in 1995, so there has been a data gap of about 8 years (Robert Anderson, Kurt Nolte).
Despite the good intentions behind nationally based datasets, it is unrealistic to expect coroners and medical examiners to obtain all the detailed information that is needed, because of limited resources (Vincent Di Maio). The first priority of coroners and medical examiners is to serve their jurisdiction, not to do research.
The quality of toxicologic testing, except for alcohol testing, is highly questionable in most jurisdictions (Vincent Di Maio).
Many rural jurisdictions do not perform any toxicologic testing during a death investigation, because they lack resources; that means that national datasets that rely on ME/C toxicologic data are skewed to urban deaths and so are not necessarily representative of the national picture (Steve Hargarten). Also needed is the actual concentration of the toxicant (such as alcohol), not just its presence or absence (Alan Trachtenberg).