Improving the Accuracy of Death Certificates

To the Editor. —Recent letters have addressed death certificate errors, prompting a few additional comments.1,2One of us (R.H.) reported that 26% of death certificates for autopsy cases indicated that an autopsy hadnotbeen performed.1Thus, death certificates may not be good indicators of whether an autopsy was performed, but the utility of such "incorrect" information was not noted. For example, if the certifier is unaware of autopsy performance and indicates on the death certificate that an autopsy wasnotperformed, documentation then exists that the stated cause of death was not based on autopsy findings. Such information is important to epidemiologists and researchers. A second letter reported a failed attempt to correct death certificate errors through independent death certificate review, suggesting that other quality improvement measures may be required.2We offer the following illustrative experience and suggest some measures that might be undertaken to make