Accurate reporting on causes of death has direct impacts on mortality data, policy making, and setting priorities in public health. A Penn State-led project aims to educate coroners, medical examiners, and others in the death certifier community in Pennsylvania about the reporting of accidental overdoses due to substance use to help local governments better respond to public health issues.
The Death Certifier Education Project was developed by an interdisciplinary team and includes a novel use of the Extension for Community Health Outcomes (ECHO) model for death certifiers in Pennsylvania. The ECHO model develops knowledge-sharing networks, led by expert specialist teams mentoring multiple community providers.
“The training focuses specifically on some of the main challenges in the death certification process, including key reminders for drug-related deaths and uniformity of language in the causes of death,” said Glenn Sterner, assistant professor of criminal justice at Penn State Abbington, a faculty affiliate of Criminal Justice Research Center, and a co-funded faculty member of the Social Science Research Institute‘s Consortium on Substance Use and Addiction.
According to Sterner, death certificates can contain errors that affect the estimation and understanding of key population health indicators. Pennsylvania has a decentralized system for death certification, with elected coroners and medical examiners appointed at the county level. “Additionally, due to the recent opioid epidemic and the COVID-19 pandemic, death certifiers have faced unique challenges that may be difficult to overcome,” said Sterner.
The issue is important, because timely, accurate death information ensures that local, state, and federal responses to public health and criminal justice issues are effective, efficient, and appropriately targeted, Sterner added.
The need for a training model that specifically works to address these issues for death certifiers was initiated through a request from the Pennsylvania Department of Health (PADOH). Penn State, in collaboration with the PADOH, assembled an interdisciplinary team of implementation experts from the National Nurse-Led Care Consortium and subject matter experts, to develop the model.
The model includes first connecting with key stakeholders to identify needs, then identifying content to meet these needs utilizing a three-pronged delivery strategy (live virtual trainings, online asynchronous trainings, and in person trainings). Feedback from the live trainings will be used to adjust the delivery of content to meet participant needs.
The team then hosted several meetings with PADOH and the Pennsylvania State Coroners Association to learn about the complexities of death certification and drug overdose in Pennsylvania.
“We developed and fielded a survey to assess the needs of the death certifier community in Pennsylvania,” said Sterner. “Based on this assessment, our team designed a training program for death certifiers addressing the identified needs. This included requiring multiple modes of engagement with training content and connection with other death certifiers delivered in three different components that included online training sessions and daylong in-person training sessions.”
The team then gathered feedback from participants and other stakeholders to inform the design and delivery of training sessions. The results from the program evaluation were recently published in the American Journal of Managed Care.
“The project was comprised of a large collaboration of interdisciplinary researchers from many different Penn State units working together, including various departments, Project ECHO, Penn State Health, the Criminal Justice Research Center and the Consortium of Substance Use and Addiction,” Sterner said. “The success of the program is a direct result of being able to maximize the units and research expertise across the Penn State system.”
In the future, Sterner would like to duplicate the project and work with the larger death certifier community, which, in addition to coroners and medical examiners, also includes medical doctors and nurse practitioners.
“The in-person sessions provided us with great conversations with participants and enabled us to learn more about the complexity of the death certifier community and how to address these audiences for future trainings,” Sterner said. “We need to conduct more outreach to the non-coroner certifier community and engage them in these types of trainings so data collection accuracy will improve and education projects like this one will have even greater impact.”
Other researchers on the project include Yunfeng Shi, associate professor of health policy and administration; Kelly Wolgast, assistant dean for outreach and professional development in the College of Nursing; and Varidhi Duggal, graduate teaching assistant, all from Penn State; Kristine Gonnella, senior director of strategy development at Public Health Management Cooperation; Elaine Arsenault, research associate at the Criminal Justice Research Center; and Penn State students Laina McInerney, Hannah Earley and Isabella Rater.
The DOH provided funding for this project. Seed grants from Penn State’s Criminal Justice Research Center and the Social Science Research Institute led to the successful grant proposal.