The Automated Classification of Medical Entities (ACME) system objectively assessed the appropriateness of underlying cause-of-death certification and assignment

Background and Objectives: To assess the feasibility of using the Automated Classification of Medical Entities (ACME) system to objectively define the appropriateness of tuberculosis (TB) related underlying cause of death (UCD) certification and the accuracy of UCD assignment. Methods: All death certificates issued in 2002 in Taiwan in which TB was mentioned were extracted for analysis. Certification of the UCD was defined as inappropriate when ACME used Rule 1 or Rule 2 in assigning the UCD. The assignment of the UCD was defined as inaccurate when the UCD selected by coders was discordant with the UCD selected by ACME. Results: Of the 2,129 death certificates mentioned TB, half (1,067 of 2,129) were inappropriately certified by physicians and 16.5% (351 of 2129) had an inaccurately assigned UCD by coders. The discrepancy rate in UCD assignment between coders and ACME increased when the number of diagnoses increased, TB was listed in Part II, and the certification of UCD was inappropriate. Conclusions: It is feasible to use the process information in ACME to objectively define the appropriateness of UCD certification and the accuracy of UCD assignment. Inappropriate certification of the UCD and TB being listed in Part II were the two most important factors associated incorrect interpretation of the World Health Organization Selection Rules by coders.