Abstract
New Zealand’s mortality review information system (MRIS) supports both local and national mortality review processes for the Child and Youth Mortality Review Committee (established 2001) and the Perinatal and Maternal Mortality Review Committee (established 2005). This study identifies the process used to compile national mortality review statistics by examining pertinent information available from the Ministry of Health, data suppliers and the data manager. The use of internal documents and data files facilitated description of the information sources and data supplied (2002 to early 2009), as well as the data integration and secure storage processes, website development and reporting for the committees.
Five government agencies, one government funded agency, coroners and Lead Maternity Carers are main sources of information. Coordinators in District Health Boards contribute further information after local review of an individual death. All information is linked to entries in the MySQL database death register. Lead maternity carers and families can add information to the database via an applicable web application. Two further web applications allow coordinators to search, view, update and produce summaries. One committee predominantly reports basic information saved in the death register whereas the other reports on all data collected on its questionnaires, using a classification assigned by local review and validated by national audit.
Although the committees have reported statistics from the MRIS, the accuracy of these had not been established. Comparison of publicly available information revealed that official statistics were similar to Child and Youth Mortality Review Committee published deaths for the period 2002-2005. Death registrations are the primary source for official mortality statistics. Whereas the Ministry of Health and Statistics New Zealand report on deaths registered in a calendar year, the MRIS reports deaths that occur in a calendar year. A comparison of the 2002-2007 deaths recorded in the Ministry of Health Mortality Collection at 31 August 2008 and in an MRIS backup from 5 September 2008 revealed there were 27 deaths missing from the MRIS (22 in 2006) and up to 333 missing from the Mortality Collection (predominantly stillbirths). These comparisons suggest the MRIS is a credible research resource.
Examination of the evolution of the MRIS (in the context of international multi-agency mortality review) allowed opportunities for improvement to be identified. Whereas information from some sources is complete or near complete, availability of information from other sources is inconsistent. There is a pattern of incomplete projects as system development occurs in response to continual external change and evolution of mortality review processes. Production of timely, reliable, accurate reports is not yet possible. Creating a single prioritisation process, allowing time to revise the data structure and complete documentation would improve the MRIS. Future development should continue to use technology to minimise the manual workload of coordinators, utilise national information sources (including a potential national birth health dataset) and ensure there is a good match between electronic and manual processes, and desired mortality reduction outcomes.