Verbal and Minimally Invasive Autopsy in the State of São Paulo: Improvement and implementation of new tools to support the public policy for investigating causes of death in the SUS

• Grant number: 23/10185-0
• Support Opportunities: Research Grants - Research in Public Policies
• Start date: April 01, 2024
• End date: March 31, 2028
• Field of knowledge: Health Sciences - Medicine - Pathological Anatomy and Clinical Pathology
• Principal Investigator: Luiz Fernando Ferraz da Silva
• Grantee: Luiz Fernando Ferraz da Silva
• Host Institution: SERVICO VERIFICACAO OBITOS CAPITAL/USP
• Associated researchers: Ana Luiza de Souza Bierrenbach ; Carmen Diva Saldiva de André ; Catia Martinez Minto ; Lucia Pereira Barroso ; Luiz Alberto Amador Pereira ; Maria de Fatima Marinho de Souza ; Marisa Dolhnikoff ; Paulo Afonso de André

Abstract

The accurate definition of causes of death is a crucial element for feeding mortality information systems. The Brazilian Unified Health System (SUS) has a network of Death Verification Services (SVOs) that aims to improve the identification of these causes of death, but the coverage of this network is irregular. Considering the difficulties and limitations of resources for implementing many SVOs, various instruments have been used to estimate the cause of death, such as Verbal Autopsy (VA) questionnaires and Minimally Invasive Autopsy (MIAs).Since 2017, the São Paulo State Health Department (SES-SP) and the University of São Paulo (USP) have developed partnerships to improve the quality of mortality data, including the validation of the Verbal Autopsy questionnaire and its emergency implementation during the COVID-19 pandemic. Given the relevance of this public policy (PP) and the improvement of data quality in regions without access to conventional autopsies (AC), we propose this project to enhance this PP.The current proposal includes an Ongoing Public Policy (PEX) called "Mortality Information - ill-defined causes" and aims to improve information quality by complementing this PP with the application of new methodologies (VA and MIA) in regions with limited access to conventional autopsiesFrom a scientific perspective, this project is an "Analysis, redesign, monitoring, or evaluation of the PP," with an assessment of the use of VA and MIA as regional calibration, their role in enhancing the PP, and improving data quality.The interface between these two objectives involves training teams in different techniques (VA and MIA) and the discussion of data obtained to align the scientific and management objectives of the present proposal.The project and PP managemente will be developed in 5 phases:1 - Selection of pilot regions for implementation and impact assessment. 2 - Development of computerized and operational strategies and tools for local application. 3 - Training of teams and professionals involved. 4 - Application of defined tools in the selected regions and monitoring their implementation. 4 - Expansion of the public policy to other regions where there is a need to improve death information.In parallel and aligned with the management steps, the necessary methods will be developed to meet the scientific objectives for each phase, including: 1-data collection and generation of basic mortality information from secondary sources; 2-specific analyses for each micro-region to facilitate discussions between state and municipal managers, and the establishment of a flow for data integration and research; 3-development of materials and implementation of training for the teams with impact evaluation; 4-evaluation and comparison of mortality information obtained through VA in this phase with previous data from the same regions and current data from regions where the tools have not been implemented. MIAs will be used to calibrate VA through a reassessment after obtaining MIA results; 5-additional data from secondary sources associated with the data obtained in phase 4 will be analyzed to support the evaluation of the possibility of implementing these tools in other regions.The main expected results are:1-Improvement of the public policy for mortality information through VA; 2-Enhancement of VA results through regional calibration by MIA; 3-Creation of a structured plan for the implementation of VA and MIA to be used in other regions of the state; 4-Computerized system for collecting VA information; 5-Training of human resources directly involved in the PP application and formation of multipliers; 6-Solid scientific contribution, particularly regarding the potential use of MIA as an enhancer and calibrator of VA. (AU)