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To the Editor.—Because of imposed budget reductions, the National Center for Health Statistics (NCHS) in 1995 ceased to collect the item indicating whether an autopsy was performed (item 28a reported on the US Standard Certificate of Death) for its national mortality statistical database.¹ The NCHS purchases mortality data from the states and pays each state for data based in part on the state's calculated cost of data entry (keystrokes). Thus, eliminating the purchase of specific data items from states is one way to reduce NCHS's expenses.

Elimination of the autopsy data item poses problems related to performance measurements, compliance, and national data analysis. Some of these problems are as follows:

• Compliance with sudden infant death syndrome diagnostic criteria, which require autopsy performance.²
  
• Measurement of autopsy utilization rate in general—a significant indicator of the quality of medical care.
  
• Measurement of the degree of confidence that can be placed in the . . . [Full Text of this Article]

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