Kresnowati, Lily and Ernawati, Dyah (2015) A QUANTITATIVE ANALYSIS ON MEDICAL RECORD DOCUMENTS OF SECTIO CESARIA CASES OF JAMKESMAS PATIENTS AS A QUALITY CONTROL EFFORT AT SEMARANG GENERAL HOSPITAL. MIK 2015.
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Abstract
The implementation of INA CBG’s requires a hospital to perform quality control, cost control, and access so that the hospital can be more efficient in managing treatment cost incurred to the patient. Quality control includes data presentation of complete medical record documents which covers quantitative and qualitative review analyses. The benefit of a good medical record has is that it enhances the health service administration which records documents related to patients’ health. This research is aimed at analyzing the quality of medical records quantitatively based on the four aspects namely identification, reporting, recording, and authentication of Jamkesmas patients especially those who had sectio caesaria cases at Semarang General Hospital. The research is an archiving one by employing observation method. The method was conducted by examining the completeness of 71 medical records of sectio caesaria cases of Jamkesmas patients at Semarang General Hospital. The data were then analyzed descriptively based on the four aforementioned aspects supported by qualitative data obtained from FGD. The result shows that the identification review is 91.55% complete (8.45% is incomplete), reporting review is 90.14% complete (9.86 % incomplete), recording review is 90.14% complete (9.86% incomplete), and authentication review is 90.14% complete (9.86 % incomplete). It can be concluded that the medical record documents of section cesaria cases of Jamkesmas patients at Semarang General Hospital is categorized as good since the percentage of all review aspects is more than 90% which approximates the standardized ideal percentage of 100%. However, since there are still incomplete DRMs, it is suggested that medical record officers, medical officers, and paramedics cooperate actively in completing medical record data especially on the aspects of recording, reporting, and authentication. Key words: medical records, quantitative analysis, quality control
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