ANALISIS PERBANDINGAN KELENGKAPAN DOKUMEN REKAM MEDIS PASIEN PESERTA ASURANSI DENGAN PASIEN NON ASURANSI DI RSUD TUGUREJO TAHUN 2006 ANLYSE THE COMPARISON OF MEDICAL RECORD DOCUMENT COMPLETENESS PATIENT INSURANCE WITH THE PATIENT NON INSURANCE IN RSUD TUGUREJO 2006

LUSWINASIS AA , HURUN'IN (2006) ANALISIS PERBANDINGAN KELENGKAPAN DOKUMEN REKAM MEDIS PASIEN PESERTA ASURANSI DENGAN PASIEN NON ASURANSI DI RSUD TUGUREJO TAHUN 2006 ANLYSE THE COMPARISON OF MEDICAL RECORD DOCUMENT COMPLETENESS PATIENT INSURANCE WITH THE PATIENT NON INSURANCE IN RSUD TUGUREJO 2006. Undergraduate thesis, Diponegoro University.

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Abstract

Ketidaklengkapan dokumen rekam medis menjadi satu masalah karena rekam medis seringkali merupakan satu-satunya catatan yang dapat memberikan informasi terinci tentang apa yang sudah terjadi selama pasien dirawat di rumah sakit. Dari hasil survei awal, ada perbedaan antara kelengkapan dokumen rekam medik peserta asuransi dengan non asuransi, juga menunjukkan rendahnya angka kelengkapan dokumen rekam medik. Tujuan penelitian yaitu melakukan analisis perbandingan kelengkapan pengisian dokumen rekam medis pasien asuransi dengan non asuransi. Metode penelitian yang digunakan adalah survei analitik rawat inap bulan Mei 2006 dengan pendekatan cross sectional study. Sampel penelitian dokumen rekam medis rawat inap bulan Mei 2006 dengan perincian 54 dokumen rekam medik pasien asuransi dan 40 dokumen rekam medik pasien non asuransi. Instrumen penelitian yaitu lembar check list. Hasil dari penelitian yaitu kelengkapan pengisian data identitas baik pada dokumen asuransi maupun non asuransi terdapat pada variabel nama pasien, alamat dan nomor rekam medis. Kelengkapan pengisian data medis untuk pasien asuransi ditunjukkan pada variabel tanggal masuk, diagnosa, dan pengobatan, sedang untuk pasien non asuransi pada variabel tanggal masuk dan diagnosa. Pada data finansial untuk variabel nama penaggung jawab pembayaran tidak diisi sama sekali sedangkan untuk nama asuransi hanya terisi 2%. Pada data sosial baik untuk dokumen rekam medik pasien asuransi maupun non asuransi tidak diisi sama sekali. Hasil uji Mann Whitney tidak ada perbedaan yang signifikan antara kelengkapan pengisian dokumen rekam medis pasien asuransi non-asuransi. Ketidaklengkapan dokumen rekam medik terjadi karena kurangnya komitmen dari berbagai pihak yang bersangkutan dalam pengisian dan penanganan kelengkapan rekam medik. Saran yang dapat diberikan yaitu untuk tetap mengisi dokumen rekam medis secara lengkao, adanya kebijakan yang mengatur tentang punisment dan reward dalam kelengkapan pengisian dokumen rekam medis, menyusun suatu program pelatihan dengan tujuan meningkatkan komitmen berbagai pihak yang bersangkutan dalam pengisian rekam medik. Pengetatan regulasi dalam pelaksanaan fungsi assembling dan penerapan SOP dalam pengisian rekam medis. Incomplete medical record document became a problem because its often represent the only one note which gave the detail information about everything was happened and conducted during patient taken care at hospital. From the survey result,descriptively indicate that there is difference between number of completeness in insurance medical record completeness, both of insurance patient's medical record and non insurance. The aim of this research is to analizes the comparison of medical record completeness between the patient insurance participant and non insurance. Research methode used is analytical survey with the approach of cross sectional study. Sample used in this research are medical record document in May 2006 with the detail 54 insurance patient's medical record documents and 40 non insurance patient's. Informant of this research are 3 medical record officers, 3 doctor and superintendent of sub medical record area.Research instrument that is sheet of check list. The result from this research is the admission filling of identity completeness represent on patient's name, patient address and medical record's number, both insurance patient's medical record and non insurance. The admission filling of medical completeness for insurance patient's medical record is represent on date which the patient first time stay in hospital, diagnosed, and medication variable, the addmission filling of medical completeness for non insurance patient's medical record is represent on date which the patient first time stay in hospital and diagnosed. The payer's name is not filled at all. The number of addmission filling for insurance company's name is only 2%. The social data is not filled at all, both of insurance patient's medical record and non insurance. The mann Whitney result is no difference between medical record document completeness of insurance patient with the non insurance patient. The incompleteness medical record document happened when thw lack of commitment from various patient in addmission filling and handling the incompleteness of medical record. Suggest to the management of TUGUREJO hospital,they can produce some policy about punisment and reward for incompleteness of medical record document. Suggest to the sub medical record area to completing the manual medical record though there is a computerize base for medical record Kata Kunci: Dokumen rekam medis, Asuransi kesehatan Medical record document, health insurance

Item Type:Thesis (Undergraduate)
Subjects:R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:Faculty of Public Health > Department of Public Health
ID Code:4439
Deposited By:admin FKM undip
Deposited On:19 Jan 2010 14:11
Last Modified:19 Jan 2010 14:11

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