IRA MAYA, 101144017 (2014) UTILIZATION REVIEW PELAYANAN RAWAT INAP DIABETES MELLITUS (STUDI DI RSUD �X� TIPE C SURABAYA). Thesis thesis, UNIVERSITAS AIRLANGGA.

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Abstract

National Security Health (JKN) requires hospital to provide effective and efficient service to optimized service quality. Therefore, utilization review are needed so hospital know condition of hospital that will be referral hospital for health insurance patient with DM in General Hospital �X� Type C in Surabaya. This is cross sectional research with case study method on medical records of inpatient care patients with diabetes mellitus on January until April 2014. This research held in General Hospital �X� Type C in Surabaya for 2 months, from June until July 2014. Sample of this research are every medical record status of inpatient care with DM, including DM type 1 and type 2, on January until April 2014. The results of this research are : Pattern of providing health services including : new patients are 71% and 29% older patients, readmissionless than 1 month are 6% in third grade treatment room, and for length of time more than 1 month in first class treatment room and third class treatment room are 100%, 100% and 94%. The absence of ALOS for each diagnose, drug usage according to DOEN are 58,89% and in appropriate according to DOEN are 41,11%, Utilization of supporting examination according to guidelines and therapy (PDT) of internal diseases are 96,67%, while 3,33% are inappropriate according to PDT, Examination and action are 100% done by specialists doctor. Pattern of incoming from health care including : average income looks higher at lower levels of severity, total claims filed is lower than the rate INA-CBGs (approved claims), total claims filed is higher than the rate INA-CBGs (approved claims)Recommendation for health insurance service providers for DM patients in general hospital �X� Type C in Surabaya : Evaluating ALOS for each diagnose, socializing decision from management, creating and utilizing clinical pathways, complete record on billing system, do medical audit.

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