支持信息完备性因子与西多哈市阿斯提法玛医院疾病编码准确性的相关性研究

Nova Mellania, Anna Rossarini, Umi Khoirun Nisak, C. Cholifah
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引用次数: 1

摘要

根据对Aisyiyah Siti Fatimah Tulangan Sidoarjo医院住院病历档案的观察获得的数据,初始数据显示仍然存在诊断代码不准确的病历档案,不匹配的比例高达33%。本研究的目的是确定影响Tulangan Sidoarjo Aisyiyah Siti Fatimah医院住院病历文件中疾病编码准确性的支持信息因素的完整性之间的关系。这种研究方法使用定量研究和相关研究,其目的是确定两个或多个可测量变量之间是否存在关系。8月至10月,通过观察住院病历数据,采用核对表进行数据收集。本研究的人群均为2021年8 - 10月的住院病历档案,本研究的样本为Aisyiyah Siti Fatimah Tulangan Sidoarjo医院的231例住院病历档案,随机抽样,采用频率表和交叉表的形式,然后使用卡方检验进行检验。本研究的卡方检验结果表明,支持信息完备性因子变量与疾病编码的准确性有关系,因为p值<0.05,即Ho被拒绝。结果表明,支持信息因子完备性的p值= 0.022。本研究建议通过增加文件的完整性来提高编码质量,并通过进行编码培训和评估编码审核来产生准确的数据,以支持疾病编码的准确性。
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CORRELATION OF SUPPORTING INFORMATION COMPLETENESS FACTORS WITH THE ACCURACY OF DISEASE CODING AT 'AISYIYAH SITI FATIMAH HOSPITAL OF SIDOARJO
Based on the data obtained from the observation on the inpatient medical record file of the Hospital 'Aisyiyah Siti Fatimah Tulangan Sidoarjo that the initial data shows that there are still medical record files with inaccurate diagnosis codes that do not match as much as (33%). The purpose of this study is to determine the relationship between the completeness of supporting information factors that affect the accuracy of disease coding in inpatient medical record files at the 'Aisyiyah Siti Fatimah Hospital, Tulangan Sidoarjo. This research method uses quantitative research with correlational research which has the aim of determining whether or not there is a relationship between two or more measurable variables. Data collection was carried out in August-October using a check list sheet by observing the inpatient medical record data. The population in this study were all inpatient medical record files in August-October 2021 and the sample in this study was 231 inpatient medical record files at the Hospital 'Aisyiyah Siti Fatimah Tulangan Sidoarjo with random sampling which was presented in the frequency table and cross tabulation, then tested using the Chi Square Test.The results of the Chi Square test of this study indicate that the supporting information completeness factor variable has a relationship with the accuracy of disease coding because the p value <0.05, which means Ho is rejected. The results show that the p value of the completeness of supporting information factor = 0.022.In this study, it is recommended to improve the quality of coding by increasing the completeness of the file, and can produce an accurate data by conducting coding training and evaluating coding audits to support the accuracy of disease coding.
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