EFFORTS TO PREVENT FRAUD DUE TO THE APPLICATION OF CLINICAL PATHWAYS IN STROKE INFARCT CASES

Abstract

Particularly during the health insurance era (BPJS), clinical pathways (CP) are useful for cost and quality control. By following the clinical paths in the health care records provided by health workers, information from the medical record can be used as material for identifying possible fraud. This study sought to ascertain how CP was implemented in medical records to combat fraud. case study on infarction from a stroke. The Hospital Management Information System was used to gather data on cases of infarction stroke. several samples 45. The study's findings indicate that the Mini-Mental State Examination (MMSE) items, diet, advice from a neurosurgeon, and nursing authentication had the highest percentages of inconsistent CP implementation, in contrast, 100% of the time was constantly spent on the execution of awareness items, vital signs, medical, laboratory tests, and drug administration. Interview findings indicate that it is uncertain whether or not it is necessary to monitor the clinical pathway form. A clinical pathway's existence can serve as a guide for the actions taken by the healthcare services offered.