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"Pandemi COVID-19 di Indonesia berdampak pada implementasi Sisrute RSUD Siti Aisyah sehingga memengaruhi morbiditas dan mortalitas pasien. Penelitian ini bertujuan untuk menganalisis implementasi Sisrute yang meliputi kebijakan, kapasitas petugas, sistem jaringan, komunikasi dan pelayanan rujukan. Penelitian ini merupakan studi kasus dengan pendekatan kualitatif melalui observasi lapangan, telaah dokumen dan wawancara mendalam 13 informan RSUD Siti Aisyah. Penolakan rujukan lebih dari 80%. Response time kurang dari 60 menit terbanyak pada rujukan keluar non-COVID-19 (64%). Alasan penolakan meliputi ketidaktersediaan ruangan isolasi COVID-19-19, ketidaklengkapan berkas, kendala sistem jaringan, petugas lambat merespons dan lainnya. Informan mengatakan tidak terdapat kebijakan Sisrute dan dokumentasi sosialisasi; kapasitas petugas rujukan cukup adekuat.; Sistem Jaringan pada komputer dan konektifitas internet, SIMRS dan infrastruktur penunjang belum adekuat; Komunikasi rujukan melalui aplikasi Sisrute dan dibantu telepon dan Whatsapp; RSUD tidak memiliki SOP Sisrute, akan tetapi mengikuti prosedur klinis, administratif, dan operasional. Kendala pada implementasi Sisrute yaitu komitmen petugas, kecepatan penyampaian informasi, rangkap tugas, situasi faskes penerima, penerimaan keluarga, permasalahan biaya dan ketersediaan infrastruktur. Monitoring dan evaluasi tidak dilakukan pada implementasi Sisrute. Dengan demikian, implementasi Sisrute di RSUD Siti Aisyah Lubuklinggau perlu perbaikan dan peningkatan pada variabel diatas dapat mempercepat proses rujukan.

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The Pandemy of COVID-19 in Indonesia has a major impact in integrated referral system (IRS) implementation of Siti Aisyah (SA) General Hospital Lubuklinggau influencing patient morbidity and mortality. This study was conducted to analyse policy, officer capacity, network system, referral communication, and referral services resulting in referral system implementation. It was a case study with qualitative approach through observation, documents research, in-depth interview with 13 informants working at Siti Aisyah General Hospital. The study suggested that Sisrute referral rejection was more than 80%. Referral response time suggest less than 60 minutes only occurring in outward non-COVID-19 referral (64%). Reasons for rejection were unavailability of COVID-19 Isolation room, incomplete referral documents, network system issue, late response, etc. Informants stated that there was no referral policy and dissemination documents; officer capacity was considered adequate enough; Network system in computer and internet connectivity, hospital management information system and supporting infrastructures remained inadequate; referral communication through IRS and assistance of phone calling and Whatsapp were performed; SA General Hospital had no standard operating procedures, but it follows clinical, administrative and operational procedures. Challenges in IRS implementation were commitment, information delivery speed, multi-tasking, current situation in referred facility, family reception, extra fee and infrastructures issue. Monitoring and evaluation had not been performed in IRS implementation. Thus, SA General Hospital needs to improve and increase IRS implementation in aforementioned variable to accelerate referral process."

"ABSTRAKSistem Informasi Jejaring Rujukan Maternal dan Neonatal SijariEMAS merupakan program terbaru di Kota Tangerang dalam upaya menjawabpermasalahan kematian ibu dan kematian bayi di Kota Tangerang yang disebabkankarena rujukan yang tidak efektif dan efisien. Penggunaan SijariEMAS padakelompok sasaran bidan praktek mandiri sebagai penolong persalinan utama diKota Tangerang masih amat rendah, hanya 15 bidan praktek mandiri yangmenggunakan SijariEMAS. Penelitian ini bertujuan untuk mengetahuiimplementasi SijariEMAS pada bidan praktek mandiri di Kota Tangerang tahun2017. Dilaksanakan pada bulan Mei-Juni 2017 menggunakan design kualitatif .Pengambilan data dilakukan melalui fokus grup diskusi pada 24 orang informanbidan praktek mandiri Bidan yang aktif dan tidak aktif menggunakan SijariEMAS serta wawancara mendalam terhadap para penentu kebijakan terkait programSijariEMAS di Kota Tangerang. Penelitian ini menunjukan bahwa response timeatau waktu cepat tanggap rujukan melalui SijariEMAS yang lama ditambahkurangnya koordinasi antara rumah sakit, bidan perujuk dan petugas call centerserta kurang nya pengawasan dari Dinas Kesehatan Kota Tangerang menjadi penyebab kurang maksimalnya implementasi SijariEMAS pada bidan praktekmandiri di Kota Tangerang.

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ABSTRACTMaternal and Neonatal Reference Network Information System SijariEMAS is thelatest program in Kota Tangerang as an effort to answer the problem of maternaland infant mortality in Kota Tangerang caused by ineffective and efficientreference. The use of SijariEMAS in the target group of private practice midwivesas primary birth attendant in Kota Tangerang is still very low, only 15 of privatepractice midwives using SijariEMAS. This study aims to determine theimplementation of SijariEMAS on i private practice midwife in Kota Tangerang2017. Implemented in May June 2017 using qualitative design. Data collection wasdone through focus group discussion on 24 midwives 39 informants active andinactive midwives using SijariEMAS as well as in depth interviews on policymakers related to SijariEMAS program in Kota Tangerang . This research indicatesthat the response time of referral through old Sijariemas plus lack of coordinationbetween hospital, referral midwife and call center officer and lack of supervisionfrom Tangerang City Health Office become the cause of less maximalimplementation of SijariEMAS at private practice midwife in Kota Tangerang."

"ABSTRAKLaporan Magang ini membahas tentang proses asesmen Konsultan terhadap peninjauan efektivitas implementasi ERM yang dilakukan oleh Divisi Audit Internal PT XYZ sebagai fungsi Third Line of Defense. Pembahasan dimulai dengan pemaparan risiko-risiko yang dihadapi PT XYZ, proses manajemen risiko yang dilakukan, dan analisis atas proses asesmen yang dilakukan oleh Konsultan. Dari hasil gap analysis menunjukkan bahwa penguatan fungsi Third Line of Defense dalam proses manajemen risiko PT XYZ menjadi inisiatif prioritas 1 yang perlu dilakukan untuk melakukan pengawasan terhadap pelaksanaan pengelolaa risiko secara keseluruhan pada First Line dan Second Line di PT XYZ.

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ABSTRACTThis report discusses the Consultant 39 s assessment process for reviewing the ERM implementation function performed by Internal Audit Division as a Third Line of Defense function at PT XYZ. The discussion begins with the exposure to the risks that PT XYZ deal with, the risk management process undertaken, and the analysis of assessment process undertaken by the Consultant. From the results of the gap analysis shows that reinforcement of the Third Lne of Defense function in PT XYZ 39 s risk management process become 1st priority of the initiative that needs to be done to conduct a whole monitoring on the risk management implementation in the First Line and Second Line at PT XYZ"

"Proporsi persalinan dengan SC dalam Program JKN di Indonesia jauh lebih tinggi apabila dibandingkan dengan proporsi negara maju dan berkembang, sehingga dapat mempengaruhi biaya Program JKN. Saat ini, isu biaya adalah hal yang sangat penting dalam Program JKN terkait dengan kondisi defisit yang sedang dihadapi. Dengan tingginya rate persalinan dengan SC jauh di atas dari rata-rata yang ditetapkan oleh WHO, maka perlu diketahui hal-hal yang menentukan metode persalinan yang dilakukan oleh ibu hamil sehingga dapat digunakan sebagai rekomendasi bagi pengambil keputusan terkait dengan pembiayaan persalinan pada Program JKN.Penelitian ini menggunakan data klaim, data kepesertaan dan data sistem informasi kesehatan Program JKN tahun 2015-2017 yang dikelola oleh BPJS Kesehatan. Obyek penelitian adalah wanita peserta JKN, berusia 15-49 tahun melahirkan dalam kurun waktu 2015-2017. Dilakukan analisis univariat, bivariat dan analisis multivariat dengan metode logit. Dari analisis terhadap 3.132.846 observasi ditemukan bahwa sebanyak 1.794.479 (57,28%) adalah Persalinan dengan SC.Seluruh variabel karakteristik fasilitas kesehatan dan variabel karakteristik pasien secara signifikan (p value < 0,05) mempengaruhi metode Persalinan dengan SC. Persalinan dengan SC lebih tinggi probabilitas terjadi di RS Kelas B, RS milik Swasta, berada di kota, berada pada regional tarif I, pada kelompok peserta PBPU dan BP, Kelas rawat 1, dan dengan tingkat keparahan I. Terdapat indikasi bahwa Persalinan dengan SC yang terjadi bukan karena alasan medis, tetapi faktor lainnya seperti insentif. BPJS Kesehatan bersama Kementerian Kesehatan mengembangkan sistem pembayaran dan sistem kendali lainnya sehingga dapat dilakukan kendali mutu dan kendali biaya pelayanan persalinan.

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The proportion of labor with C-Section of JKN participants in Indonesia is much higher when compared to the proportion of developed and developing countries, which may affect the cost of the JKN. Currently, the issue of cost is very important in the JKN related to the current deficit condition. With the high rate of labor with C-Section well above the average set by the WHO, it is necessary to know the things that determine the method of delivery performed by pregnant women so that it can be used as a recommendation for decision makers related to the financing of labor on the JKN.

This study uses claims data, membership data and health information system data of JKN from 2015-2017 managed by BPJS Health. The object of the study was the female participants of JKN, aged 15-49 gave birth in the period 2015-2017. Univariate, bivariate and multivariate analysis (logit method) were performed. From the analysis of 3,132,846 observations it was found that as many as 1,794,479 (57.28%) were deliveries with C-Section.

All health facilities characteristic variable and patient characteristic variable significantly (p value <0,05) influence method of delivery with C-Section. Labor with a higher probability of Section occurred in Class B Hospital, Private Hospital, located in the city, located at region I, in the group of informal participants, Class treatment 1, and with severity level I. There is an indication that the delivery with the C-Section occurs not for medical reasons, but other factors such as incentives. BPJS Kesehatan together with the Ministry of Health have to develop payment system and other control system so that cost containment can be done."

"ABSTRAKTingginya angka kematian ibu, bayi di Indonesia menunjukkan rendahnya kualitas pelayanan kesehatan, dipengaruhi pelayanan rujukan. Salah satu masalah rujukan di Kabupaten Serang adalah keterlambatan pasien sampai ke fasilitas kesehatan. Disebabkan sistem rujukan belum terintegrasi, tidak ada komunikasi data dan koordinasi antar fasilitas rujukan. Tujuan studi membangun model sistem informasi rujukan komplikasi ibu dan bayi terintegrasi secara online. Studi kualitatif dengan metode pengembangan SDLC. Penelitian di Kabupaten Serang, melibatkan Puskesmas PONED, rumah sakit PONEK dan Dinkes Kabupaten Serang.Hasil penelitian yaitu pelayanan rujukan belum dilakukan sesuai prosedur. Kurangnya SDM, sarana, alat dan kebijakan menjadi penyebab terhambatnya pelayanan rujukan. Aplikasi rujukan dirancang untuk kecepatan akses informasi, alat bantu monitoring evaluasi dan pengawasan pengendalian mutu pelayanan rujukan. Kesimpulan penelitian terbangunnya model sistem informasi rujukan obstetri dan neonatal online dan terintegrasi.

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ABSTRACTThe high rates of maternal and infant mortality in Indonesia showed low quality of health services that influenced referral. One of the problems at Serang referral is delaying until the patient to the health facility. This is due not integrated, there is no data communication and coordination between the referral facility. The purpose of this study to establish a model of referral information system integrated maternal and neonatal by online. A qualitative study, approach to the SDLC methods. The study at Serang, involving PONED health centers, PONEK hospitals and Serang District Health Office as an application model.The results are referral services not performed with procedures. Inadequate human resources, facilities, equipment and policy has contributed to the delays in referral. Reference application is designed to speed access information, monitoring, evaluation tools and quality control monitoring referral service. The Conclusion are the establishment of research referral systems online models and integrated facilities."

"ABSTRAKRumah sakit Umum Daerah Tipe C sebagai Pusat Rujukan di Kabupaten mempunyai peranan penting dalam program penurunan angka kematian ibu dan anak di daerahnya. Demikian juga Rumah Sakit Umum Subang di Jawa Barat yang berpenduduk 1,3 juta orang mempunyai dua dokter spesialis kebidanan dan dua spesialis anak dengan sepuluh orang bidan, melayani rujukan yang berasal dari dokter, Puskesmas, Bidan maupun dukun bayi.Sampai dengan saat ini kegiatan pelayanan rujukan tersebut belum pernah dievaluasi.Penelitian ini bertujuan untuk mengkaji aktivitas pelayanan kesehatan ibu dan anak di kabupaten Subang dengan berfokus pada aktivitas rujukan medis dalam serial waktu 1989-1996 dengan menilai proses yang terjadi selama delapan tahun dan hasil yang tercatat. Data dikumpulkan melalui catatan medis dalam sistem rujukan.Pada analisis terlihat perbedaan yang mencolok terjadi pada tahun 1993, dimana terjadi kenaikan sebanyak 33-43 % kasus-kasus rujukan maternal maupun perinatal. Sejalan dengan itu angka bedah Caesar meningkat 11% setiap tahunnya dan rujukan partus normal menurun. Angka kematian perinatal meningkat terutama pada kasus yang dirawat kurang dan 48 jam pertarna dengan sebab kematian asfiksia dan Berat Badan Lahir Rendah. Pada kasus ini dengan jumlah kasus yang meningkat tidak diimbangi dengan kelengkapan pelayanan intensif perinatal, sehingga banyak kasus yang tidak dapat ditolong. Rujukan kasus kehamilan resiko tinggi meningkat dan sebab kematian maternal ialah perdarahan dan eklamsi.Selama delapan tahun dilakukan sekitar 9 bentuk interfensi yang dilakukan oleh Rumah Sakit Umum Subang bersama Dinas Kesehatan Kabupaten Daerah Tingkat II Subang, antara lain pembentukan Puskesmas dengan perawatan, penempatan bidan desa, menyediakan ruang perinatologi di rumah sakit, membentuk Tim Rujukan rumah sakit, ceramah di organisasi IDI dan IBI, pelatihan tenaga kesehatan dan pelatihan dukun bayi.Banyak spesialis kebidanan maupun spesialis anak di daerah enggan terjun ke daerah, kami menyarankan kepada Departemen Kesehatan untuk membuat suatu posisi tertentu bagi para spesialis sehingga mereka mau tidak mau terjun dalam program kesehatan di daerah melalui suatu Surat Keputusan resmi. Penelitian ini juga mengusulkan kepada rumah sakit untuk melengkapi dengan unit pelayanan intensif perinatal/neonatal. Diperlukan juga peningkatan partisipasi dari lintas sektoral untuk mendukung kegiatan rujukan ini terutama bagi kaum yang tidak mampu.Daftar bacaan : 24 buah

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ABSTRACT

Referral System of Maternal and Child Health Analysis. A Studi Case in General Hospital of Subang District in 1989-1996.

Set up as a medical referral for complicated maternal and child cases, a district hospital in Indonesia plays a huge role in its contribution to decrease infant and maternal death in its catchman area. Subang District Hospital is one of it. Lies in hilly Subang District in West Java province, serves 1,3 million population. It has run maternal and child health care since its establishment in 1984, given at the obgyn outpatient and inpatient service, which is staffed by 2 obgyn, 2 pediatrician and 10 clinical midwives. Complicated cases have been referred so far, either a self referral or sent by the traditional birth attendants, or by the health center doctors and midwives.

It is felt nowadays that Subang Hospital has made a sufficient contribution toward the improvement of MCH program in Subang district, however, these activities renders by the hospital has never been evaluated. Therefore, no empirical data could be shown sa far to evident the contribution, moreever, no lesson learned or successful stories could be disseminated. This study aimed to evaluate the maternal- and child health activities conducted by Subang Hospital, focusing on its activities related to the medical referral system, using a 8 years time series data from 1989 to 1996 , to assess the process accrued during those years in order to achieve outputs recorded. The data was collected through the medical records to this referral system activities.

The analysis showed that differences in output achievements started to occur after 1993,.where in that year high risk Maternal and Prenatal cases referred to the hospital increase sharply to 33-43% per year afterwards. Commensurating to that, number of sectio caesarians conducted in the hospital increases 11% every year, and normal deliveries decreased. Neonatal death after the first 48 hours of hospitalization increase since 1993, with main causes are neonatal asphyxia and low birth weight. In this case, number of cases increase, but the hospital is not equipped with a neonatal emergency room, which made the hospital failed in surviving those little souls. High risk pregnancy cases referred increases, and main cause of deaths are severe bleeding predisposed by heavy anemia and eclampsia.

During those 8 years 9 kind of interventions have been conducted in the hospital setting. Those were; the formal establishment of the AMP team, the deployment of new young fresh graduates midwives in each village in Subang district, intensive maternal and child care education to the community through the health eadres and community midwives, knowledge and eithiocal backup by midwives and physicians's proffesional organizations, continous trainning to the traditional birth attendants, and emergency obgyn care and treatment trainings for the community midwives.

The study recommends to the Department of Health to respect the obgyns and pediatrician who are also dedicate their work by serving community outside the hospital setting through issuing a legal acknowledgement (Letter of Decree). This is because most obgyns and pediatricians only focus their work and job at their station, hospital, and only a few of them are willing to serve in the community setting. The hospital also pleas for the provision of emergency prenatal care unit, since the need is obvious. Increase participation and contribution from other related sectors as well as from the community to back up transportation fee for those low socioeconomic high risk cases (mothers and or infants) which have to be referred to the hospital for survival is very much expected. The Medical trainings for community midwives are urged to be continued and training should be given in the hospital in an internship setting.

Bibliography : 24"

"Tourist-generated content (TGC) merupakan jenis user-generated content spesifik dalam konteks kepariwisataan, yang menyediakan informasi perjalanan dalam tipe media sebagai mode utama penyebaran informasi perjalanan. Sebagai salah satu bentuk TGC, online review kini dapat menjadi sumber data terbarukan dan perspektif untuk memahami citra destinasi pada suatu tujuan berwisata. Citra destinasi merupakan elemen kunci dalam menarik wisatawan dengan menyediakan persepsi individu tentang citra terhadap suatu destinasi, yangmana berkaitan erat dengan perilaku kunjungan dan pemilihan destinasi. Labuan Bajo merupakan Destinasi Super Prioritas dengan potensi keunikan dan daya tarik wisata yang besar. Meski demikian pariwisata di Labuan Bajo masih terbilang baru, sehingga perlu diteliti lebih lanjut untuk pengelolaan dan pengembangannya. Sehingga penelitian ini berupaya mengetahui bagaimana citra kognitif dan citra afektif yang terdapat dalam online review oleh turis terhadap wisata Labuan Bajo. Selanjutnya data berupa ulasan daring yang diunggah pada media sosial TripAdvisor diambil untuk diteliti lebih lanjut. Dimana riset ini menggunakan metode analisis isi kualitatif dengan pendekatan directed content analysis. Kategorisasi pada analisis isi kualitatif mengacu kepada aspek yang terdapat pada citra destinasi yakni aspek kognitif dan afektif. Sehingga citra kognitif yang terdapat dalam online review oleh turis terhadap wisata Labuan Bajo dideskripsikan dengan atribut atraksi alam, aktivitas, masyarakat, kuliner, harga, kualitas, infrastruktur, transportasi, lingkungan, dan keamanan. Kemudian citra afektif digambarkan melalui atribut positif, netral, dan negatif. Tidak hanya itu, penelitian ini juga menggunakan model Johari Window dalam memetakan temuan ulasan daring terhadap wisata Labuan Bajo. Lantas berdasarkan pemetaan area pada Jendela Johari, terlihat adanya kesenjangan informasi antara pihak internal (pengelola yakni Destination Management Organisation/DMO) dan pihak eksternal (konsumen berupa turis). Kesenjangan informasi tersebut menunjukkan bahwa perlu adanya saluran komunikasi yang lebih baik antara DMO dengan konsumen. Serta selaku pengelola destinasi, DMO perlu menyusun strategi komunikasi terintegrasi dan memanfaatkan media sosial untuk menjangkau konsumen dan menyampaikan informasi terkait produk dan jasa yang dikelolanya.

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Tourist-generated content (TGC) is a type of user-generated content in the context of tourism that provides travel information in the form of media as the main mode of dissemination of travel information. As one of the forms of TGC, online reviews can now be a source of updated data and perspective to understand the image of a destination as a travel destination. Destination imagery is a key element in attracting tourists by providing an individual perception of an image of a destination that is closely related to the behavior of visiting and choosing a destination. Labuan Bajo is a Super Priority Destination with unique potential and great tourist attractions. Nevertheless, Labuan Bajo tourism is still in its early stages, further research is necessary to manage and broaden it. Therefore, the purpose of this study is to investigate how cognitive and emotive images are found in online reviews by travellers concerning Labuan Bajo tourism. Furthermore, the data of online reviews uploaded on social media sites such as TripAdvisor is taken for further analysis using the method of qualitative content analysis with the approach of directed content analysis. Categorization in qualitative content analysis refers to the aspects that are present in the destination image, namely the cognitive and affective aspects. Thus the cognitive image contained in the online review by tourists is described by attributes of nature attractions, activities, society, culinary, price, quality, infrastructure, transportation, environment, and security. Then the affective image is depicted through positive, neutral, and negative attributes. Not only that, but the study also used the Johari Window model in mapping findings of the negative online review. In addition, the study mapped the online review findings using the Johari Window model. The area mapping on the Johari Window indicates that there is an information gap between the internal party (Destination Management Organisation, or DMO), and the external party (consumer which is the tourist). The gaps in the information suggest that DMO and consumers need to communicate with each other more effectively. As a destination manager, DMO must create a comprehensive communication plan and utilize social media to engage consumers and disseminate information about the goods and services it oversees."

"Dalam rangka meningkatkan efektivitas dan efisiensi pencapaian tujuan strategis bank, bank dimungkinkan menggunakan pihak penyedia jasa teknologi informasi dalam menyelenggarakan kegiatan teknologi informasi bank. Penggunaan pihak penyedia jasa teknologi informasi dapat mempengaruhi risiko bank antara lain risiko operasional, hukum, reputasi dan stratejik. Dalam hal penyelenggaraan teknologi informasi bank dilakukan oleh pihak penyedia jasa teknologi informasi, bank harus memiliki prinsipprinsip penggunaan penyedia jasa teknologi informasi, salah satunya adalah penggunaan penyedia jasa teknologi informasi harus didasarkan pada hubungan kerja sama secara wajar, dalam hal pihak penyedia jasa teknologi informasi merupakan pihak terkait dengan bank. Hubungan kerja sama secara wajar adalah kondisi dimana transaksi antar pihak bersifat independen sebagaimana pihak yang tidak terkait, antara lain memiliki kesetaraan dan didasarkan pada harga pasar yang wajar sehingga meminimalisasi terjadinya benturan kepentingan. Pihak terkait adalah perseorangan atau perusahaan yang mempunyai hubungan pengendalian dengan bank, baik secara langsung maupun tidak langsung, melalui hubungan kepemilikan, kepengurusan, dan/atau keuangan. Pokok permasalahan yang akan dibahas adalah mengenai penerapan perjanjian kerjasama secara wajar antara bank umum dengan pihak terkait dan konsekuensi hukum bagi bank umum apabila tidak menerapkan arms length principle pada perjanjian penggunaan penyedia jasa teknologi informasi dengan pihak terkait.

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In order to increase the effectiveness and efficiency of achieving banks strategic objectives, banks are allowed to use information technology service providers in carrying out banks information technology activities. The use of information technology service providers can influence bank risks including operational, legal, reputation and strategic risks. In the event that the implementation of bank information technology is carried out by the provider of information technology services, banks must have the principles of using information technology service providers, one of which is the use of information technology service providers must be based on arms length principle, in the event that the provider of information technology services is a party related to the bank. Arms length principle is a condition where transactions between parties are as independent as unrelated parties, including having equality and based on fair market prices so as to minimize conflicts of interest. Related parties are individuals or companies that have control relationships with banks, both directly and indirectly, through ownership, management, and or financial relationships. The main issues to be discussed in this research are implementation against the arms length agreement between commercial banks with related party and legal consequences for commercial banks if they dont implement arms length principle into the agreement on use of information technology service provider with related party."

"Kepatuhan kunjungan ulang pasien rujukan persalinan merupakan salah satu upaya menurun AKI. AKI di RSUP Fatmawati 100% berasal dari kasus rujukan, dan pada bulan Januari, Februari dan Maret 2004 pasien rujukan persalinan yang patuh melakukan kontrol hanya 25%. Kasus rujukan persalinan 95,7% mempunyai penyulit sehingga perlu kunjungan ulang, mengingat asuhan masa nifas sangat penting dimana perlu memberikan konseling KB sedini mungkin, bahaya kehamilan yang akan datang, serta untuk mengetahui dampak intervensi sebelumnya, maka perlu identifikasi faktor-faktor penyebabnya.Tujuan penelitian ini adalah diketahuinya gambaran kepatuhan kunjungan ulang pasien rujukan persalinan dan faktor-faktor yang mempengaruhinya di RSUP Fatmawati Jakarta tahun 2003-2004. Penelitian menggunakan desain cross sectional. Responden dalam penelitian ini, adalah ibu hamil trimester ke III yang dirujuk untuk bersalin dari tanggal 1 juni 2003 sampai dengan 31 Mei 2004, menggunakan data sekunder, pengambilan sampel secara simpel random sampling sebanyak 212 orang.Hasil penelitian ini menunjukan tingkat kepatuhan sebesar 18,9%. Penelitian ini dari 12 variabel yang diteliti yang ada hubungan bermakna adalah 5 variabel yaitu umur, paritas, jarak kelahiran, pendidikan ibu, pengalaman berobat, dengan kepatuhan kunjungan ulang. Untuk variabel pekerjaan ibu, pekerjaan kepala keluarga, penanggung biaya, jarak tempuh, riwayat persalinan yang lalu, penyulit kehamilan, dan penyakit yang diderita ibu tidak hubungan. Dalam hal ini lima dari dua betas hipotesa yang berhasil dibuktikan kebenarannya.Dan hanya 2 variabel yang secara signifikan berhubungan yaitu jarak kehamilan dan pengalaman berobat. Dimana setiap kenaikan 1 tahun jarak kelahiran berpeluang untuk melakukan kunjungan ulang sebesar 1,21 kali dengan (95% CI: 1.03-1,43) setelah dikontrol pengalaman berobat. Responden yang berpengalaman berobat berpeluang untuk patuh sebesar 6.61 kali dengan ( 95% CI:3,07-14,20) setelah dikontrol variabel jarak kelahiran responden.Dari 12 variabel independen yang dapat diintervensi untuk meningkatkan kepatuhan di rumah sakit hanya I variabel adalah pengalaman berobat dan 11 variabel Iainnya yang berasal dari iuar rumah sakitldiluar kontrol RSUP Fatmawati, intervensinya harus dilakukan dengan koordinasi lintas sektoral baik DepKes, Depag, Depdiknas, Departemen Pemberdayaan Wanita, Depdagri dan LSM.

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Factors Related To Compliance Of Revisit Among Referred Delivery Patients In Fatmawati General Hospital, Jakarta 2003-2004Revisit compliance among referred delivery patients is one of important effort to reduce Maternal Mortality Rate. In the Fatmawati General Hospital all maternal death was caused by referred delivery cases. During January, February and March 2004 the revisit compliance of the referred delivery cases was only 25%. Revisit during post partum period is absolutely important since during this time it is timely appropriate to early introduce family planning methods for preventing future problems of maternal and newborn health_ Therefore, it is quite important to identify factors related with the revisit compliance of the referred delivery patients in the hospital.

The objective of this study was to assess factors related to revisit compliance among referred delivery patients in the Fatmawati General Hospital 2003-2004. The design of the study was a cross-sectional design. Population of the study was 3'1 quarter pregnant women who were referred to the delivery room and had a referral letter. The referral took place between June 1 2003 to May 31, 2004. A total of 212 sample of the study was selected using a simple random sampling method.

Results of the study indicated that the revisit compliance of the referred delivery patients in the Fatmawati General Hospital was 18,9%. In addition, it showed that there was a significant correlation between revisit compliance of the patients with the following independent variables namely age, parity, birth space, education of mothers, and previous experience of using the hospital services. There was no significant relationship between revisit compliance with the following variables: work status of the mother, occupation of the head of household, person respoiisible for cost of care in the hospital, distance of home to hospital, obstetric history, problems of pregnancy and diseases affecting the mothers. In this study, 5 out of 12 hypotheses was accepted.

There were significant relationship between birth space and the experience of utilization of hospital services of the pregnant women. After being controlled with the previous experience of the pregnant women in using hospital service, for each year increase of birth space provides a chance of revisit compliance 1.21 times (95% confidence interval 1,03-1,43). After being control with variable of birth space, those pregnant women who had experience in using previous hospital service had a chance 6,61 times (95% confidence interval 3,07-14,20).

Out of 12 variables that are amenable to intervention only previous experience of using hospital service which could be intervened by the hospital. Some other variables such as birth space, occupation of the husband, obstetric history etc could only be intervened by inter-sectoral cooperation among different institutions. Therefore, it is strongly recommended that the improvement of women status and their empowerment should become a priority of the government and non-government intervention."