Turning Practice into Policy: Qualitative Determinants and Interventions for Accurate UCOD Reselection

Achmad Jaelani Rusdi; Fita Rusdian Ikawati; M.Syauqi Haris

doi:10.55927/fjmr.v4i10.565

Authors

Achmad Jaelani Rusdi ITSK RS dr. Soepraoen Malang
Fita Rusdian Ikawati ITSK RS dr. Soepraoen Malang
M.Syauqi Haris ITSK RS dr. Soepraoen Malang

DOI:

https://doi.org/10.55927/fjmr.v4i10.565

Keywords:

Underlying Cause of Death (UCOD), Death Certificate, Structural Equation Modeling (SEM), Medical Reporting Accuracy

Abstract

Accurate reselection of the Underlying Cause of Death (UCOD) is vital for mortality statistics. Errors persist when workflows, coordination, and digital controls are weak. This study examined multilevel drivers of UCOD accuracy and designed policies for hospital records units. We ran a qualitative study in four hospitals in Batu, using in-depth interviews with four key informants involved in MCCOD completion/reselection and one focus group with four participants from clinical, records, and managerial roles. Transcripts were analyzed using thematic analysis across personal (knowledge, skills, self-efficacy), interpersonal (communication, pre-final peer review, feedback), and organizational (SOP/SLA, EMR support, audit, workload) levels. Accuracy hinged on two moments: time-bounded clinical–records clarification with evidence, and a pre-final peer review focused on causal sequence and UCOD etiology. A policy package emerged: a one-page SOP with SLA covering Draft MCCOD → Clarification → Reselection → Peer review → Finalization → System entry; a one-page two-focus peer-review checklist; a dashboard of four indicators (sequence consistency, correct UCOD etiology, MMDS compliance, adherence to mortality rules); minimal EMR rules (ban ill-defined or symptom UCOD, hard-stop required fields, warn on illogical chains); and a 30-second self-check with brief case-based micro-learning. UCOD accuracy is a socio-technical outcome. A compact, staged package anchored in SOP/SLA, pre-final peer review, simple dashboards, and EMR guardrails offers a feasible route to strengthen mortality reporting.

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