Abstrak
Pendahuluan: Penduduk usia lanjut global secara cepat meningkat, hingga dapat mencapai 1,5-2 miliar pada tahun 2050, yang membawa masalah kesehatan termasuk peningkatan angka rawat inap dan rehospitalisasi pada geriatri. Hal tersebut akan menyebabkan penurunan kualitas perawatan geriatri di RS. Untuk mengatasi masalah ini, strategi perencanaan pulang khusus geriatri harus dikembangkan. Penelitian ini bertujuan untuk menjelaskan pengaruh perencanaan pulang terintegrasi terhadap kualitas perawatan RS bagi geriatri. Metode: Dilakukan penelitian mixed method di fasilitas perawatan akut dan rawat inap geriatri RSUPN Dr. Cipto Mangunkusumo, penelitian kuantitatif melibatkan 259 geriatri, dengan 130 dalam kelompok kontrol dan 129 dalam kelompok intervensi. Perhitungan besar sampel mengikuti formula uji hipotesis beda dua proporsi. Analisis meliputi analisis univariat, Chi-Square, Mantel-Haenszel, serta regresi logistik dengan luaran yaitu rehospitalisasi dan perawatan akut dalam 30 hari. Penelitian kualitatif dikerjakan dengan melakukan wawancara mendalam dan observasi terhadap pelaku rawat dan tenaga kesehatan untuk mencapai saturasi informasi. Hasil dan Pembahasan: Hasil menunjukkan perencanaan pulang terintegrasi secara signifikan mengurangi tingkat rehospitalisasi dalam 30 hari (ARR 12,1%; RRR 34,3%; RR 0,657; IK 95% 0,445-0,971; p 0,045), namun tidak signifikan mengurangi tingkat penggunaan perawatan akut (ARR 11,4%; RRR 28,3%; RR 0,717; IK 95% 0,508-1,012; p 0,074) pada geriatri. Pada analisis stratifikasi dan multivariat, tidak ditemukan adanya confounding maupun interaksi antar confounding. Temuan kualitatif dari wawancara mendalam mendukung manfaat perencanaan pulang, dengan tercapainya kejenuhan informasi tentang perlunya implementasi dan saran untuk memanfaatkan media dalam edukasi perencanaan pulang. Dari observasi didapati bahwa implementasi perencanaan pulang di RS belum sesuai dengan pemahaman dan harapan informan. Simpulan: perencanaan pulang terintegrasi meningkatkan kualitas perawatan rumah sakit pada geriatri, dengan signifikan mengurangi tingkat rehospitalisasi. Penelitian lebih lanjut sangat dianjurkan.
Introduction: The global elderly population is rapidly increasing, with projections indicating it could reach 1.5-2 billion by 2050, leading to various health challenges including increased hospitalization and rehospitalization rates which marked the decline in hospital care quality. To address these issues, specific discharge planning strategies must be developed for geriatric population. This study establishes an integrated discharge planning model for geriatric post-discharge care and aims to elaborate on its influence on hospital care quality. Methods: Mixed method research was conducted at Dr. Cipto Mangunkusumo Hospital's geriatric acute care and inpatient facilities. Quantitative research involved 259 hospitalized geriatrics, with 130 in the control group and 129 in the intervention group. Sample size calculation followed a hypothesis testing formula for two-proportion difference. Analyses included univariate, Chi-Square, Mantel-Haenszel stratification analyses, and logistic regression multivariate analyses, focusing on rehospitalization and acute care utilization rates within 30 days post-discharge. Qualitative research was done by conducting in-depth interviews and observations upon caregivers and healthcare professionals to achieve information saturation. Results & Discussion: Results showed integrated discharge planning significantly reduced rehospitalization rates within 30 days (ARR 12,1%; RRR 34,3%; RR 0.657; 95% CI 0.445-0.971; p 0.045), but did not significantly reduce acute care utilization rates (ARR 11,4%; RRR 28,3%; RR 0.717; 95% CI 0.508-1.012; p 0.074) in geriatrics. In stratification and multivariate analyses, both confounding and confounding interactions were not found. Qualitative findings from in-depth interviews supported the benefits of discharge planning, with information saturation on the need for its implementation and suggestions for media utilization in discharge planning education. Observation revealed that discharge planning implementations in routine hospital geriatric care were not yet satisfactory, according to the informants understanding and expectations. Conclusion: In conclusion, integrated discharge planning improved hospital care quality in geriatrics, significantly reducing rehospitalization rates. Further research is recommended.