Penyakit Jantung Bawaaan (PJB) Tetralogy of Fallot (TOF) merupakan PJB sianotik (biru) yang terbanyak. Tatalaksana definitif yang dilakukan adalah dengan operasi total koreksi sedini mungkin. Sebagian besar pembiayaan untuk perawatan operasi TOF menggunakan BPJS Kesehatan berdasarkan tarif INA-CBG. Tetapi karena terdapat selisih negatif antara tarif INA-CBG lama tahun 2016 dengan tagihan perawatan operasi TOF, banyak rumah sakit tidak mau melaksanakan operasi dan langsung merujuk ke RSJPD Harapan Kita yang merupakan pusat rujukan jantung nasional. Hal ini menyebabkan antrian operasi yang panjang dan berakhir kematian. Dengan adanya tarif INA-CBG terbaru tahun 2023 yang telah mengalami kenaikan, diperlukan penelitian apakah masih terdapat selisih negatif tersebut. Analisis faktor-faktor yang berhubungan dengan tagihan perawatan operasi TOF lebih diperlukan karena biasanya kebijakan baru akan memakan waktu. Kepatuhan terhadap Clinical Pathway (CP) TOF Repair perlu dilakukan analisa juga. Penelitian observasional deskriptif dengan pendekatan cross sectional mengambil sampel pasien perawatan operasi total koreksi TOF tahun 2022 yang sesuai kriteria sejumlah 82 pasien. Hasil penelitian didapatkan karakteristik pasien yang dioperasi di RSJPD Harapan Kita sebagian besar masih usia ≥ 1 tahun, berjenis kelamin perempuan, status gizi normal, memiliki diagnosa sekunder dan tingkat keparahan PPK derajat I (ringan) serta tingkat keparahan INA-CBG derajat II (sedang). Karakteristik tindakan dengan median lama CPB 103,5 menit dan lama AoX 55 menit dan sebagian besar tidak ada komplikasi. Karakteristik pelayanan didapatkan kelas rawat III adalah yang terbanyak dengan median lama rawat post operasi 6 hari dan lama rawat total 8 hari, sebagian besar patuh terhadap lama rawat PPK (8 hari) dan lama rawat CP (6 hari). Faktor-faktor yang berhubungan dengan tagihan perawatan operasi total koreksi TOF adalah komplikasi, kelas rawat dan lama rawat CP. Masih banyak hal yang belum sesuai dengan Clinical Pathway TOF Repair RSJPD Harapan Kita yaitu lama rawat, pemeriksaan penunjang laboratorium dan radiologi, pemakaian obat-obatan dan alkes serta BMHP. Masih terdapat selisih negatif dari nilai total tagihan perawatan pasien operasi total koreksi TOF tahun 2022 dibandingkan dengan nilai total tarif INA-CBG terbaru tahun 2023.
Tetralogy of Fallot (TOF) is the most common cyanotic (blue) Congenital Heart Disease. The definitive treatment is total corrective surgery as early as possible. Most of the financing for TOF surgery care uses BPJS Kesehatan based on the INA-CBG rate. However, because there is negative difference between the 2016 INA-CBG rate and the TOF surgery treatment bill, many hospitals do not want to carry out the operation and refer directly to the Harapan Kita Hospital which is the national heart referral center. This causes long operating queues and leads to death. With the latest 2023 INA-CBG rates which have increased, it is necessary to be analyzed whether there is still such a negative difference. Analysis of the factors related to TOF surgery treatment bills is more needed, because usually new policies will take time. Compliance with the TOF Repair Clinical Pathway (CP) need to be analyzed as well. This descriptive observational study with a cross-sectional approach took a sample of patients undergoing TOF corrective surgery at RSJPD Harapan Kita in 2022 who met the criteria for a total of 82 patients. The results showed that the characteristics of patients who were operated were mostly aged ≥ 1 year, female, normal nutritional status, had a secondary diagnosis and the severity of PPK degree I (mild) and the severity of INA-CBG degree II (moderate). Characteristics of the procedure with a median CPB duration of 103.5 minutes and AoX duration of 55 minutes and most of them had no complications. Characteristics of service was mostly obtained class III with a median postoperative length of stay of 6 days and a total length of stay of 8 days, most of them adhered to the length of stay for PPK (8 days) and the length of stay for CP (6 days). Factors related to total TOF correction surgery bills were complications, class of stay and length of stay for CP. There are still many things that are not in accordance with the Clinical Pathway TOF Repair RSJPD Harapan Kita such as the length of stay, laboratory and radiological investigations, use of drugs and medical devices as well as BMHP. There is still a negative difference in the total value of patient care bills for total TOF correction surgery in 2022 compared to the total value of the latest 2023 INA-CBG rates.
Felicia Gunardi-Tesis-FKM-Full Text-2023.pdf ::