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Susi Kurnia Riza; Pembimbing: Atik Nurwahyuni; Penguji: Vetty Yulianty Permanasari, Fanty Rahmania, Nina Rosyina
Abstrak:
Apendektomi adalah tindakan operasi pada kasus apendisitis yang merupakan kasus emergensi bedah paling sering yaitu sebanyak 250.000 di Amerika Serikat dan 621.435 kasus di Indonesia setiap tahunnya. Menurut data RS XYZ tahun 2018, Apendektomi termasuk lima besar tindakan operasi dengan total kasus sebanyak 107 kasus dan menempati urutan pertama tindakan berbiaya tinggi dengan selisih tarif RS terhadap tarif INA CBGS 363 %. Clinical pathway merupakan sebuah kerangka kerja dalam memberikan pelayanan kesehatan sebagai upaya mengendalikan mutu dan biaya pelayanan kesehatan, dimana clinical pathway mampu mengurangi variasi-variasi yang terjadi dalam pelayanan kesehatan. Penelitian ini bertujuan untuk mengevaluasi penerapan clinical pathway Apendektomi di RS XYZ Tahun 2019. Metode yang digunakan adalah mix method research dengan metode kuantitatif dan kualitatif. Pengambilan sampel menggunakan teknik total sampling dari seluruh data pasien apendektomi di RS XYZ pada bulan Januari i Desember 2019 yang sesuai dengan kriteria inklusi dan eksklusi dan didapatkan sejumlah 85 data tagihan pasien. Dari hasil penelitian didapatkan ketidaksesuaian antara pelayanan yang diberikan dengan clinical pathway. Gap terbesar pada penggunaan obat yaitu sebesar 42 % . Variasi yang didapat yaitu pada pemberian obat dan alat kesehatan, tindakan medis dan keperawatan, serta pemeriksaan penunjang, hal ini mengakibatkan rata-rata lama hari rawat menjadi lebih panjang dibandingan dengan clinical pathway yaitu 3,76 hari. Variasi yang tidak sesuai dengan clinical pathway dapat mempengaruhi mutu pelayanan dan jumlah tagihan rumah sakit.
Appendectomy is a surgical procedure for appendicitis, which is the most frequent surgical emergency case, as many as 250,000 in the United States and 621,435 cases in Indonesia each year. According to data from XYZ Hospital in 2018, Appendectomy is one of the top five operations with a total of 107 cases and ranks first in high-cost procedures with the difference between hospital rates and INA CBGS rates of 363%. Clinical pathway is a framework in providing health services as an effort to control the quality and cost of health services, where clinical pathways are able to reduce variations that occur in health services. This study aims to evaluate the application of clinical pathway appendectomy at XYZ Hospital in 2019. The method used is a mix method research with quantitative and qualitative methods. Sampling used a total sampling technique from all appendectomy patient data at XYZ Hospital in January - December 2019 according to the inclusion and exclusion criteria and obtained a total of 85 patient bill data. From the research results, it was found that there was a mismatch between the services provided and the clinical pathway. The biggest gap in drug use is 42%. The variations obtained were in the provision of drugs and medical devices, medical and nursing actions, and supporting examinations, this resulted in the average length of stay being longer compared to the clinical pathway, namely 3.76 days. Variations that are not in accordance with the clinical pathway can affect the quality of service and the amount of hospital bills.
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Appendectomy is a surgical procedure for appendicitis, which is the most frequent surgical emergency case, as many as 250,000 in the United States and 621,435 cases in Indonesia each year. According to data from XYZ Hospital in 2018, Appendectomy is one of the top five operations with a total of 107 cases and ranks first in high-cost procedures with the difference between hospital rates and INA CBGS rates of 363%. Clinical pathway is a framework in providing health services as an effort to control the quality and cost of health services, where clinical pathways are able to reduce variations that occur in health services. This study aims to evaluate the application of clinical pathway appendectomy at XYZ Hospital in 2019. The method used is a mix method research with quantitative and qualitative methods. Sampling used a total sampling technique from all appendectomy patient data at XYZ Hospital in January - December 2019 according to the inclusion and exclusion criteria and obtained a total of 85 patient bill data. From the research results, it was found that there was a mismatch between the services provided and the clinical pathway. The biggest gap in drug use is 42%. The variations obtained were in the provision of drugs and medical devices, medical and nursing actions, and supporting examinations, this resulted in the average length of stay being longer compared to the clinical pathway, namely 3.76 days. Variations that are not in accordance with the clinical pathway can affect the quality of service and the amount of hospital bills.
B-2166
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Rizka Chairani Riza; Pembimbing: Atik Nurwahyuni; Penguji: Mardiati Nadjib, Kurnia Sari, Dyana Ratna Mariza, Agus Budhy
Abstrak:
Proses penyusunan hingga tahap penerapan dan faktor output berupa kesesuaian pelayanan kesehatan dengan clinical pathway demam tifoid (lama hari rawat, visite, pemeriksaan penunjang, penggunaan obat dan alat kesehatan serta tindakan keperawatan). Hasil penelitian didapatkan bahwa faktor input sumber daya manusia menjadi salah satu faktor penghambat penerapan clinical pathway demam tifoid sehingga penerapannya kurang berjalan baik, sedangkan dari sisi proses langkah penyusunan clinical pathway tidak dijalankan dengan benar sehingga menjadi awal hambatan pada proses penerapan selanjutnya, dan dari faktor output masih belum ada kesesuaian pelayanan dengan clinical pathway demam tifoid seperti penggunaan obat dan pemeriksaan penunjang.
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B-2107
Depok : FKM-UI, 2019
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Yusuf Subekti; Pembimbing: Atik Nurwahyuni; Penguji: Anhari Achadi, Vetty Yulianty Permanasari, Tranggono Yudo Utomo, Armansyah
Abstrak:
Stroke adalah penyebab utama kematian dan kesakitan di Indonesia, menurut data Riskesdas prevalensinya terus meningkat dengan angka 10,9 per mil di tahun 2018. Stroke non hemoragik merupakan kasus terbanyak di rawat inap RSUD dr. Chasbullah Abdulmadjid Bekasi. RS telah membuat clinical pathway, tetapi belum dilakukan pembaharuan setelah lebih dari 3 tahun dibuat. Penelitian ini bertujuan mendapatkan gambaran input, proses, output, dan outcome dan tantangan yang dihadapi saat implementasi clinical pathway. Penelitian ini retrospektif menggunakan pendekatan kuantitatif dan kualitatif dalam kerangka evaluasi sistem. Hasil penelitian menunjukan bahwa pada variabel input dari sisi SDM, dana, kebijakan, sarana prasarana, obat dan alkes tersedia dan siap menerapkan CP, tantangan pada koordinasi tim. Variabel proses sudah berjalan dengan tantangan pada identifikasi tim, penunjukan ketua tim dan sosialisasi CP belum optimal. Variabel output didapatkan LHR rata-rata sesuai dengan CP, varian didapatkan pada visite, pemeriksaan penunjang, tindakan, konsultasi obat dan alkes. Variabel outcome terdapat selisih tagihan sebesar Rp. 224.103 (5%) dengan Selisih positif pada layanan fisioterapi Rp 178.470 (143%), Visite Rp. 88.215 (26%), Gizi Rp. 78.014 (18%), Akomodasi Rp. 53.625 (10%), Tindakan Rp. 45.805 (7%), Konsultasi Rp. 6.750 (6%). Selisih negatif terjadi pada layanan Obat Rp. 123.911 (25%), Laboratorium Rp. 92.465 (21%), Radiologi Rp. 8.238 (1%) dan Alkes Rp. 2.162 (1%).
Stroke is the leading cause of death and illness in Indonesia, according to Riskesdas data the prevalence continues to increase by 10.9 per mile in 2018. Non-hemorrhagic strokes are the most frequent inpatients cases at dr.Chasbullah Abdulmadjid Hospital. The hospital has made the clinical pathway, but no updates have been made after more than 3 years. This study aims to get an overview of the inputs, processes, outputs, and outcomes and challenges faced when implementing clinical pathways. This is retrospective research, uses quantitative and qualitative approaches in a system evaluation framework. The results showed that the input variables in terms of HR, funds, policies, infrastructure, drugs and medical equipment are available and ready to apply CP, the challenge is lies in the team coordination. Process variables are already running with challenges in team identification, team leader election and the CP socialization still not optimal. Output variables obtained an average LHR in accordance with CP, variants were obtained on the visit, supporting examinations, nursing services, drug consultations and medical devices. The outcome variable, there is a price difference between real and appropriate CP of Rp. 224,103 (5%), Positive difference in physiotherapy services Rp. 178,470 (143%), Visite Rp. 88,215 (26%), Nutrition Rp. 78,014 (18%), Accommodation Rp. 53,625 (10%), nursing services Rp. 45,805 (7%) and Consultation Rp. 6,750 (6%). A negative difference occurs in the drug service Rp. 123,911 (25%), Laboratory Rp. 92,465 (21%), Radiology Rp. 8,238 (1%) and Medical Devices Rp. 2,162 (1%).
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Stroke is the leading cause of death and illness in Indonesia, according to Riskesdas data the prevalence continues to increase by 10.9 per mile in 2018. Non-hemorrhagic strokes are the most frequent inpatients cases at dr.Chasbullah Abdulmadjid Hospital. The hospital has made the clinical pathway, but no updates have been made after more than 3 years. This study aims to get an overview of the inputs, processes, outputs, and outcomes and challenges faced when implementing clinical pathways. This is retrospective research, uses quantitative and qualitative approaches in a system evaluation framework. The results showed that the input variables in terms of HR, funds, policies, infrastructure, drugs and medical equipment are available and ready to apply CP, the challenge is lies in the team coordination. Process variables are already running with challenges in team identification, team leader election and the CP socialization still not optimal. Output variables obtained an average LHR in accordance with CP, variants were obtained on the visit, supporting examinations, nursing services, drug consultations and medical devices. The outcome variable, there is a price difference between real and appropriate CP of Rp. 224,103 (5%), Positive difference in physiotherapy services Rp. 178,470 (143%), Visite Rp. 88,215 (26%), Nutrition Rp. 78,014 (18%), Accommodation Rp. 53,625 (10%), nursing services Rp. 45,805 (7%) and Consultation Rp. 6,750 (6%). A negative difference occurs in the drug service Rp. 123,911 (25%), Laboratory Rp. 92,465 (21%), Radiology Rp. 8,238 (1%) and Medical Devices Rp. 2,162 (1%).
B-2156
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Herlin Putri Tanjung; Pembimbing: Atik Nurwahyuni; Penguji: Anhari Achadi, Ede Surya Darmawan, Sjahrul Amri, Rizka Hasanah
Abstrak:
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Diare merupakan penyakit yang sering dijumpai dan menyebabkan 4% dari seluruh kematian di dunia. Kasus diare akut pada anak merupakan salah satu penyakit yang termasuk high risk, high volume dan high cost. Menurut data tahun 2018 total kasus diare akut sebanyak 938 kasus dan termasuk urutan pertama dari 10 besar kasus rawat inap di RSU Bhakti Yudha. Implementasi clinical pathway berhubungan erat dengan upaya mengendalikan mutu dan biaya pelayanan kesehatan yang terjangkau serta dapat diperkirakan. Pengendalian biaya dapat terealisasi jika proses dalam pelayanan kesehatan secara menyeluruh dapat direncanakan dan distandarisasi sejak awal.Clinical pathway jika dilakukan dengan baik dan benar dapat mengurangi biaya pelayanan kesehatan, mengurangi lama hari rawat inap, meningkatkan hasil klinis pasien. Adanya ketidaksesuaian penerapan clinical pathway dapat berpengaruh pada jumlah tagihan/ billing pasien. Penelitian ini bertujuan mengetahui kesesuaian penerapan clinical pathway diare akut ringan - sedang pasien rawat inap anak di RSU Bhakti Yudha. Disain penelitian mix method yang bersifat deskriptif kuantitatif dan studi kasus kualitatif. Hasil penelitian didapatkan Kepatuhan dokter masih kurang dalam pemberian tatalaksana medis. Masih ditemukan ketidaksesuaian antara clinical pathway dengan pelayanan yang diberikan. Ketidaksesuaian tersebut diantaranya adanya variasi dalam pemberian terapi obat-obatan, pemeriksaan penunjang, dan tindakan keperawatan. Variasi tersebut dilakukan karena kondisi pasien berbeda-beda kebutuhan penanganan. Gap terbesar pada penggunaan obat yaitu 145 % dimana pada billing tagihaan riil lebih besar dibanding tagihan sesuai clinical pathway dikarenakan penggunaan obat yang tidak sesuai clinical pathway. Banyaknya varian yang tidak sesuai clinical pathway akan mempengaruhi besaran tagihan rumah sakit
Diarrhea is a disease that is often found and causes 4% of all deaths in the world. Cases of acute diarrhea in children is a disease that includes high risk, high volume, and high cost. According to 2018 data, there were 938 cases of acute diarrhea and were in first place in the top 10 causes of hospitalization at Bhakti Yudha General Hospital. The implementation of clinical pathways is closely related to efforts to control the quality and cost of affordable and predictable health services. Cost control can be realized if the process of overall health services can be planned and standardized from the start. Clinical pathways if done properly and correctly can reduce the cost of health services, reduce the length of stay, and improve patient clinical outcomes. The existence of a mismatch in the application of clinical pathways can affect the number of billing patients. This study aims to determine the appropriateness of the application of clinical pathways of mild acute diarrhea - moderate inpatient children in Bhakti Yudha General Hospital. The mixed-method research design is quantitative descriptive and qualitative case studies. The results showed that doctor compliance was still lacking in the provision of medical management. There are still discrepancies between clinical pathways and services provided. These discrepancies include variations in drug therapy, supporting examinations, and nursing actions. This variation was made because the patient's condition needed different treatments. The biggest gap in the use of drugs is 145% wherein real billing is greater than the bill according to the clinical pathway due to the use of drugs that are not following the clinical pathway. The number of variants that do not fit the clinical pathway will affect the amount of the hospital bill.
B-2148
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Joan Puspita Tanumihardja; Pembimbing: Atik Nurwahyuni; Penguji: Amal Chalik Sjaaf, Helen Andriani, Nanin Susanti, Clara Yosefina Francis
Abstrak:
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enyakit Paru Obstruktif Kronis (PPOK) merupakan salah satu penyakit kronis yang memiliki potensi kejadian readmisi dengan beberapa determinan yang saling berkaitan. Jika determinan ini dapat dicegah maupun dikendalikan maka ada kemungkinan kejadian ulangan dapat dicegah pula. Tesis ini membahas hubungan kepatuhan penerapan clinical pathway terhadap readmisi Penyakit Paru Obstruktif Kronis di RS St Elisabeth Lela Kabupaten Sika tahun 2019. Penelitian ini menggunakan metode cross sectional dengan pendekatan kuantitarif. Terdapat 3 kelompok determinan yang berhubungan dengan readmisi pasien PPOK yaitu faktor fasilitas kesehatan rujukan (kepatuhan implementasi clinical pathway), faktor follow up pengobatan (follow up ke Instalasi Rawat Jalan dan Puskesmas), serta faktor pasien (umur, jenis kelamin, penyakit penyerta dan penyakit penyulit). Hasil penelitian mengungkap variabel dominan yang berkaitan dengan kejadian readmisi pasien PPOK di rumah sakit adalah penyakit penyulit, setelah dikontrol oleh kepatuhan implementasi clinical pathway dan kunjungan kontrol pasien ke Puskesmas. Diperlukan perbaikan implementasi clinical pathway terutama pada indikator gizi pasien serta penerapan Manajer Pelayanan Pasien (MPP) yang menjadi jembatan antar Profesional Pemberi Asuhan (PPA) sehingga pasien PPOK mendapatkan tatalaksana berkesinambungan dari fasilitas kesehatan rujukan ke fasilitas kesehatan primer maupun sebaliknya.
As one of chronic diseases, COPD patient has a potential to excacerbate and readmitted to hospital, having few relatable determinants if which avoided or controlled can give a chance of avoidable excacerbation and or readmssion.This thesis discusses how clinical pathway implementation adherence influences Chronic Obstructive Pulmonary Disease (COPD) readmission in St Elisabeth Lela Hospital in Sikka District 2019. This research used cross sectional design with quantitative approach. Variables analyzed were within 3 determinant groups related to COPD patient readmission : referral health facilites (clinical pathway implementation adherence), treatment follow up (to policlinics or primary care health facilities) and patient (age, gender, comorbidities and complications). Research result suggest that complications dominantly related to patient readmission, controlled with clinical pathway implementation adherence and follow up visits to primary care health facility. Further improvement on clinical pathway implementation is needed especially for the nutrition indicator and also the need to put Case Manager into practice to coordinate health proffesionals surrounding and taking take of COPD patients in hospital to be able to attain continued treatment from referral to primary care health facilities and vice versa
As one of chronic diseases, COPD patient has a potential to excacerbate and readmitted to hospital, having few relatable determinants if which avoided or controlled can give a chance of avoidable excacerbation and or readmssion.This thesis discusses how clinical pathway implementation adherence influences Chronic Obstructive Pulmonary Disease (COPD) readmission in St Elisabeth Lela Hospital in Sikka District 2019. This research used cross sectional design with quantitative approach. Variables analyzed were within 3 determinant groups related to COPD patient readmission : referral health facilites (clinical pathway implementation adherence), treatment follow up (to policlinics or primary care health facilities) and patient (age, gender, comorbidities and complications). Research result suggest that complications dominantly related to patient readmission, controlled with clinical pathway implementation adherence and follow up visits to primary care health facility. Further improvement on clinical pathway implementation is needed especially for the nutrition indicator and also the need to put Case Manager into practice to coordinate health proffesionals surrounding and taking take of COPD patients in hospital to be able to attain continued treatment from referral to primary care health facilities and vice versa
B-2152
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Christina Prilia Damaranti; Pembimbing: Dumilah Ayuningtyas; Penguji: Anhari Achadi, Masyitoh, Ramaniya Kirana, Eka Ginanjar
Abstrak:
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PPOK merupakan penyakit pernapasan kronis penyebab morbiditas dan mortalitas terbanyak dengan dampak pembiayaan yang cukup tinggi di Indonesia. Clinical Pathway (CP) adalah bagian dari pelaksanaan tata kelola klinis rumah sakit dan salah satu tools dalam mewujudkan sistem kendali mutu dan kendali biaya di era JKN. Efektivitas kepatuhan penerapan clinical pathway (CP) terhadap luaran klinis pasien pada beberapa penelitian menunjukkan hasil yang positif. RS Paru Respira Yogyakarta telah menetapkan CP PPOK sebagai CP prioritas, namun dalam proses evaluasi kepatuhan CP belum menggunakan seluruh komponen PPA seperti yang diatur dalam Permenkes Nomor 30 Tahun 2022. Paradigma pelayanan kesehatan saat ini adalah value-based healthcare sehingga perlu dilakukan evaluasi dampak kepatuhan CP terhadap luaran klinis pasien. Penelitian ini bertujuan untuk mengetahui hubungan kepatuhan CP terhadap luaran klinis pasien PPOK dan proses penerapan kepatuhan CP PPOK di RS Pusat Paru Respira Yogyakarta tahun 2022. Desain penelitian adalah observasional (cross sectional) dengan pendekatan mix method. Pengambilan data metode kuantitatif menggunakan rekam medis pasien rawat inap dengan diagnosis utama PPOK tahun 2022 (n=57) dan metode kualitatif dengan wawancara mendalam, observasi dan telaah dokumen. Hasil penelitian kuantitatif didapatkan tingkat kepatuhan CP PPOK sebesar 87,7%, ada hubungan yang signifikan antara DPJP dengan kejadian komplikasi (p value=0,003) dan antara kepatuhan CP dengan luaran klinis yaitu komplikasi (p value=0,05 dan OR=6,75), faktor yang paling berpengaruh pada luaran klinis pasien adalah kepatuhan terhadap CP. Metode kualitatif, berdasarkan perspektif 10 variabel dalam teori Gibson dan Mathis-Jackson, didapatkan hasil yang baik pada variabel sikap. Untuk variabel pengetahuan, supervisi, komunikasi, pelatihan, SDM, standar kinerja, sarana prasarana, insentif dan struktur organisasi masih perlu peningkatan. Untuk meningkatkan kepatuhan CP diperlukan komunikasi yang efektif antara pembuat dan pelaksana CP, pemahaman dan komitmen penuh para PPA, dukungan manajemen untuk rutin meninjau ulang tata laksana CP, meningkatkan sosialisasi, pelatihan, sarana prasarana, kebutuhan SDM, fasilitas IT penunjang serta regulasi terkait pelaksanaan CP.
COPD is a chronic respiratory disease that causes the most morbidity and mortality with a high cost impact in Indonesia. Clinical Pathway (CP) is part of the implementation of hospital clinical governance and one of the tools in quality and cost control system in JKN era. The effectiveness of clinical pathway (CP) compliance to patient clinical outcomes in several studies has shown positive results. Respira Lung Hospital Yogyakarta has designated CP COPD as a priority CP, but in the process of evaluating CP compliance, it has not used all Profesional Caregiver components as stipulated in Health Ministerial Regulation No. 30 of 2022. The current paradigm of health services is value-based healthcare, so it is necessary to evaluate the impact of CP compliance on the patient's clinical outcome. This study aims to determine the association of CP compliance to the clinical outcome of COPD patients and the process of implementing COPD CP compliance at the Respira Lung Hospital Yogyakarta in 2022. The research design is observational (cross sectional) with mix method approach. Quantitative method data collection using inpatient medical records with a primary diagnosis of COPD in 2022 (n=57) and qualitative method using with in-depth interviews, observation and document review. The results of quantitative study showed that COPD CP compliance rate is 87.7%, there is a significant relationship between doctor in charge of services with the incidence of complications (p value=0.003) and between CP compliance with clinical outcomes of complications (p value=0.05 and OR=6.75), factor that most influenced the patient's clinical outcome was CP compliance. Qualitative methods, based on the perspective of 10 variables in the theory of Gibson and Mathis-Jackson, showed good results on attitude variables. Knowledge, supervision, communication, training, human resources, performance standards, infrastructure, incentives and organizational structure variables still need improvement. To improve CP compliance, an effective communication between CP makers and implementer are required, full understanding and commitment of Profesional Caregivers, management support to regularly review CP governance, improve socialization, training, infrastructure, human resource needs, supporting IT facilities and regulations related to the implementation of CP are required.
B-2383
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Analisis Implementasi Clinical Pathway Sectio Caesarea di Rumah Sakit Universitas Udayana Tahun 2020
Ida Ayu Wirastuti; Pembimbing: Prastuti Soewondo; Penguji: Amal Chalik Sjaaf, Kurnia Sari, Made Ayu Haryati, I Gusti Agung Gede Utara Hartawan
Abstrak:
Tesis ini membahas implementasi clinical pathway sectio caesarea yang telah berlaku. Rumah sakit ditantang untuk meningkatkan pelayanan dengan penekanan pada kendali mutu dan kendali biaya. Penerapan clinical pathway merupakan hal yang baru di lingkungan Rumah Sakit Universitas Udayana. Penelitian ini menggunakan studi kasus kualitatif. Data dikumpulkan dengan cara wawancara mendalam yang ditujukan kepada pemangku kebijakan dan pelaksana kebijakan dengan menggunakan metode purposive sampling. Hasil penelitian mengungkap bahwa implementasi clinical pathway sectio caesarea belum sepenuhnya berjalan dimana ada hambatan yang dapat dilihat dari faktor komunikasi, sumber daya, disposisi dan struktur birokrasi yang saling berkaitan. Penelitian ini menunjukkan belum adanya komunikasi efektif antara pemangku kebijakan dan pelaksanan kebijakan serta antarpelaksana kebijakan, belum adanya sosialisasi dan edukasi terkait implementasi clinical pathway sehingga kurangnya pengetahuan staf tentang fungsi dan manfaat serta tugas dan kewenangannya dalam implementasi clinical pathway, belum adanya SOP terkait alur dan pengisian clinical pathway, serta belum adanya case manager yang memegang peranan penting dalam implementasi clinical pathway. Disarankan kepada pemangku kebijakan untuk melaksanakan sosialisasi dan pelatihan yang disampaikan secara jelas dan konsisten serta tersampaikan pada seluruh pelaksana kebijakan, menyusun rencana strategis dalam mengangkat case manager yang memegang peranan penting dalam proses implementasi clinical pathway. Serta untuk pelaksana kebijakan diharapkan dapat meningkatkan komitmen dalam implementasi clinical pathway yang lebih baik
This thesis discusses the implementation of the clinical pathway for sectio caesarea that has been applied. Hospitals are challenged to improve services with an emphasis on quality control and cost control. The application of clinical pathways is new in the Udayana University Hospital environment. This research uses a qualitative case study. Data were collected by means of in-depth interviews aimed at policy makers and policy implementers using purposive sampling method. The results of the study revealed that the implementation of clinical pathway of caesarean section was not yet fully implemented where there were obstacles which could be seen from the interrelated factors of communication, resources, disposition and bureaucratic structure. This research shows that there is no effective communication between policy makers and policy implementation as well as between policy implementers, there is no socialization and education regarding the implementation of clinical pathways so that there is a lack of staff knowledge about the functions and benefits as well as their duties and authorities in implementing clinical pathways, there is no SOP related to the flow and filling. clinical pathway, and the absence of a case manager who plays an important role in the implementation of clinical pathways. It is recommended to policy makers to carry out socialization and training that is delivered clearly and consistently and delivered to all policy implementers, formulating a strategic plan in appointing case managers who play an important role in the process of implementing clinical pathways. As well as implementing policies, it is hoped that they can increase commitment in implementing better clinical pathways
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This thesis discusses the implementation of the clinical pathway for sectio caesarea that has been applied. Hospitals are challenged to improve services with an emphasis on quality control and cost control. The application of clinical pathways is new in the Udayana University Hospital environment. This research uses a qualitative case study. Data were collected by means of in-depth interviews aimed at policy makers and policy implementers using purposive sampling method. The results of the study revealed that the implementation of clinical pathway of caesarean section was not yet fully implemented where there were obstacles which could be seen from the interrelated factors of communication, resources, disposition and bureaucratic structure. This research shows that there is no effective communication between policy makers and policy implementation as well as between policy implementers, there is no socialization and education regarding the implementation of clinical pathways so that there is a lack of staff knowledge about the functions and benefits as well as their duties and authorities in implementing clinical pathways, there is no SOP related to the flow and filling. clinical pathway, and the absence of a case manager who plays an important role in the implementation of clinical pathways. It is recommended to policy makers to carry out socialization and training that is delivered clearly and consistently and delivered to all policy implementers, formulating a strategic plan in appointing case managers who play an important role in the process of implementing clinical pathways. As well as implementing policies, it is hoped that they can increase commitment in implementing better clinical pathways
B-2242
Depok : FKM-UI, 2021
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Maria Wahyu Daruki; Pembimbing: Atik Nurwahyuni; Penguji: Ede Surya Darmawan, Amal Chalik Sjaaf, Made Koen Wirawan, Ni Ketut Agustiani
Abstrak:
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Tesis ini membahas evaluasi implementasi clinical pathway, dengan tujuan diketahui implementasi Clinical Pathway dan analisa biaya satuan dari tindakan Sectio Caesarea di RSU Bhakti Rahayu Denpasar. Desain penelitian yan digunakan yaitu mix method yaitu desain penelitian kuantitatif dan kualitatif, yang diperoleh dari data billing pasien dan wawancara mendalam. Penelitian dilakukan pada bulan April 2019 hingga Juli 2020. Hasil yang didapatkan adalah masih terdapat variasi pada beberapa layanan yang diberikan sehingga mendapatkan biaya yang berbeda antara total biaya tindakan yang sesuai dengan clinical pathway sebesar Rp 1.920.000,- dengan biaya riil pelayanan yang diberikan sebesar Rp 3.319.281,- yang berarti masih terdapat selisih sebesar Rp 1.399.281
This thesis discusses the evaluation of clinical pathway implementation, with the aim of knowing the implementation of Clinical Pathway and unit cost analysis of the Sectio Caesarea action at Bhakti Rahayu General Hospital Denpasar. The research design used is the mix method, namely quantitative and qualitative research designs, obtained from patient billing data and in-depth interviews. The study was conducted in April 2019 to July 2020. The results obtained are still variations in some of the services provided so that they get different costs between the total cost of action in accordance with the clinical pathway of Rp 1,920,000, - with the real cost of services provided at IDR 3,319,281, - which means there is still a difference of IDR 1,399,281, -.
B-2145
Depok : FKM-UI, 2020
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Genoveva Maditias Dwi Pertiwi; Pembimbing: Atik Nurwahyuni; Penguji: Prastuti Soewondo, Amal Chalik Sjaaf, Elga Ria Vinensa, Isnaini Ashar
Abstrak:
Stroke merupakan salah satu penyakit cerebrovaskuler yang masih menjadi masalah besar dalam kesehatan masyarakat di dunia. American Stroke Association melaporkan bahwa dalam penanganan stroke dengan fasilitas yang tidak memadai dan tidak terintegrasi akan berkontribusi terhadap kematian, kecacatan, dan biaya perawatan yang tinggi. Oleh sebab itu untuk diperlukan kolaborasi tim professional dan implementasi perawatan berbasis bukti pada pelayanan stroke. Clinical Pathway (CP) merupakan suatu konsep perencanaan pelayanan yang berisi langkah-langkah perawatan pasien dan berbasis bukti. Rumah Sakit Mitra Husada telah menetapkan CP Stroke Infark sejak tahun 2019 karena termasuk dalam 10 besar penyakit terbanyak. Sementara itu capaian indikator mutu Kepatuhan Terhadap CP Stroke Infark pada tahun 2020 belum mencapai standar. Apabila hal ini terus terjadi maka Kendali Mutu dan Kendali Biaya (KMKB) di Rumah Sakit Mitra Husada tidak akan tercapai. Penelitian ini merupakan penelitian kuantitatif dengan menggunakan desain cross sectional untuk menganalisis hubungan kepatuhan terhadap CP Stroke Infark dengan tarif perawatan di RS Mitra Husada tahun 2021. Hasil penelitian menunjukkan bahwa hanya 72 pasien (38.3%) yang ditatalaksana patuh sesuai CP, artinya hasil ini belum mencapai standar (80%). Didapatkan Rata-rata tarif seluruh pasien stroke infark yang dirawat inap sebesar Rp. 4.955.564.- Terdapat 18 pasien (18.8%) yang ditatalaksana patuh terhadap CP memiliki tarif> rata-rata tarif seluruh pasien, sedangkan terdapat 52 pasien (81.2%0 yang ditatalaksana tidak patuh tergadap CP memiliki tarif > rata-rata tarif seluruh pasien. Terdapat hubungan yang bermakna antara kepatuhan terhadap CP stroke Infark, komplikasi, dan kelas rawat dengan tarif perawatan. Rumah sakit perlu mengkaji ulang isi CP dan melakukan monitoring evaluasi terhadap pelaksanaan CP dalam rangka mewujudkan Kendali Mutu dan Kendali Biaya di Rumah Sakit Mitra Husada Pringsewu.
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B-2275
Depok : FKM-UI, 2022
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Leonardo Emil FS; Pembimbing: Ronnie Rivany; Penguji: Mieke Savitri, Budi Hartono, Kuntum Cheyra
B-1185
Depok : FKM-UI, 2009
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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