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Estefania Toledo ... [et al.]
AJE Vol.178, No.3
Oxford : Oxford University Press, 2013
Indeks Artikel Jurnal-Majalah Pusat Informasi Kesehatan Masyarakat
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Lies Dina Liastuti; Pembimbing: Hasbullah Thabrany; Penguji: Mardiati Nadjib, Prastuti Soewondo, Fresley Hutapea Sundoro
Abstrak:
Abstrak
Penelitian ini meneliti tentang selisih antara tagihan dengan klaim yang dibayar oleh para penjamin biaya kesehatan terhadap pelayanan kasus Infark Miokiard Akut di RSJPDHK serta selisih antara tagihan dengan klaim menggunakan tarif INA-CBG`s. Tujuan dari penelitian adalah untuk dapat memperoleh data karakteristik, mutu layanan dan permasalahan biaya dan pembayaran klaim terhadap RS oleh para penjamin/pembayar. Penelitian ini mendapatkan 5472 pasien Infark Miokard Akut selama periode 1 Januari 2009 sampai 31 Desember 2012 terdiri dari laki laki 81,5% dan perempuan 18,5%, rata-rata usia 56,3 tahun rentang usia yang lebar (21-97 th vs 26-96 th). Sebagian besar berasal dari DKI Jakarta (51%), Tingkat keparahan I 46%, Tingkat II 47,4%, dan Tingkat III 5,9%. Lebih dari separuh pasien (54,64%) mendapat tatalaksana intervensi PTCA atau bedah jantung (CABG), sedangkan 44,54% pasien dirawat tanpa tindakan intervensi non bedah maupun bedah. Penelitian mendapatkan 43,7% pasien dengan jaminan Askes, dan hanya 2,9 % dijamin dengan Jamkes yang dibayar dengan sistem INA-CBG`s. Lama rawat pasien rata rata 7,71±6,30 hari, 87,8, % keluar RS dengan status sembuh. Kesimpulan : Mutu layanan IMA di RSJPDHK tidak dibedakan berdasarkan jenis penjamin, dan adanya selisih antara tagihan RS dengan klaim yang dibayar oleh para penjamin berhubungan secara bermakna dengan kode diagnosis, jumlah tindakan sekunder, lama rawat dan tingkat keparahan penyakit. Penelitian mendapatkan nilai selisih dalam simulasi perhitungan antara tagihan terhadap klaim dengan sistem INA-CBG`s.
The Study examined the differences between the published rates and the CBG rates among patients with acute myocardial infarction (AMI) in National Cardiovascular Center (NCC) Harapan Kita. The purpose of this study is to examine whether there is quality and other differences among AMI patients paid by difference payers and payment levels. This study analyzed medical records of patients with AMI during the period of January 1, 2009 until December 31, 2012. The study found 5,472 patients with AMI consisting of 81.5% males and 18.5% females with the mean age of 56.3 years (range between 21-97 years vs. 26-96 years). Most of the patients were from Jakarta (51%). On severity levels, 46% patients were in severity level I, 47.7% severity level II, and 5.9% level III. More than half (54.6%) patients were treated with intervention (PTCA) or surgical procedures (CABG), while 44.4% patients were treated conventionally. We found that 43.7% of patients were covered by Askes, and only 2.9% were Medicaid (Jamkesmas) that were paid on DRGs. The average length of stays was 7.7 days and 87.8% were discharged in a good recovery. There was no difference in quality of treatment by difference payers or payment system although there was significant discrepancy in charges among difference payers. This differences in charges were associated differences in diagnoses, the number of secondary procedures, length of stays, and severity of the cases. It is concluded that the doctors provided the same quality of services among AMI patients, regardless of payers` status or charges.
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Penelitian ini meneliti tentang selisih antara tagihan dengan klaim yang dibayar oleh para penjamin biaya kesehatan terhadap pelayanan kasus Infark Miokiard Akut di RSJPDHK serta selisih antara tagihan dengan klaim menggunakan tarif INA-CBG`s. Tujuan dari penelitian adalah untuk dapat memperoleh data karakteristik, mutu layanan dan permasalahan biaya dan pembayaran klaim terhadap RS oleh para penjamin/pembayar. Penelitian ini mendapatkan 5472 pasien Infark Miokard Akut selama periode 1 Januari 2009 sampai 31 Desember 2012 terdiri dari laki laki 81,5% dan perempuan 18,5%, rata-rata usia 56,3 tahun rentang usia yang lebar (21-97 th vs 26-96 th). Sebagian besar berasal dari DKI Jakarta (51%), Tingkat keparahan I 46%, Tingkat II 47,4%, dan Tingkat III 5,9%. Lebih dari separuh pasien (54,64%) mendapat tatalaksana intervensi PTCA atau bedah jantung (CABG), sedangkan 44,54% pasien dirawat tanpa tindakan intervensi non bedah maupun bedah. Penelitian mendapatkan 43,7% pasien dengan jaminan Askes, dan hanya 2,9 % dijamin dengan Jamkes yang dibayar dengan sistem INA-CBG`s. Lama rawat pasien rata rata 7,71±6,30 hari, 87,8, % keluar RS dengan status sembuh. Kesimpulan : Mutu layanan IMA di RSJPDHK tidak dibedakan berdasarkan jenis penjamin, dan adanya selisih antara tagihan RS dengan klaim yang dibayar oleh para penjamin berhubungan secara bermakna dengan kode diagnosis, jumlah tindakan sekunder, lama rawat dan tingkat keparahan penyakit. Penelitian mendapatkan nilai selisih dalam simulasi perhitungan antara tagihan terhadap klaim dengan sistem INA-CBG`s.
The Study examined the differences between the published rates and the CBG rates among patients with acute myocardial infarction (AMI) in National Cardiovascular Center (NCC) Harapan Kita. The purpose of this study is to examine whether there is quality and other differences among AMI patients paid by difference payers and payment levels. This study analyzed medical records of patients with AMI during the period of January 1, 2009 until December 31, 2012. The study found 5,472 patients with AMI consisting of 81.5% males and 18.5% females with the mean age of 56.3 years (range between 21-97 years vs. 26-96 years). Most of the patients were from Jakarta (51%). On severity levels, 46% patients were in severity level I, 47.7% severity level II, and 5.9% level III. More than half (54.6%) patients were treated with intervention (PTCA) or surgical procedures (CABG), while 44.4% patients were treated conventionally. We found that 43.7% of patients were covered by Askes, and only 2.9% were Medicaid (Jamkesmas) that were paid on DRGs. The average length of stays was 7.7 days and 87.8% were discharged in a good recovery. There was no difference in quality of treatment by difference payers or payment system although there was significant discrepancy in charges among difference payers. This differences in charges were associated differences in diagnoses, the number of secondary procedures, length of stays, and severity of the cases. It is concluded that the doctors provided the same quality of services among AMI patients, regardless of payers` status or charges.
B-1544
Depok : FKM-UI, 2013
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Fadhila Nafilah Azzahra; Pembimbing: Nurhayati Adnan; Penguji: Putri Bungsu, Bambang Widyantoro, Prima Almazini
Abstrak:
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Infark Miokard Akut (IMA) menjadi penyebab kematian tertinggi di Indonesia. Studi tahun 2022 mendapatkan mortality rate pasien IMA di Indonesia mencapai 8,9%. Penelitian ini bertujuan untuk mengetahui hubungan antara faktor demografi, faktor risiko, komorbiditas, parameter klinis, parameter laboratorium, pemberian terapi inisial, dan pemberian tindakan revaskularisasi dengan kejadian kematian intrahospital pada pasien IMA di RS Jantung dan Pembuluh Darah Harapan Kita Jakarta Tahun 2019 – 2023. Desain studi cross sectional dengan populasi penelitian pasien IMA yang tercatat dalam registri Sindroma Koroner Akut (SKA) di RSJPDHK pada Januari 2019 – Agustus 2023. Analisis multivariat dengan menggunakan regresi logistik berganda untuk menemukan prediktor kematian, dan analisis skoring dilakukan dengan menggunakan ROC Curve untuk mengetahui kualitas diskriminasi skor. Sampel penelitian berjumlah 3593 pasien IMA dengan kejadian kematian intrahospital sebesar 9,6%.Variabel yang dapat dijadikan prediktor kejadian kematian intrahospital pada pasien IMA adalah Usia ≥65 tahun (AOR 1,64; 95% CI=1,24 – 2,18; p=0.001), kejadian gagal ginjal akut (AOR 1,80; 95% CI=1,32 – 2,44; p<0.001), gagal jantung akut (AOR 2,76; 95% CI=1,95 – 3,92; p<0.001), syok kardiogenik (AOR 24,45; 95% CI=16,85 – 35,47; p<0.001), FEVKi ≤ 40% (AOR 1,54; 95% CI=1,14 – 2,08; p=0.005), Hs Troponin ≥ 9 ng/dL (AOR 2,01; 95% CI=1,19 – 3,40; p=0.009), kreatinin > 2 mg/dL (AOR 1,83; 95% CI=1,26 – 2,65; p=0.001), GDS ≥ 200 mg/dL (AOR 1,71; 95% CI=1,30 – 2,25; p<0,001), riwayat dislipidemia (AOR 0,57; 95% CI=0,40 – 0,81; p=0,002), ticagrelor (AOR 0,63; 95% CI=0,41 – 0,99; p=0,043), statin (AOR 0,38; 95% CI=0,25 – 0,57; p<0,001), dan tindakan revaskularisasi (AOR 0,71; 95% CI=0,52 – 0,98; p=0,035). Hasil penilaian skoring menunjukkan nilai diskriminasi yang baik (AUC 0,886).
Acute myocardial infarction (AMI) is the leading cause of death in Indonesia. A study in 2022 found that the mortality rate of AMI patients in Indonesia reached 8.9%. This study aimed to know the relationship between demographic factors, risk factors, comorbidities, clinical parameters, laboratory parameters, administration of initial therapy, and provision of revascularization procedures with the incidence of in-hospital mortality in AMI patients at National Cardiovascular Center Harapan Kita from 2019 to 2023. The study design was cross-sectional with a population of AMI patients who were recorded in the Acute Coronary Syndrome (ACS) registry at RSJPDHK from January 2019 to August 2023. Multivariate analysis used multiple logistic regression to find predictors of in hospital mortality, and scoring analysis was carried out using the ROC Curve to determine the quality of score discrimination. Sample of this study consisted of 3593 AMI patients with an in-hospital mortality rate of 9.6%.Variables that can be used as predictors of inhospital mortality in AMI patients are age ≥65 years (AOR 1.64; 95% CI=1.24 – 2.18; p=0.001), acute kidney injury (AOR 1.80; 95% CI=1.32 – 2.44; p<0.001), acute heart failure (AOR 2.76; 95% CI=1.95 – 3.92; p<0.001), cardiogenic shock (AOR 24.45; 95% CI=16.85 – 35.47; p<0.001), left ventricular ejection fraction (LVEF) ≤ 40% (AOR 1.54; 95% CI=1.14 – 2.08; p=0.005), Hs Troponin ≥ 9 ng/dL (AOR 2.01; 95% CI=1.19 – 3.40; p=0.009), creatinine > 2 mg/dL (AOR 1.83; 95% CI=1.26 – 2.65; p=0.001), blood glucose (BG) ≥ 200 mg/dL (AOR 1.71; 95% CI=1.30 – 2.25; p<0.001), history of dyslipidemia (AOR 0.57; 95% CI=0.40 – 0.81; p=0.002), ticagrelor (AOR 0.63; 95% CI=0.41 – 0.99; p=0.043), statin (AOR 0.38; 95% CI=0.25 – 0.57; p<0.001), and revascularization (AOR 0.71; 95% CI=0.52 – 0.98; p=0.035).The results of the scoring assessment showed good discrimination values (AUC 0.886).
T-6883
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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