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Based on data from the Research and Development Agency of the Ministry of Health of the Republic of Indonesia and the world research parameter on Hepatitis B in 2013 estimated that as many as 7,000 health workers in Indonesia were infected with the Hepatitis B virus, this is due to the low vaccine coverage. This research was conducted to observe the relation of the attitudes of midwives on the status of hepatitis B immunization in midwives who work in public health centers DKI Jakarta area. This is a quantitative research using cross sectional design with the dependent variable is Hepatitis B immunization status in midwives, the independent variable is Attitude, and the covariates are knowledge, cost, and length of work. The sample of this research were 294 midwives who worked in the public health centers DKI Jakarta area using cluster sampling technique and gave a questionnaire to the subject. The findings confirm that 75.9% of midwives had incomplete hepatitis B immunization status and 24.1% midwives had complete hepatitis B immunization status. The incompleteness of hepatitis B immunization status in midwives resulted in 70.5% of the midwives were supportive and 85.6% unsupportive. The results of the Logistics Regression analysis were carried out with an interaction test as well as a test confounding, there was no interaction between attitudes and knowledge and there were no variables of confounding. OR value obtained is 2.48, means that the attitude of a midwife who support has an odds of 2.48 times higher complete hepatitis B immunization status than a midwife who does not supports hepatitis B immunization (95% CI; 1.321-4,654) with a P- value of 0.006
ABSTRAK Keberhasilan universal health coverage di Indonesia sangat ditentukan oleh utilisasi sumber daya yang efisien di rumah sakit. Variasi biaya yang tinggi untuk perawatan tertentu menunjukkan indikasi bahwa rumah sakit belum cukup efisien dalam memanfaatkan sumber dayanya untuk menyediakan pelayanan. Length of stay (LOS) adalah salah satu faktor penting penentu biaya yang banyak digunakan sebagai indikator efisiensi rumah sakit dalam penggunaan sumber daya. LOS dan biaya perawatan dipengaruhi oleh banyak faktor, baik yang merupakan karakteristik pasien maupun faktor terkait manajemen di rumah sakit. Penelitian ini bertujuan untuk mengidentifikasi seberapa besar hubungan antara karakteristik pasien dengan variasi LOS dan biaya perawatan,dan mengetahui gambaran penerapan clinical pathway sebagai upaya kendali mutu dan biaya pada pasien JKN rawat inap di RSUP Fatmawati dari tahun 2015 – September 2017. Hasil penelitian menunjukkan bahwa variasi usia, jumlah diagnosis, jumlah prosedur dan kelas rawat hanya dapat menjelaskan sedikit variasi LOS dan biaya perawatan (R 2 <34%). Sementara itu clinical pathway sebagai salah satu pendekatan manajemen untuk kendali mutu dan biaya belum diterapkan secara optimal. Berbagai upaya kreatif perlu dilakukan manajemen antara lain implementasi care plan, difungsikannya kembali case manager, pengisian CP secara elektronik dan identifikasi inefisiensi dalam pelayanan menggunakan data unit cost rumah sakit. Kata kunci: Length of stay (LOS), biaya (costs), efisiensi, clinical pathway, CMG
ABSTRACT Efficient use of resources in hospitals will contribute to successful implementation of universal health coverage in Indonesia. Substantial variation in hospital costs for certain diagnosis or procedure is an indication of resource use inefficiency. Length of stay is a well-accepted measure of resource utilization and a key driver to hospital costs. Variation in LOS and costs can be influenced by patient demographic and clinical factors that are outside a hospital’s control, in the meanwhile there are also factors within the control of a hospital. This research focuses on five Casemix Main Groups and aims to identify how patient characteristic factors contribute to variation in LOS and costs, and to investigate qualitatively the implementation of Clinical Pathway as a management approach to control LOS as well as hospital costs for JKN patients at RSUP Fatmawati, a class-A teaching hospital in Jakarta, from 2015 to September 2017. The result indicates that the variance in LOS and cost is not significantly correlated to patient’s age, number of diagnoses, number of procedures and room types as independent variables. The hospital has numerous clinical pathways that have not been optimally implemented yet for LOS and cost control. This research provides information for hospital management team to improve LOS performance by implementing care planning, intensive case management and to use cost data for identification of inefficiency of certain types of care. Keywords: Length of stay (LOS), costs, efficiency, clinical pathway, CMG
