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"ABSTRAKNational Health Insurance (NIH/JKN) has been enacted since January 2014. Various outcomes of geriatric patient care, such as improved functional status and quality of live have not been evaluated. Prolonged hospitalization and re-hospitalization are potentially affecting the affeciency care of this vulnerable group. This study aimed to identify the differences of functional status improvement, quality of life improvement, length of stay, and hospitalization of geatric patients admitted to CMH between prior to and after NHI implementation is favor."

"[Latar belakang : Kelompok geriatri memiliki karakteristik khusus yang berpotensi meningkatkan lama masa rawat dan menurunkan kualitas hidup dan terbukti dapat diperbaiki dengan Pendekatan Paripurna Pasien Geriatri (P3G). Terdapat kemungkinan adanya perbedaan antara lama masa rawat dan kualitas hidup pasien geriatri dengan P3G sebelum dengan sesudah adanya sistem pembiayaan JKN (Jaminan Kesehatan Nasional)Tujuan: melakukan evaluasi pelaksanaan sistem JKN terhadap lama rawat, quality adjusted life days (QALD) dan efektivitas biaya pasien geriatri yang dirawat di ruang rawat geriatri akut RSCM.Metode: Penelitian kohort retrospektif dengan kontrol historis dilakukan pada pasien geriatri ≥ 60 tahun dengan ≥ 1 sindrom geriatri yang dirawat di ruang rawat geriatri akut RSCM periode Juli-Desember 2013 (era non JKN) dan Januari-Juni 2014 (era JKN). Perbedaan dua rerata lama rawat dan QALD era non JKN dengan JKN dianalisis dengan uji-T tidak berpasangan. Dilakukan juga penghitungan incremental cost effectivity ratio (ICER) program JKN dengan outcome lama rawat dan QALD yang akan dipresentasikan dalam skema ICER.Hasil: Dari total 225 subjek, 100 subjek berada di era non JKN dan 125 subjek di era JKN dengan karakteristik relatif sama. Rerata usia adalah 70 [60-86] tahun dan 68 [60-85] tahun secara berurutan. Tidak ada perbedaan lama rawat antara era non JKN dan JKN dengan median 12 [2-76] dan 12 [2-59] hari, p= 0,974. Begitu juga tak ada perbedan QALD antara kelompok non JKN dan JKN dengan median 0,812[-3,1 – 24,37] dan 0,000 [-7,37 – 22,43], p= 0,256. Biaya per satu kali rawat pada era non JKN adalah Rp. 19.961,000 [Rp.2.57 juta –Rp. 100 juta] dan JKN Rp. 20.832.000,- [Rp.3.067 juta - Rp.100 juta]. Skema ICER memperlihatkan biaya rawat lebih mahal Rp. 1.500.000,- untuk mendapatkan lama rawat lebih pendek 0,91 hari. Berdasarkan QALD, biaya rawat lebih murah Rp.3.484.887,- dengan 0,25 QALD lebih rendah dibanding era non JKN.Simpulan: Tidak ada perbedaan lama rawat dan kualitas hidup pasien yang dirawat pada era non JKN dengan era JKN.;Background: Geriatric population with special characteristics tend to have longer average length of stay and lower quality of life. CGA (comprehensive Geriatric Assesment) was proven to improve the outcomes and has already be the standard procedure in RSCM. There were concerns on the difference between length of stay and quality of life before and after NHIP (National Health Insurance program) applied.Objectives: To evaluate the implementation of NHIP system according to length of stay, quality adjusted life days and cost effectiveness of care in geriatric patients in acute care for elderly Cipto Mangunkusumo HospitalMethod : This is a retrospective cohort study with historical control. The subjects were geriatric patients ≥60 years old with one or more geriatrics giants between Juli to Desember 2013 (Non NHIP) and Januari to Juni 2014 (NHIP). We used independent T test to compare between two mean of length of stay and QALD.Results : The characteristics were relatively similar between 100 subject in non NHIP group and 125 subject in NHIP group. the median of age were 70 [60- 86] dan 68 [60- 85] years old respectively. There was no significant difference between length of stay in non NHIP, median 12[2-76] days and NHIP group, median 12[2-59] days, p= 0,974. Quality of life which described as QALD proved that there was also no significant difference between non NHIP, median 0,812[-3,1 – 24,37] and NHIP group, median 0,000 [-7,37 –22,43], p= 0,256. The cost spent for one admission was Rp. 19.961,000 [Rp.2.57–Rp. 100 millions] in non NHIP and Rp. 20.832.000,- [Rp.3.067-Rp.100 millions] in NHIP group. Incremental cost effectiveness ratio (ICER) scheme showed NHIP is more expensive Rp.1.500.000,- to have 0,91 shorter days than non NHIP system. For QALD, the cost was cheaper Rp.3.484.887,- to have 0,25 QALD lower than non NHIP.Conclusion: There were no difference in length of stay and quality of life of patients who admitted in acute geriatric Cipto Mangunkusumo hospital with CGA approach before and after National Health Insurance program implementation., Background: Geriatric population with special characteristics tend to have longer average length of stay and lower quality of life. CGA (comprehensive Geriatric Assesment) was proven to improve the outcomes and has already be the standard procedure in RSCM. There were concerns on the difference between length of stay and quality of life before and after NHIP (National Health Insurance program) applied.Objectives: To evaluate the implementation of NHIP system according to length of stay, quality adjusted life days and cost effectiveness of care in geriatric patients in acute care for elderly Cipto Mangunkusumo HospitalMethod : This is a retrospective cohort study with historical control. The subjects were geriatric patients ≥60 years old with one or more geriatrics giants between Juli to Desember 2013 (Non NHIP) and Januari to Juni 2014 (NHIP). We used independent T test to compare between two mean of length of stay and QALD.Results : The characteristics were relatively similar between 100 subject in non NHIP group and 125 subject in NHIP group. the median of age were 70 [60- 86] dan 68 [60- 85] years old respectively. There was no significant difference between length of stay in non NHIP, median 12[2-76] days and NHIP group, median 12[2-59] days, p= 0,974. Quality of life which described as QALD proved that there was also no significant difference between non NHIP, median 0,812[-3,1 – 24,37] and NHIP group, median 0,000 [-7,37 –22,43], p= 0,256. The cost spent for one admission was Rp. 19.961,000 [Rp.2.57–Rp. 100 millions] in non NHIP and Rp. 20.832.000,- [Rp.3.067-Rp.100 millions] in NHIP group. Incremental cost effectiveness ratio (ICER) scheme showed NHIP is more expensive Rp.1.500.000,- to have 0,91 shorter days than non NHIP system. For QALD, the cost was cheaper Rp.3.484.887,- to have 0,25 QALD lower than non NHIP.Conclusion: There were no difference in length of stay and quality of life of patients who admitted in acute geriatric Cipto Mangunkusumo hospital with CGA approach before and after National Health Insurance program implementation.]"

"[Latar belakang : Pendekatan Paripurna Pasien Geriatri (P3G) telah menjadi standar pelayanan di RSCM karena terbukti menghasilkan luaran perawatan geriatri yang lebih baik. Semenjak awal tahun 2014, di Indonesia diberlakukan sistem pembiayaan Jaminan Kesehatan Nasional. Belum diketahui apa pengaruh penerapan JKN terhadap kesintasan dan efektifitas biaya pasien geriatri yang dirawat di RSCM.Tujuan : Mengetahui perbandingan kesintasan dan efektifitas biaya pasien geriatri pada era JKN dan non JKN yang dirawat di RSCM.Metode : Penelitian menggunakan metode kohort retrospektif dengan kontrol historis. Sampel dikumpulkan dari pasien geriatri yang dirawat di RSCM selama periode Juli 2013-Juni 2014 yang kemudian dibagi menjadi kelompok JKN dan kelompok non JKN sebagai kontrol. Akan dinilai perbedaan kesintasan dengan kurva kesintasan dan efektifitas biaya perawatan dengan menghitung incremental cost effectiveness ratio (ICER). Hasil : Dari total 225 subjek, 100 subjek berada di era non JKN dan 125 subjek di era JKN dengan karakteristik demografis dan klinis yang relatif sama. Tidak ada perbedaan mortalitas selama perawatan dan kesintasan 30 hari antara kelompok JKN dan non JKN (31,2% vs 28%, p=0,602 dan 65,2% vs 66,4%, p = 0,086). Kurva kesintasan 30 hari antara kedua kelompok tidak menunjukkan perbedaan bermakna. ICER memperlihatkan pada era JKN investasi biaya Rp. 1,4 juta,- terkait dengan penurunan kesintasan 1,2% dibandingkan kelompok non JKN, namun perbedaan tersebut tidak bermakna secara klinis dan statistik.Simpulan : Tidak ada perbedaan bermakna angka mortalitas antara pasien geriatri yang dirawat di RSCM pada kelompok JKN dan non JKN. Perhitungan ICER menunjukkan dibutuhkan investasi biaya untuk memperoleh penurunan kesintasan pada penerapan JKN, namun perlu dipertimbangkan implentasi JKN yang masih dalam tahap awal. Diperlukan penelitian lanjutan saat implementasi JKN telah berlangsung dalam kurun waktu lebih panjang., Background : Comprehensive Geriatrics Assesment (CGA) has been proven to improve the overall outcome of inpatient geriatric patients, and has been implemented in RSCM as the standard geriatric medical care. Since January 2014, a new insurance system called National Health Insurance Program (NHIP) was implemented in Indonesia. It is unclear how NHI will affect survival and cost effectiveness of geriatric inpatients receiving CGA.Objectives : To compare the survival and cost effectiveness betewwn NHIP and non NHIP era in geriatric patients admitted in RSCM.Method : This is a retrospective cohort study with hystorical control. The subject were geriatric inpatients ≥60 years old with one or more geriatrics giants between Juli to Desember 2013 (non NHIP) and Januari to Juni 2014 (NHIP). A survival analysis and determination of incremental cost effectivitveness ratio (ICER) was used to compare the survival and cost effectiveness between the two group.Result : The clinical and demographics characteristics were relatively similar between the NHIP and non NHIP group. No difference in inhospital mortaliy rate and 30 day survival rate between NHIP and non NHIP group (31,2% vs 28%, p=0,602, 65,2% vs 66,4%, p = 0,086, respectively). No significant difference was found when comparing the survival curve between the two group. Calculation of ICER shows thatNHIP is associated with an increased cost of 1,4 million rupiah and 1,2 % higher mortality rate.Conclusion: NHIP had no impact on survival in geriatric inpatients. ICER calculation shows NHIP implementation is associated with higher investment cost to yield lower survival rate. Further research is needed to evaluate this result when NHIP had been implemented for a longer duration.]"

"Pendahuluan: Profil Kesehatan Mulut dan Saliva pada Pasien Geriatri di Rumah Sakit Cipto Mangunkusumo. Pasien geriatri meningkat sejalan dengan peningkatan populasi Lansia. Permasalahan kesehatan umum dan gigi-mulut akan mempengaruhi kualitas hidup mereka. Tujuan: Studi ini bertujuan untuk mendeskripsikan kesehatan gigi dan mulut secara menyeluruh pada pasien geriatri di poliklinik geriatri di Rumah Sakit Cipto Mangunkusumo. Bahan dan Cara: penelitian ini adalah studi deskriptif. Kuesioner digunakan untuk mendapatkan data demografik. Pemeriksaan klinis intreoral dilakukan berdasarkan standar Fakultas Kedokteran Gigi Universitas Indonesia. Hasil: Jumlah sampel adalah 75 pasien geriatri dengan usia 60-86 tahun. Rata-rata skor DMF-T adalah 4.68±2.89, OHI-S 2.79±1.10, PBI 0.78±0.59. Rata-rata skor unstimulated salivary pH 6.62±0.54 dan stimulated buffer capacity saliva 7.46±2.83. Ratarata laju aliran saliva adalah 0,24 mL/menit dan hiposalivasi ditemukan pada 39 orang. 93 variasi normal dan 117 lesipatologis ditemukan pada studi ini. Kesimpulan: Ditemukannya status kesehatan gigi dan mulut yang rendah pada sampel penelitian ini menunjukkan adanya kemungkinan penyebabnya adalah rendahnya laju alur saliva, pH saliva, dan kemampuan buffer saliva. Pemeriksaan kesehatan gigi dan mulut secara sistematik dan rutin pada Lansia merupakan hal yang penting dan seyogyanya dilakukan secara holistik dengan kolaborasi antara dokter dan dokter gigi.

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Introduction: Population of geriatric patients would increase in line with that of elderly population. Health problems related to this group of people would have impact on general and oral health maintenance aiming for good quality of life. Objectives: This study aimed to determine the profile of oral health, saliva, and oral mucosa on geriatric patients at Geriatric Policlinic in Cipto Mangunkusumo Hospital. Materials and Methods: This research was a descriptive crosssectionalstudy, which data was taken using questionnaire containing basic demographical information and oral clinical examination using standard form used by Faculty of Dentistry Universitas Indonesia. Results: The study included 75 geriatric patients, ranging from 60 to 86 of age. The mean of DMF-T score of 69 geriatric patients was 4.68 ±2.893, OHI-S 2.790 ±1.102, PBI 0.779±0.585. The mean of unstimulated salivary pH score was 6.618 ± 0.54 and stimulatedbuffer capacity of saliva was 7.46±2.827. Mean of salivary flow rate is 0.24mL/min and 39 people had hiposalivation. 93 normal variations and 117 pathological oral lesion was found. Conclusion: This study showed that poor oral health status and pathological oral lesion found in this study elderly population could be caused from poor salivary flow, pH saliva, and buffer capacity of saliva. Systematic oral examination of the elderly is of considerable importance and oughtbe carried out regularly by a dentist in collaboration with the physician; making holistic management of the elderly properly performed."

"ABSTRAKLatar Belakang : Sejak dimulai penyelenggaraan sistem Jaminan Kesehatan Nasional, pemerintah menerapkan sistem rujukan berjenjang. Namun, RSUPN Dr. Cipto Mangunkusumo sebagai fasilitas kesehatan rujukan tingkat lanjutan mengalami peningkatan jumlah pasien, khususnya di Poliklinik Obstetri dan Ginekologi. Peneliti ingin mengetahui perbandingan pola kasus rujukan sebelum dan setelah era JKN di Poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo.Metode : Penelitian ini adalah observasional potong lintang dengan menggunakan data rekam medis pasien yang dirujuk ke Poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo selama tahun 2013 dan 2014. Analisis dilakukan dengan analisis bivariat dengan chi square untuk membedakan ketepatan diagnosis rujukan, ketepatan asal fasyankes perujuk, dan kesesuaian diagnosis rujukan sebelum dan setelah pelaksanaan JKN.Hasil : Terdapat peningkatan jumlah kunjungan Poliklinik Obstetri dan Ginekologi sejak dilaksanakannya program JKN pada tahun 2014, yaitu sebanyak 4.311 pasien. Jumlah subjek adalah sebanyak 222 subjek, terdiri dari 104 subjek pada tahun 2013 dan 118 subjek pada tahun 2014. Dari analisis data, didapatkan tingkat ketepatan diagnosis sebelum JKN adalah 81,7% dan setelah JKN 72,9% (p=0,118), tingkat ketepatan fasyankes perujuk sebelum JKN adalah 63,5% dan setelah JKN 71,2% (p=0,220), serta tingkat kesesuaian diagnosis sebelum JKN adalah 89,4% dan setelah JKN 84,7% (p=0,302).Kesimpulan : Tidak ada perbedaan yang bermakna secara statistik antara ketepatan diagnosis rujukan, ketepatan fasyankes perujuk, dan kesesuaian diagnosis fasyankes rujukan sebelum dan sesudah pelaksanaan JKN.

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ABSTRACTBackground : Since the start of National Health Coverage Program or in Indonesian Jaminan Kesehatan Nasional (JKN), the government has implemented vertical referral system. Even though Dr. Cipto Mangunkusumo General Hospital is the highest referral health facility, there is a growing number of patients, specifically in obstetric and gynacology outpatient clinic.Objective : To understand the pattern of referral cases (accuracy of referral diagnosis, accuracy of referral health facility and consistency of referral diagnosis) in obstetrics and gynecology outpatient clinic before and after the implementation of JKN.Methods : This is an observational cross sectional study using medical records of patients who were referred to obstetrics and gynecology outpatient clinic in Dr. Cipto Mangunkusumo General Hospital in 2013 and 2014. Data was analyzed with bivariate analysis with chi square, consisting the accuracy of referral cases, accuracy of referral health facility, and consistency of referral cases before and after implementation of JKN.Results: There is a growing number of patients in obstetrics and gynecology outpatient clinic after the implementation of JKN in 2014, which is 4.311 patients. Subjects were 222 cases, 104 cases from 2013 and 118 cases from 2014. From the analyzed data, the accuracy of referral diagnosis before JKN is 81,7% and after JKN 72,9%. (p=0,118), the accuracy of referral health facility before JKN is 63,7% and after JKN 72,9% (p=0,220), and the consistency of referral diagnosis before JKN is 89,4% and after JKN 84,7% (p=0,302).Conclusion : There is no statistically significant difference between the accuracy of referral diagnosis, accuracy of referral health facility, and consistency of referral diagnosis before and after the implementation of JKN."

"Clinical Pathway (CP) Apendisititis Akut (AA) memberikan gambaran secara rinci tahap-tahap pelayanan yang akan diberikan kepada pasien. Implementasi CP AA di RSI Ibnu Sina Pekanbaru diharapkan dapat mengendalikan variasi proses perawatan dalam upaya meningkatkan kendali mutu dan kendali biaya. Tujuan penelitian ini adalah untuk melihat peran implementasi CP AA dalam meningkatkan efisiensi biya apendiktomi pasien JKN di RSI Ibnu Sina Pekanbaru. Desain penelitian ini adalah cross sectional menggunakan pendekatan kuantitatif dengan menghitung tagihan biaya pasien yang menjalani apnediktomi sebelum dan sesudah implementasi CP AA dan diolah dengan uji statistik. Pendekatan kualitatif melalui wawancara mendalam dengan informan yang terkait dalam implementasi CP AA. Hasil penelitian terjadi pemendekan Length of Stay (LOS) secara bermakna (P<0.001) pada kelompok pasien sesudah implementasi CP dibandingkan sebelumnya. Terjadi penurunan rata-rata total biaya apendiktomi sebelum dan sesudah implementasi CP (Rp. 5.214.188.02 vs Rp. 4.436.438.37) yang bermakna (P<0.001) dengan persentase selisih 17,5%. Penurunan varian pelayanan berupa utilisasi alat kesehatan (Alkes), obat dan pemeriksaan laboratorium mempengaruhi peningkatan efisiensi biaya apendiktomi. Adanya varian dalam implementasi CP AA menjadi masukan untuk mencapai implementasi CP yang ideal. Varian berupa pengurangan pelayanan yang seharusnya diberikan kepada pasien harus ditinjaklanjuti dengan melakukan penilaian outcome pasien seperti tingakat kejadian readmission dan kondisi pasien ketika melakukan kontrol setelah pulang dari Rumah Sakit (RS).

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Clinical pathway for acute appendicitis provides a detailed description of the steps of healthcare to be given to patients. Implementation of clinical pathway for acute appendicitis at Ibnu Sina Islamic Hospital Pekanbaru is expected to be able to control variations in the treatment process in an effort to improve quality and cost control.The purpose of this study aimed to see the role of implementation of clinical pathway for acute appendicitis in improving appendectomy cost efficiency in The Indonesian National Health Insurance patients at Ibnu Sina Islamic Hospital Pekanbaru. The study design was cross sectional with a quantitative approach through calculating the cost bills of patients who underwent appendectomy before and after the implementation of clinical pathway and processed with statistical tests. Qualitative approach through indepth interviews with informants who were involved in the implementation of CP. The results of the study showed shortening length of stay statistically significant as (P <0.001) in the patient group after the implementation of the clinical pathway compared to before. There was a decrease in average total costs of appendectomy before and after the implementation of clinical pathways (IDR.5.214.188.02 vs IDR.4.436.438.37) statistically significant as (P <0.001) with a percentage difference of 17.5%. Decreasing service variants in the form of the utilization of medical equipment, drug, and laboratory test affected the increase in appendectomy cost efficiency. The existence of variants in the implementation of CP can be used as input to achieve the ideal CP. Variants in the form of reducing services that should be given to patients must be followed up by evaluating patient outcomes such as readmission rates and the patient's condition when controlling after returning from the hospital. "

"Latar Belakang: Pasien geriatri memiliki kompleksitas unik yang dapat meningkatkan beban dan biaya perawatan. Perbaikan status fungsional dan penurunan rehospitalisasi merupakan luaran keberhasilan pelayanan pasien geriatri yang dapat dicapai lebih baik dengan P3G (Pendekatan Paripurna Pasien Geriatri). Sejak implementasi sistem pembiayaan Jaminan Kesehatan Nasional (JKN) pada Januari 2014 belum diketahui perbandingan luaran perbaikan status fungsional, rehospitalisasi, dan efektivitas biaya pasien geriatri di RSCM dengan P3G.Tujuan: Mengetahui perbandingan perbaikan status fungsional, kejadian rehospitalisasi, dan efektivitas biaya pasien geriatri yang dirawat di RSCM pada era sebelum dan sesudah penerapan JKN.Metode: Kohort retrospektif dengan kontrol historis dilakukan pada pasien geriatri yang dirawat di RSCM pada periode Januari-Juni 2014 sebagai kelompok JKN dan Juli-Desember 2013 sebagai kelompok pra-JKN. Pengumpulan data dilakukan secara total sampling dari rekam medis. Pasien meninggal dieksklusi. Status fungsional dinilai dengan indeks ADL (activity of daily living) Barthel. Kemudian dilakukan analisis perbedaan proporsi rehospitalisasi, perbaikan status fungsional, dan perhitungan efektivitas biaya menggunakan incremental cost-effectiveness ratio (ICER).Hasil: Dari total 158 pasien, 72 subjek berada di kelompok pra-JKN dan 86 subjek di kelompok JKN dengan karakteristik yang relatif tidak berbeda. Tidak ada perbedaan median perbaikan status fungsional dan kejadian rehospitalisasi antara kelompok pra-JKN dan JKN (1 [-5 to 13] vs 2 [-2 to 15], p=0,715 dan 21,7,1% vs 18,1%, p=0,603). Telaah efektivitas biaya menunjukkan dengan menginvestasikan 3,7 juta rupiah pada implementasi JKN menyebabkan peningkatan 1 skor ADL Barthel dan penghematan 600 ribu rupiah pada implementasi JKN menyebabkan penurunan rehopitalisasi 3,6%; namun secara klinis dan statistik perbedaan tersebut tidak bermakna.Simpulan: Tidak ada perbedaan perbaikan ADL, kejadian rehospitalisasi, dan efektivitas biaya pasien geriatri yang dirawat di RSCM pada era JKN dan pra-JKN.

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Background: Geriatric patients have unique characteristics with high burden of care and cost. Functional status improvement and reduction of rehospitalization are the outcome of health care that can be achieved better by implementation of CGA (Comprehensive Geriatric Assessment). Since January 2014, National Health Insurance Program (NHIP) has been implemented and there are no data that explain the comparison of fuctional status improvement, rehospitalization, and cost-effectiveness ratio in geriatric patients receiving CGA at RSCM.

Objectives: to determine the comparison of functional status improvement, rehospitalization, and cost-effectiveness ratio in patients admitted to RSCM acute geriatric ward before and after implementation of NHIP.

Method: Retrospective cohort with historical control was done toward geriatric patients in periode of January-June 2014 as NHIP group and periode of July-December 2013 as pra-NHIP group. Data was collected from medical record and enrolled by total sampling. Death cases were excluded. Functional status was measured using activity of daily living (ADL) Barthel index. Analysis the difference of activity of daily living score, rehospitalization, and incremental cost effectiveness ratio (ICER) were done to compare both groups.

Result : From 158 patients, 72 subjects are in pra-NHIP group and 86 subject in NHIP groups. Both group have similar characteristics. There are no difference of functional status improvement and rates of rehospitalization between pra-NHIP and NHIP group (1 [-5 to 13] vs 2 [-2 to 15], p=0,715 and 21,7% vs 18,1%, p=0,603). ICER shows that by investing 3,7 million rupiah on implementation of NHIP cause 1 score improvement of ADL Barthel index and by saving 600 thousand rupiah on NHIP cause 3,6% declining rehopitalization rates. Statistically and clinically both ICER are not significant.

Conclusion: There are no difference of functional status improvement, rates of rehospitalization, and cost-effectiveness ratio in geriatric patients between NHIP and pra-NHIP groups."

"Dalam UUD 1945 menyebutkan bahwa setiap orang berhak memperoleh pelayanan kesehatan dan Negara bertanggung jawab atas penyediaan fasiltas kesehatan dan fasilitas umum yang layak. Untuk memenuhi dan mewujudkan hak bagi setiap warga negara dalam mendapatkan pelayanan kesehatan yang layak dan kewajiban pemerintah penyediaan fasilitas kesehatan sebagai amanat UUD 1945 maka pemerintah pusat menyelenggarakan program jaminan kesehatan nasional (JKN) dan untuk pemerintahan daerah khusus Ibukota (DKI Jakarta) menyelenggarakan jaminan kesehatan daerah yang dikenal dengan nama Kartu Jakarta Sehat (KJS). RSCM adalah rumah sakit milik pemerintah pusat yang salah satu visinya adalah menjadi rumah sakit pusat rujukan nasonal terkemuka di Asia Pasifik tahun 2014. RSCM diharapkan dapat melayani masyarakat dari seluruh penjuru Indonesia dengan sistem rujukan berjenjang dengan optimal sesuai dengan standar pelayanan kesehatan dan peraturan yang berlaku. Penelitian ini membahas mengenai indeks kepuasan masyarakat miskin terhadap pelayanan di RSCM dalam program JKN dan KJS. Program kesehatan JKN dan KJS ini tidak lepas dari permasalahan dalam pelaksanaannya, salah satunya adalah mengenai pelayanan di rumah sakit dalam pelaksanaan program tersebut. Tujuan dalam penelitian ini adalah untuk mengukur nilai indeks kepuasan masyarakat miskin di RSCM dalam pelaksanaan program JKN dan KJS serta untuk mengetahui unsurunsur yang sudah baik dan yang masih membutuhkan peningkatan kualitas pelayanannya. Hasil dari penelitian kuantiatif menilai bahwa indeks kepuasan masyarakat miskin di RSCM adalah sangat baik, tetapi ada beberapa pelayanan yang perlu menjadi perhatian dan atau perbaikan yang didapat dari hasil penelitian kualitatif.

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Indonesia Constitution (UUD 1945) states that every citizen has the right to obtain medical care and the Government is responsible for the provision of health and adequate public facilities. In order to satisfy and fulfil the right of every citizen in getting proper health care as mandated by the Constitution, The central government has issued the National Health Insurance Program (JKN) whereas the Jakarta Provincial Government has issued a Regional-based Health Insurance Program known as the Jakarta Health Card (KJS).

National General Hospital Dr. Cipto Mangunkusumo (RSCM) is one of the hospitals owned by the central government and one of its visions is to become regional referral hospitals in Asia Pacific in 2014. RSCM is expected to serve people from all over Indonesia accordance with the standard of health services and regulations.

This study discusses the satisfaction index of the poor with regard to services in RSCM especially on the implementation of the JKN and KJS. The problem of the implementation of JKN and KJS are still occurred, one of the problems is the hospital services in the implementation of the programs.

The purpose of this research is to measure the value of the satisfaction index of the poor in RSCM on the implementation of JKN and KJS as well as to determine the factors that are good and which are still in need of improvement of service quality.

The results of the quantitative study is conclude that the satisfaction index of the poor in RSCM is "very good", yet there are some services that need to be improved derived from the results of qualitative research."

"Pendahuluan: Arteriovenous malformation (AVM) serebral adalah kelainan vaskular di otak yang sering menyebabkan perdarahan intraserebral dan kejang, dengan prevalensi 10-18 per 100.000 orang pada populasi dewasa. Modalitas terapi meliputi observasi, reseksi bedah, bedah radiasi stereotaktik, dan embolisasi endovaskular. Studi ini bertujuan untuk mengevaluasi luaran klinis dan radiologis pasien AVM serebral setelah Gamma Knife Radiosurgery (GKRS) di RSUPN dr. Cipto Mangunkusumo (RSCM).

Metode: Studi observasional kohort-retrospektif dilakukan pada pasien AVM serebral yang menjalani GKRS di RSCM antara 2018 dan 2022. Evaluasi klinis dan radiologis dilakukan pada 6 bulan, 1 tahun, 2 tahun, dan 3 tahun pasca tindakan. Pengambilan sampel menggunakan metode consecutive sampling berdasarkan kriteria inklusi dan eksklusi.

Hasil: Dari 41 pasien yang memenuhi kriteria inklusi dan ekslusi, usia rerata pasien adalah 25,76 tahun dengan mayoritas laki-laki (63,45), gejala klinis yang paling umum adalah nyeri kepala dan kejang. Rata-rata tingkat obliterasi AVM setelah 1 tahun pasca-GKRS adalah 71,69%, meningkat menjadi 87,21% setelah 2 tahun, dan mencapai 91,07% setelah 3 tahun. Dalam evaluasi satu tahun pasca-GKRS, seluruh 41 pasien mengalami resolusi nyeri kepala. Sedangkan, dari 15 pasien yang mengalami kejang sebelum GKRS, hanya 2 pasien yang masih mengalami kejang dalam evaluasi 1 tahun setelah GKRS. Terdapat korelasi kuat antara tingkat obliterasi dan ukuran nidus <3cm (r=0.39) dan ukuran 3-6 cm (r=0.83). Selain itu, peningkatan tingkat obliterasi memiliki korelasi terhadap Spetzler-Martin (SM) Grade yang lebih rendah (p=0,001).

Pembahasan: Penelitian ini menunjukkan tingkat obliterasi yang tinggi pada pasien AVM serebral pasca-GKRS, terutama pada kelompok SM grade rendah dan ukuran nidus yang kecil. Meskipun demikian, perdarahan tetap merupakan risiko selama periode evaluasi pasca GKRS, terutama pada pasien dengan SM grade tinggi. Faktor seperti embolisasi sebelum GKRS tidak mempengaruhi tingkat obliterasi secara signifikan, sementara hubungan antara tingkat obliterasi dengan perbaikan klinis, seperti penurunan nyeri kepala, ditemukan bermakna.

Kesimpulan: Sebagai kesimpulan, ukuran nidus yang lebih kecil mempunyai korelasi signifikan dalam memprediksi obliterasi AVM serebral pasca GKRS. Meskipun GKRS dapat menjadi pilihan utama pada pasien dengan SM grade rendah dan ukuran nidus kecil, risiko perdarahan perlu dipertimbangkan selama pemantauan pasca tindakan. Perbaikan klinis, khususnya dalam mengurangi nyeri kepala, berkorelasi positif dengan tingkat obliterasi AVM setelah GKRS.

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Introduction: Brain arteriovenous malformation (AVM) is a vascular disorder in the brain often associated with intracerebral hemorrhage and seizures, with a prevalence of 10-18 per 100,000 adults. Treatment modalities include observation, surgical resection, stereotactic radiosurgery, and endovascular embolization. This study aimed to evaluate the clinical and radiological outcomes of cerebral AVM patients after Gamma Knife Radiosurgery (GKRS) at Dr. Cipto Mangunkusumo National General Hospital (RSCM).

Methods: A retrospective cohort observational study was conducted on brain AVM patients who underwent GKRS at RSCM between 2018 and 2022. Clinical and radiological evaluations were performed at 6 months, 1 year, 2 years, and 3 years post-procedure. Sampling was conducted using consecutive sampling based on inclusion and exclusion criteria.

Results: Of the 41 patients meeting the inclusion and exclusion criteria, the mean age was 25.76 years with a predominance of males (63.45%). The most common clinical symptoms were headache and seizures. The average AVM obliteration rate after 1 year post-GKRS was 71.69%, increasing to 87.21% after 2 years, and reaching 91.07% after 3 years. At the one-year evaluation post-GKRS, all 41 patients experienced resolution of headaches. Among the 15 patients with pre-GKRS seizures, only 2 patients still experienced seizures at the 1-year evaluation post-GKRS. There was a strong correlation between obliteration rate and nidus size <3 cm (r=0.39) and size 3-6 cm (r=0.83). Furthermore, increased obliteration rates correlated with lower Spetzler-Martin (SM) Grade (p=0.001).

Discussion: This study demonstrates high obliteration rates in brain AVM patients after GKRS, particularly in the low SM grade and small nidus size groups. However, hemorrhage remains a risk during the post-GKRS evaluation period, especially in patients with high SM grades. Factors such as pre-GKRS embolization did not significantly affect obliteration rates, while a significant association between obliteration rate and clinical improvement, such as reduction in headaches, was found.

Conclusion: In conclusion, smaller nidus size significantly predicts brain AVM obliteration post-GKRS. Although GKRS may be the primary choice for patients with low SM grade and small nidus size, the risk of hemorrhage needs consideration during post-procedural monitoring. Clinical improvements, particularly in reducing headaches, positively correlate with AVM obliteration rates after GKRS."

"Latar belakang: Hemofilia merupakan gangguan perdarahan yang bersifat herediter yang disebabkan oleh kekurangan faktor VIII. Pada kadar faktor koagulasi yang sama dapat menunjukkan karakteristik klinis yang berbeda. Tujuan: Mengidentifikasi karakteristik klinis, penggunaan faktor VIII, dan komplikasi pada anak hemofilia A. Metode: Penelitian kohort retrospektif pada anak le;18 tahun. Data diambil dari rekam medis Januari 2014 ndash; Juni 2016 meliputi data usia awitan perdarahan sendi, usia saat didiagnosis, kekerapan perdarahan, lokasi perdarahan, penggunaan faktor VIII, dan komplikasi yang dialami. Hasil: Terdapat 109 subjek anak lelaki terdiri dari 2,8 subjek hemofilia A ringan, 27,5 hemofilia A sedang, dan 69,7 hemofilia A berat. Perdarahan paling sering ditemukan pada sendi 60,6 terutama pada lutut 37,2 . Anak hemofilia A berat menunjukkan usia awitan perdarahan sendi yang lebih dini median 12,5 4 - 120 bulan , kekerapan perdarahan sendi yang lebih sering median 8 1-44 kali/tahun , menggunakan konsentrat faktor VIII yang lebih banyak median 712 131 - 1913 IU/kg/tahun . Komplikasi yang ditemukan adalah hemofilik artropati dan sinovitis 46,8 , terbentuknya inhibitor faktor VIII 7,3 , anemia akibat perdarahan 2,6 , pseudotumor 0,9 , dan fraktur 0,9 . Terdapat 15,5 subjek hemofilia A berat yang menunjukkan karakteristik klinis yang lebih ringan. Simpulan: Usia awitan perdarahan sendi berhubungan dengan kekerapan perdarahan sendi, kebutuhan faktor VIII, dan artropati. Artropati dan sinovitis merupakan komplikasi yang paling banyak ditemukan.

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Background: Hemophilia A is a congenital bleeding disorder caused by deficiency of factor VIII. Phenotypic differences between patients with hemophilia is well known from clinical practice.

Aim: To identify clinical characteristics, factor VIII usage for on demand therapy, and complications of children with hemophilia A.

Method: A retrospective cohort study on children aged le 18 years. Data was obtained from medical record January 2014 ndash June 2016 including age of diagnosis, age of first joint bleed, number of bleeding, site of bleeding, treatment requirement, and complications.

Result: We found a total of 109 boys with hemophilia A consisted of 2.8 mild, 27.5 moderate, and 69.7 severe hemophilia. The most common bleeding was hemarthrosis 60.6 of the knee 37.2 . Severe hemophilia children showed earlier age of first joint bleed median 12,5 4 to 120 months , higher number of joint bleeds median 8 1 44 times year , and higher consumptions of clotting factor median 712 131 to 1913 IU kg year compared to mild and moderate hemophilia. Complications commonly found in severe hemophilia were haemophilic arthropathy and sinovitis 46.8 , followed by factor VIII inhibitors 7.3 , anaemia due to bleeding 2.6 , pseudotumour 0.9 , and fracture 0.9 . This study showed that 15.5 of patients with severe hemophilia A have mild clinical characteristics.

Conclusion: The onset of joint bleeding is related with number of joint bleeds, treatment requirement, and arthropathy and may serve as an indicator of clinical phenotype."