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"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. "

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Analisis Pemanfaatan Clinical Pathway Sectio Caesaria Di Rumah Sakit Dalam Program Jaminan Kesehatan Nasional Penelitian ini bertujuan menganalisis hubungan antara faktor sosial ekonomi dan klinis ibu melahirkan Sectio Caesaria (SC) di Rumah Sakit (RS) dengan pemanfaatan Clinical Pathway (CP), outcome klinis serta pembayaran klaim. Studi desain Cross Sectional pada unit analisis 1155 data rekam medis ibu melahirkan SC periode 1 Januar-31 Desember 2018 di 3 RS. Hasil penelitian menunjukan pemanfaatan CP peserta Jaminan Kesehatan Nasional (JKN) yaitu sebanyak 939 Ibu melahirkan SC proporsinya sebesar 43.1% masih menunjukkan pemanfaatan yang kurang baik. Pemanfaatan CP terkait penyimpanan dokumen Clinical Pathway ibu melahirkan SC peserta JKN sebanyak 71.8% tidak tersimpan di Rekam Medis, 72.6% tidak lengkap pengisiannya dan 64.6% kondisi klinis Ibu melahirkan SC tidak sesuai dengan PPK RS. RS Pemda memiliki Proporsi tertinggi skor pemanfaatan CP yang kurang baik sebesar 76.8%, kemudian diikuti RSP (36.8%). RSNP menunjukkan proporsi skor pemanfaatan CP baik. Jenis RS (p=0.000), Kelas rawat (p=0.014) dan Rujukan (p=0.008), jenis SC (p=0.005), Usia Ibu (p=0.053), Paritas (p=0.016), Riwayat ANC (p=0.000), Kondisi Panggul p=0.000), kondisi plasenta (p=0.001), penyakit penyerta (p=0.000) dan riwayat SC (p=0.000) menunjukkan berhubungan secara signifikan dengan pemanfaatan CP (p<0.05). Pemanfaatan CP ibu melahirkan SC peserta JKN menunjukan adanya hubungan yang signifikan dengan Outcome klinis (p=0.002). Outcome Klinis ibu melahirkan SC menunjukkan sebesar 67.5% bermasalah antara lain terkait LOS yang tidak sesuai Panduan Praktek Klinis (PPK) RS, Ibu memiliki komplikasi klinis paska SC atau kondisi bayi saat dilahirkan tidak normal. Pemanfaatan CP berhubungan secara signifikan dengan pembayaran klaim (p=0.000). Pembayaran klaim ibu melahirkan SC peserta JKN bermasalah sebesar 39.3% terkait jangka waktu pembayaran klaim dari BPJSK ke pihak RS. Pembayaran klaim yang tidak bermasalah pada pemanfaatan CP yang kurang baik lebih banyak. Monitoring dan evaluasi yang komprehensif pada pemanfaatan CP, outcome klinis dan proses pembayaran klaim sebagai kendali mutu pelayanan ibu melahirkan SC dalam JKN oleh RS, Organisasi Profesi dan Pemerintah. Pemerintah harus membuat payung hukum yang bersifat operasional pada pemanfaatan CP Ibu melahirkan SC di RS dalam program JKN, sehingga kendali mutu dan kendali biaya pelayanan ibu melahirkan SC menjadi efektif dan efisien. Pedoman Nasional Pelayanan Kedokteran perlu segera diterbitkan dan disosialisikan ke Rumah Sakit. Kata kunci: SC, Sosial-ekonomi dan Klinis, Pemanfaatan Clinical Pathway, Outcome Klinis, Klaim Pembayaran

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Analysis of Sectio Caesarea Clinical Pathway Utilization in Hospital Under National Health Insurance This study aims to analyze the relationship between socioeconomic and clinical factors of women giving birth to Sectio Caesaria (SC) in Hospitals (RS) with the utilization of Clinical Pathway (CP), clinical outcomes and claim payment. Cross Sectional design study in the 1155 unit of analysis of medical records of women giving birth to SC for the period January 1 to December 31, 2018 in 3 hospitals. The results showed that the utilization of CP for mothers giving birth to SC (939) participants of the National Health Insurance (JKN) from the 3 research study hospitals, the proportion of 43.1%, still showed poor utilization. Utilization of CP related to document keeping of mother who gave birth SC to JKN participants as much as 71.8% were not kept in the Medical Record, 72.6% were incomplete filling and 64.6% of clinical conditions of mother who gave birth to SC were not in accordance with PPK RS. Regional Government Hospital has the highest proportion of poor CP utilization scores of 76.8%, followed by RSP (36.8%). RSNP shows the proportion of good CP utilization scores. Type of hospital (p = 0.000), nursing class (p = 0.014) and type of referral (p = 0.008), type of SC (p = 0.005), maternal age (p = 0.053), parity (p = 0.016), ANC history (p = 0.000), Pelvic Conditions (p = 0.000), placental conditions (p = 0.001), comorbidities (p = 0,000) and history of SC (p = 0,000) showed significant correlation with CP utilization (p <0.05). Utilization of CP for mothers giving birth to SC JKN participants showed a significant relationship with clinical outcome (p = 0.002). Clinical Outcomes of mothers giving birth to SC showed that 67.5% had problems, among others related to LOS that was not in accordance with the Clinical Practice Guidelines (PPK) of the Hospital. CP utilization was significantly related to claim payment (p = 0,000). Claim Payment of mothers with SC under JKN participants was 39.3% related to the period of payment of claims from BPJSK to the hospital. The utilization of CP which were under score mean seems not having administration problem and paid by JKN earlier and without any problem. Comprehensive monitoring and evaluation of the utilization of CP , clinical outcomes and the process of claim as a quality control service for SC mothers in JKN by hospitals, professional organizations and the government. The government must make an operational legal policy on the utilization of CP for women giving birth to SC in hospitals under the JKN program, so that quality control and cost control of maternal care services for SC become effective and efficient. National Guidelines for Medical Services need to be immediately published and disseminated to hospitals. Keywords: SC, Socio-economic and Clinical, Clinical Pathway Utilization, Clinical Outcome, Payment Claims

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"Latar belakang. Masalah yang sering dihadapi pada pelayanan pasien Jaminan Kesehatan Nasional adalah kesenjangan biaya perawatan pasien stroke dengan tarif INA-CBGs. Hal ini terkait dengan biaya perawatan dan Clinical Pathway. Tujuan. Mengetahui biaya perawatan pasien stroke di Rumah Sakit Pusat Otak Nasional. Metoda. Penelitian kuantitatif deskriptif mengikutsertakan 277 subjek penyakit stroke yang diperoleh di Rumah Sakit Pusat Otak Nasional Jakarta selama Januari ? Juni 2015. Biaya perawatan stroke dihitung berdasarkan biaya satuan (unit cost) dengan menggunakan metode activity based costing dan Clinical Pathway. Hasil. Biaya satuan perawatan stroke iskemik dan stroke hemoragik berdasarkan Clinical Pathway, dengan memperhitungkan biaya investasi dan biaya gaji, tanpa memperhitungkan jasa medis berturut-turut adalah Rp 311,860,860.83 dan Rp 585,083,610.01; dengan memperhitungkan biaya investasi, biaya gaji, dan jasa medis berdasarkan tarif rumah sakit adalah Rp 321,682,940.73 dan Rp598,929,450.01; dengan memperhitungkan biaya investasi, biaya gaji, dan jasa medis berdasarkan tarif IDI adalah Rp 318,360,860.73 dan Rp 594,333,610.01; tanpa memperhitungkan biaya investasi, biaya gaji, dan jasa medis adalah Rp30,361,681.00 dan Rp25,698,199.46; tanpa memperhitungkan biaya investasi dan biaya gaji, tetapi memperhitungkan jasa medis berdasarkan tarif rumah sakit adalah Rp 40,183,761.00 dan Rp 39,544,199.46; tanpa memperhitungkan biaya investasi dan biaya gaji, tetapi memperhitungkan jasa medis berdasarkan IDI adalah Rp 36,861,681.00 dan Rp 34,948,199.46. Simpulan: Dijumpai selisih biaya perawatan berdasarkan biaya satuan dan Clinical Pathway, baik yang memperhitungkan biaya investasi, gaji, dan jasa medis, maupun tanpa memperhitungkan biaya investasi, gaji, dan jasa medis, dengan tarif layanan existing dan tarif INA-CBGs.

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Background. Problem often encountered in patient care National Health Insurance is the gap between the cost of stroke treatment with INA-CBGs tariff. This is related to the cost of treatment and the Clinical Pathway.

Aim. Knowing the cost of stroke treatment in the National Brain Center Hospital Jakarta.

Methods. Descriptive quantitative study involving 277 subjects stroke obtained at the National Brain Center Hospital Jakarta during January - June 2015. The cost of stroke treatment are calculated based on the unit cost using activity-based costing method and Clinical Pathway.

Results. The unit cost of ischemic stroke and hemorrhagic stroke treatment by Clinical Pathway, taking into account investment costs and salary costs, regardless of medical services is IDR 311,860,860.83 and IDR 585,083,610.01; taking into account investment cost, salary cost, and medical services tariff based hospital is IDR 321,682,940.73 and IDR 598,929,450.01; taking into account investment cost, salary cost, and medical services tariff based IDI is IDR 318,360,860.73 and IDR 594,333,610.01; without taking into account investment cost, salary cost, and medical services are IDR 30,361,681.00 and IDR 25,698,199.46; without taking into account the investment cost and salary cost, but taking into account medical services tariff based hospital is IDR 40,183,761.00 and IDR 39,544,199.46; without taking into account the investment cost and salary cost, but taking into account medical services tariff based IDI is IDR 36,861,681.00 and IDR 34,948,199.46.

Conclusion. Found difference in the cost of stroke treatment is based on unit cost and Clinical Pathway, both of which take into account the investment, salaries, and medical services cost, and without taking into account investment, salaries, and medical services cost, with existing services and tariff rates INA-CBGs."

"Pada tahun 2014, Indonesia memulai program Jaminan Kesehatan Nasional (JKN) yang menggunakan Indonesia Case Based Groups (INA-CBGs) sebagai sistem pembayaran rumah sakit. Sistem pembayaran ini memberikan insentif kepada rumah sakit untuk meningkatkan pendapatan dengan cara meningkatkan kunjungan pasien baru, salah satunya dengan upaya readmisi. Tujuan penelitian ini adalah menganalisis faktor yang mempengaruhi readmisi pada pasien rawat inap kasus Hepatobilier di Rumah Sakit X. Penelitian ini menggunakan metode penelitian kuantitatif dengan desain penelitian cross sectional. Data yang diambil merupakan data sekunder kasus hepatobilier rawat inap sebelum pelaksanaan JKN (tahun 2010- 2013) dan sesudah pelaksanaan JKN (tahun 2014-2017). Hasil analisis bivariat menunjukkan bahwa setelah pelaksanaan JKN, pasien dengan readmisi ≥ 30 hari mengalami peningkatan median lama rawat inap, sedangkan pasien dengan readmisi < 30 hari mengalami penurunan lama rawat inap. Hasil uji multivariat menunjukkan variabel yang paling dominan berpengaruh dengan jenis readmisi adalah lama rawat inap dengan nilai marginal effect -0.041. Hasil estimasi diperoleh nilai koefisien negatif yang menunjukkan semakin pendek lama rawat inap, peluang readmisi < 30 hari semakin tinggi. Hal tersebut menunjukkan adanya kemungkinan upaya memperpendek lama rawat inap dan upaya readmisi yang sengaja dilakukan oleh rumah sakit setelah pelaksanaan sistem pembayaran INA CBGs. Pernyataan tersebut didukung dengan hasil analisis bivariat yang menunjukkan proporsi readmisi < 30 hari lebih tinggi pada payer dengan sistem pembayaran INA CBGs dan FFS negosiasi dibandingkan dengan payer dengan sistem pembayaran FFS.

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In 2014, Indonesia has started a National Health Insurance (JKN) program that used Indonesia Case Based Groups (INA-CBGs) as hospital payment system. This payment system provides an incentive for hospitals to increase revenue by increasing new patient visits, one of which is by readmissions. The purpose of this study is to analyze the factors that affect the readmissions of Hepatobiliary inpatients in Hospital X. This study uses a quantitative research method with a cross sectional research design. The data taken is secondary data on hepatobiliary cases hospitalized before the implementation of JKN (2010-2013) and after the implementation of JKN (2014-2017). The results of the bivariate analysis show that after the implementation of JKN, patients with ≥ 30 days readmission experience an increase in median length of stay, while patients with <30 days readmission experience a decrease in length of stay. The multivariate test results show that the most dominant variable influencing the type of readmissions is the length of stay with a value of marginal effect -0.041. Estimation results obtain negative coefficient values which indicate the shorter the length of stay, the chances of <30 days readmission are higher. This shows that there is a possibility of efforts to shorten the length of stay and efforts to readmissions deliberately carried out by the hospital after the implementation of the INA CBGs payment system. The statement is supported by the results of bivariate analysis which shows the proportion of <30 days readmission higher for payers with INA CBGs and FFS negotiations payment system compared to payer with the FFS payment system."

"[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.]"

"Clinical Pathway di rumah sakit merupakan pedoman yang mencakup semua aktivitas dari pasien masuk hingga keluar rumah sakit. Tesis ini membahas mengenai pengaruh clinical pathway terhadap lama hari rawat dan biaya resep pasien di RS IMC. Penelitian ini adalah kualitatif dan kuantitatif dengan desain studi kasus analisis deskriptif. Hasil penelitian menggambarkan tahapan proses implementasi clinical pathway di RS IMC dimulai dengan perencanaan, pembentukan tim, penyusunan draft formulir clinical pathway, sosialisasi, uji coba hingga implementasi; serta terjadi penurunan lama hari rawat dan biaya resep pasien hernia inguinalis akibat pengaruh implementasi clinical pathway di RS IMC Bintaro.

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Clinical Pathway in the hospital is a guideline which includes all activities from admission until hospital discharge. This thesis discusses the effect of clinical pathways towards length of stay and cost of prescription patient in IMC hospital. This study is a qualitative and quantitative, analysis of a descriptive case study design. Results of the study illustrate the stages of the process of implementing clinical pathways in IMC Hospital that begins with planning, team building, clinical pathways form drafting, dissemination, trial and implementation; as well as a decline in length of stay and cost of prescription inguinal hernia patients due to the effect of the implementation of clinical pathways in IMC Hospital."

"Clinical pathway merupakan sebuah alat untuk menjaga kualitas pelayanan dan efisiensi biaya dengan cara menstandarkan pelayanan. Penelitian ini bertujuan untuk mengetahui dampak dari implementasi clinical pathway terhadap peningkatan kualitas pelayanan dan pengeluaran biaya yang lebih efisien. Analisis dampak dari implementasi clinical pathway dilakukan dengan cara membandingkan lama hari rawat, pelayanan, dan tagihan antara kelompok sebelum dan setelah implementasi clinical pathway dengan standar pelayanan. Tidak ada perbedaan rata-rata yang signifikan antara sebelum dan setelah clinical pathway pada lama hari rawat yaitu sebesar 5,9 hari, namun pada setelah clinical pathway terjadi penurunan variasi dan lebih mengikuti standar dalam clinical pathway. Variasi laboratorium dan radiologi mengalami penurunan pada kelompok setelah clinical pathway namun pada obat terjadi peningkatan jumlah variasi. Tagihan pasien mengalami kenaikan yang signifikan yaitu sebesar 19,66%. Peningkatan tagihan disebabkan oleh lama hari rawat yang cenderung lebih panjang pada kelompok setelah clinical pathway sehingga meningkatkan biaya akomodasi dan tindakan. Rumah sakit perlu melibatkan seluruh tenaga kesehatan terkait mulai dari proses pembuatan clinical pathway hingga implementasinya agar proses implementasi menjadi lebih maksimal. Selain itu, diperlukan peninjauan dan sosialisasi perihal peraturan terkait Pedoman Nasional Pelayanan Kesehatan, Panduan Praktik Klinis, dan clinical pathway oleh Kementerian Kesehatan, serta diperlukan kerja sama antara rumah sakit, Kementerian Kesehatan, dan BPJS dalam penyusunan hospital base rate untuk perbaikan tarif INACBG.

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Clinical pathway is a tool to maintain service quality and cost efficiency by standardizing services. This study aims to determine the variations of medical services and costs by comparing before and after clinical pathway implementation. Medical services that were compared with service standard were length of stay and medical services including laboratory, radiology, and drugs. In this study, costs were the calculation of patients bills. There was no significant difference between the average length of stay before and after the clinical pathway, which was 5.9 days, but after clinical pathway group followed standard more precise with a decrease in variation. Laboratory and radiological variations decreased in the group after clinical pathway but for the drugs, there was an increase in the number of variations. Patient bills experienced a significant increase of 19.66%. The increase of patient bills was caused by length of stay which tend to be longer in groups after clinical pathway, thereby increasing accommodation and medical service costs. Hospitals need to involve all related medical practitioner starting from clinical pathway planning process to the implementation, so then the implementation become better. In addition, it is necessary to review and socialize regulation regarding National Health Service Guidelines, Clinical Practice Guidelines, and clinical pathway by the Ministry of Health, and cooperation between hospitals, Ministry of Health, and Social Insurance Administration Organization is required in preparation of base rate hospitals to improve INA-CBG tariffs."

"Penelitian ini bertujuan untuk menganalisis perbedaan antara biaya rawat inap berdasarkan tarif INA-CBGs dengan biaya rawat inap berdasarkan tarif rumah sakit pada pasien Jaminan Kesehatan Nasional (JKN) dengan diagnosis infeksi HIV di Rumah Sakit Ketergantungan Obat Jakarta. Penelitian ini menggunakan metode deskriptif kualitatif. Hasil penelitian menunjukan bahwa secara keseluruhan perbedaan biaya rawat inap antara BPJS Kesehatan dengan rumah sakit disebabkan oleh adanya perbedaan tarif dan perbedaan metode pembebanan biaya. Akibat perbedaan tersebut, rumah sakit mengalami kerugian. Rumah sakit dapat menekan kerugian dengan meningkatkan cost effectiveness proses bisnis rawat inap, menetapkan harga target, menyusun biaya standar serta melakukan monitoring dan evaluasi penyelenggaraan Program JKN.

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This study's objective is to analyze the difference between inpatient cost based on INA-CBGs rates with the one based on hospital rates on JKN patient with HIV infection in Rumah Sakit Ketergantungan Obat Jakarta. This study uses a descriptive-qualitative methods. The study shows for overall the difference casuses loss to the hospital. It because of the rate and the charging method differences between BPJS Kesehatan and the hospital. The hospital reduces the loss by improving the cost effectiveness of business processes, planning and controlling the inpatient cost through target pricing and standard costing as well as monitoring and evaluating the programs."

"Clinical Pathway (CP) merupakan perangkat alat multidisiplin ilmu yang digunakan untuk perawatan kesehatan berbasis bukti (evidence based). CP memiliki fungsi menyeragamkan terapi sehingga mampu meminimalkan komplikasi dan kesalahan pengobatan. Rumah Sakit Pusat Otak Nasional (RS PON) merupakan rumah sakit rujukan otak dan persarafan nasional. Stroke perdarahan menjadi penyakit kedua tertinggi di RS.PON. Keberagaman keputusan dilakukannya operasi atau tidak, meskipun sudah masuk indikasi, menjadi poin penting untuk menganalisis implementasi pelaksanaan Clinical Pathway ini.Tujuan penelitian: menilai implementasi CP stroke perdarahan yang telah dijalankan sehingga diharapkan mampu menjadi dasar penentu kebijakan rumah sakit jejaring maupun rumah sakit seluruh Indonesia. Menilai hubungan antara variabel-variabel dalam clinical pathway terhadap Length of Stay (LOS), morbiditas dan mortalitasMetode: ​​Penelitian ini menggunakan metode mixed method, dengan pendekatan retrospektif. Dalam penelitian kuantitatif dilakukan analisis univariat dan multivariat, dimana menggunakan data sekunder dari rekam medis pasien stroke perdarahan yang dirawat di RS PON pada januari 2020 - Desember 2021. Dari total populasi 1254 pasien setelah dilakukan kriteria inklusi dan inklusi didapatkan 1001 pasien. Penelitian kuantitatif, dilakukan dengan menganalisis pengaruh implementasi CP terhadap lama hari rawat, morbiditas (nilai NIHSS) dan mortalitas. Faktor risiko dan efek atau penyakit yang terjadi di masa lampau diukur melalui catatan historis. Sementara pengumpulan data secara kualitatif menggunakan kuisioner dan wawancara secara mendalam kepada Kepala Bidang Pelayanan Medis, Kepala Komite Medis, Kepala Komite Keperawatan, Kepala Divisi Vaskular, Dokter Spesialis Neurologi, Dokter Spesialis Bedah Saraf, Dokter IGD, Perawat, Fisioterapi, Terapi wicara, Gizi dan Farmasi untuk mengetahui tahapan proses Clinical Pathway di RS PON. Total responden 129 orang. Penelitian kualitatif menilai pengetahuan tenaga medis dan paramedis terkait CP, implementasi, supervisi, monitoring dan evaluasi.Hasil: penelitian kuantitatif menemukan adanya hubungan antara beberapa variabel yang berada dalam CP, seperti pemeriksaan penunjang, terapi sesuai indikasi dan penyakit komorbid terhadap LOS, morbiditas dan mortalitas. Sementara pada penelitian kualitatif menilai implementasi CP di RS PON memerlukan perbaikan dari segi sosialisasi, implementasi, monitoring dan evaluasi.

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Clinical Pathway is a multidisciplinary toolkit used for evidence-based health care. The Clinical Pathway has the function to unify the therapy so as to minimize complications and medication errors. The National Brain Center Hospital (PON Hospital) is a national brain and nervous referral hospital. Hemorrhagic stroke is the second-highest disease in PON Hospital. The diversity of decisions to have surgery or not, even though it is indicated, is an important point to analyze the implementation of this Clinical Pathway.

Objective: to evaluate the implementation of CP bleeding stroke that has been carried out so that it is expected to be the basis for determining policy for network hospitals and hospitals throughout Indonesia. Assessing the relationship between variables in clinical pathways on Length of Stay (LOS), morbidity, and mortality

Methods: This study uses a mixed-method, with a retrospective approach. In this quantitative study, univariate and multivariate analyzes were carried out, which used secondary data from the medical records of hemorrhagic stroke patients treated at the PON Hospital in 2020-2021. From the total population of 1254 patients, after the inclusion and inclusion criteria were carried out, there were 1001 patients. Quantitative research was conducted by analyzing the effect of Clinical Pathway implementation on length of stay, morbidity (NIHSS value), and mortality. `Risk factors and effects or diseases that occurred in the past are measured through historical records. Meanwhile, qualitative data collection used in-depth interviews with the Head of Medical Services, Head of the Medical Committee, Head of Nursing, Head of the Vascular Division, Neurology Specialist, Neurosurgeon Specialist, Emergency Room Doctor, Nurse, Farmation, physiotherapist, speech therapist, nutritionist to find out the stages of the Clinical Pathway process at the PON Hospital. The total number of respondents are 129 people. Qualitative research assesses the knowledge of medical and paramedical personnel related to CP, implementation, supervision, monitoring, and evaluation.

Result: Quantitative research found a relationship between several variables in CP, such as investigations, therapy, and comorbid with LOS, morbidity, and mortality. Meanwhile, qualitative research showed that the implementation of CP in the PON Hospital was still unsatisfactory in terms of socialization, implementation, monitoring and evaluation.

Conclusion: Implementation of CP is associated with clinical outcomes of hemorrhagic stroke patients."

"Biaya belanja obat pada tahun 2000 di Rumah Sakit "IBNU S1NA" Pekanbaru sebesar Rp 2.784.442.315,00 atau 31,29% dari seluruh biaya operasional rumah sakit (Rp 8.894.418.879,00). Meskipun biaya yang dikeluarkan untuk pembelanjaan obat tersebut sudah cukup besar tetapi masih ditemukan masalah berupa belanja obat ke apotek luar sebesar Rp 325.687.400,00 atau 11,69%, dari biaya belanja obat. .Obat yang dibeli secara kontrak menumpuk sebesar Rp 249.059.000,00 atau 49,18% dari nilai obat yang dibeli secara kontrak yaitu sebesar Rp 600.000.000,00. Sejumlah obat deadstock sebesar Rp. 22.603.827,00 atau 0,8% dari biaya belanja obat. Penulis berasumsi masalah tersebut terjadi karena belum memadainya perencanaan obat di Rumah Sakit "IBNU S1NA" Pekanbaru. Berdasarkan hal tersebut penulis ingin mendapatkan gambaran perencanaan obat di Rumah Sakit "IBNU SINA" Pekanbaru pada Januari 2000 sampai dengan Desember 2000.Penelitian ini merupakan studi kasus dengan menggunakan pendekatan kualitatif. Data diperoleh melalui wawancara mendalam yang mencakup informasi dari informan yang terkait, observasi dengan menelusuri data yang terdokumentasi. Penelitian ini dilaksanakan dari awal Mei sampai akhir Juni 2001.Hasil wawancara mendalam dari observasi yang dilakukan terhadap variabel-variabel terkait dengan perencanaan obat di Rumah Sakit "IBNU SINA" Pekanbaru tahun 2000, didapatkan hal-hal yang sudah dipertimbangkan, yaitu pemakaian obat periode sebelumnya, stok akhir, masa tenggang (lead time), kapasitas gudang, stok pengaman, usulan dokter, usulan kepala kamar operasi, dan anggaran. Dengan catatan belum adanya data yang mendukung perhitungan terhadap hal-hal yang dipertimbangkan tersebut. Didapatkan juga hal-hal yang seharusnya sudah dipertimbangkan, tetapi pada kenyataannya belum dipertimbangkan, yaitu usulan komite medik, usulan panitia farmasi dan terapi, usulan kepala IGD, usulan kepala ruangan perhitungan analisis ABC pemakaian, perhitungan analisis ABC investasi, perhitungan indeks kritis ABC, perhitungan Economic Order Quantity (EOQ), pertimbangan Length of Slay, pola penyakit, formularium, dan standar terapi.Hasil penelitian menggambarkan bahwa perencanaan obat di Rumah Sakit "IBNU SINA" Pekanbaru tahun 2000 belum efektif, mengingat hal-hal yang harus dipertimbangkan dalam perencanaan obat belum sepenuhnya dipertimbangkan, dan pihak-pihak yang seharusnya terlibat belum dilibatkan.Agar perencanaan obat lebih efektif dan efisien, maka penulis menyarankan kepada pihak manajemen dalam membuat perencanaan kebutuhan obat sebaiknya mempertimbangkan hal-hal yang semestinya dipertimbangkan dengan melibatkan pihak-pihak terkait. Selain itu, perlu dibuat prosedur tetap dan kebijakan-kebijakan yang berhubungan dengan perencanaan obat.

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The Process of Planning for Medical Supplies at IBNU SINA Moslem Hospital, Yarsi Riau - Pekanbaru, 2000.The medicine expenditure in the year 2000 at IBNU SINA Hospital, Pekanbaru was Rp 2,784,442,315.00 or 31.29% from the whole operational costs (Rp 8,894,418,879.00). Although the medicine expenditure is quite large, there still are prescriptions filled to other pharmacies amounting to Rp 325,687,4000.00 or 11.69% from the total medicine expenditure. Unused medication bought through contracts reached Rp 249,059,000.00 or 49.18% from the Rp 600,000,000.00 spent on medicine. The amount of dead stock medicine was Rp 22,603,827.00 or 0.8% from the total medicine expenditure. The author assumes that inadequate medical planning at IBNU SINA Hospital, Pekanbaru, caused it. Based on those facts, the author aims to achieve an illustration of the medical planning at IBNU SINA Hospital, Pekanbaru in January 2000 to December 2000.

This study was a case study that applies a qualitative approach. The data obtained through in-depth interviews that comprised of the information from related informants, observation by tracing documenting data, and Discussion Group Focus (FGD). This study began in early May to the end of June 2001.

The in-depth interviews, Discussion Group Focus, and observations on related variables against medical planning at IBNU SINA Hospital, Pekanbaru, in the year 2000, these aspects were already being considered: the use of medical supplies during the previous period, final stocks, lead time, warehouse capacity, safety stock, doctor recommendations, recommendations from the head of the surgery room, and budget. However, there is no data that supports the calculations on the aspects above. There were also several items that should be considered, but were not, such as the recommendations from the medical committee, pharmacy and therapy committee, the head of the IGD, the head of the room, calculations analysis of the ABC use, calculations analysis of the ABC investing, calculations on the ABC critical index, the Economic Order Quantity (ECQ), the Length of stay, disease pattern, Hospital drug standard, and therapy standard.

The study indicated that the medical supplies planning at IBNU SINA Hospital, Pekanbaru, in the year 2000, was ineffective, since the aspects that should be considered had not been considered, and the parties that should be involved were not involved.

To make the planning more effective and efficient, the author suggests the management to take into consideration the aspects above and involve the related parties. In addition to that, create a standard procedure and policies that is related to the planning."