clinicalpathwaycotselasa-121111233935-phpapp02.ppt

8/10/2019 clinicalpathwaycotselasa-121111233935-phpapp02.ppt

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Clinical Pathway Cost of Treatment(Conceptual Thinking Application)

Ronnie Rivany Health Hospital Economics

Pusat Kajian Ekonomi & Kebijakan Kesehatan FKMUI


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JASTIFIKASI

Standarisasi tarif RS ?

Belum ada Clinical Pathway sebagai penjagamutu & sebagai basis layanan MUTU danbasis perencanaan/perhitungan biaya

Sistem, Kebijakan dan Prosedur yang tidak jelas dan tidak konsisten serta belumterintegrasi

Buku Tarif Departemen Kesehatan 2007 (?)


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1 Diseases and disorders of the nervous system

2 Disease and disorders of the eye

3 Disease and disorders of the ear, nose, and throat

4 Disease and disorders of the respiratory system

5 Disease and disorders of the circulatory system6 Disease and disorders of the digestive system

7 Disease and disorders of the hepatobiliiary system and pancreas

8 Disease and disorders of the musculoskeletal system and connective tissue

9 Disease and disorders of the skin, subcutaneous tissue, and breast

10 Endocrine, nutritional, and metabolic diseases and disorders

11 Disease and disorders of the kidney and the urinary tract

12 Disease and disorders of the male reproductive

13 Disease and disorders of the female reproductive system

14 Pregnancy, childbirth, and the purperium

15 Newborn and other neonates with conditions originating in the perinatal period

16 Disease and disorders of blood and blood forming organs and immunological disorders

17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm

18 Infectious and parasitic disease (systemic or unspecified sites)

19 Mental diseases and disorders

20 Alcohol/drug use and alcohol/drug- induced organic mental disorders

21 Injuries, poisoning, and toxic effects of drugs

22 Burns

23 Factors influencing health status and other contact with health services

Major Diagnostic Categories (AR-DRG v 5,2, 2006)


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DRG Numbering The format = A DD S A = Pre MDC DRGs ; B = nervous system

DRG; O = Reproductive System ; Z = DRGsrelating to other health factors; 9 = the errorDRGs

DD = DRGs partition; Range 01 39 Surgical Partition Range 40 59 Other Partition

Range 60 99 Medical Partition S = split indicator A = highest resources DRG B = second highest resources


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General Logic,Diagnosis Related Groups All acute admited patien

Principal diagnosis

Major diagnostic category # 1

Significant secondary condition ?

Procedure cluster A over age X

What age groups

What procedure

ProcedureCuster A

Procedure cluster A

Over Age X, with CC

Surgical Partition of MDC # 1

Procedure cluster A

Over Age X, without CC

Procedure cluster A under age X

ProcedureCluster C

ProcedureCluster D

ProcedureCluster B

Medical Partition of MDC # 1

MDc # 4MDC # 3MDC # 2

Yes No

Over Under X

Yes No


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INDONESIAN DRGs


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INDONESIAN DRGs

Pola pikir ICD tetap MDC untuk sementara tetap Clinical Pathway bisa dibuat DRG di konfirmasi + bisa dibuat

Casemix di konfirmasi + bisa dibuat Costing dilakukan dengan pendekatan

Activity Based Costing + Simple

Distribution


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POLA PIKIR INDONESIAN DRGs (1)

INA - DRG

1.Konfirmasi DRG 2.Hitung Cost/DRG

Clinical Pathway & Casemix

Activity Based Costing


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POLA PIKIR INDONESIAN DRGs (2)

ICD

MDC

DRG DRG

CASEMIX

COST

COST

DRG

TARIF

TARIF

1

2


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Clinical Pathway

Anticipated Recovery Pathway (ARPs) Multidisciplinary Pathways of Care (MPCs)

Care Protocols Integrated Care Pathways Pathways of Care Care Packages

Collaborative Care Pathways Care Maps Care Profiles


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Konsep perencanaan pelayananterpadu yang merangkum setiap

langkah yg diberikan kepada pasienberdasarkan standar yanmed,standar asuhan keperawatan&

standar pelayanan tenaga kesehatan

lainnya , yg berbasis bukti dng hasilyg dpt diukur dan dalam jangka

waktu tertentu selama di rumah sakit


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1 Diseases and disorders of the nervous system

2 Disease and disorders of the eye

3 Disease and disorders of the ear, nose, and throat

4 Disease and disorders of the respiratory system

5 Disease and disorders of the circulatory system6 Disease and disorders of the digestive system

7 Disease and disorders of the hepatobiliiary system and pancreas

8 Disease and disorders of the musculoskeletal system and connective tissue

9 Disease and disorders of the skin, subcutaneous tissue, and breast

10 Endocrine, nutritional, and metabolic diseases and disorders

11 Disease and disorders of the kidney and the urinary tract

12 Disease and disorders of the male reproductive

13 Disease and disorders of the female reproductive system

14 Pregnancy, childbirth, and the purperium

15 Newborn and other neonates with conditions originating in the perinatal period

16 Disease and disorders of blood and blood forming organs and immunological disorders

17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm

18 Infectious and parasitic disease (systemic or unspecified sites)

19 Mental diseases and disorders

20 Alcohol/drug use and alcohol/drug- induced organic mental disorders

21 Injuries, poisoning, and toxic effects of drugs

22 Factors influencing health status and other contact with health services

23 Medical Outpatient Visit

Major Diagnostic Categories (Pedoman Tarif ?? DEPKES,2007


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HUBUNGAN C.P & DRG/CASEMIX

ICD

MDC

TARIF

DRG DRG

CASEMIX

COST

COST

TARIF

DRG

Clinical Pathway

l l h l


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Clinical Pathway in Hospital


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International Classification of Disease (ICD)

Major Diagnostic Categories (MDC)

Surgical / Other / Medical

Diagnosis Related Groups (DRGs)

Casemix

ClinicalPathway

Pengembangan KonsepClinical Pathway


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Format dasar Clinical Pathway Aktivitas pelayanan Pra R.I

(Poliklinik/ UGD)

Rawat Inap (R.I)

Hari I Tgl

Hari 2 Tgl

Komplikasi /

Co- morbidity

1 2 3 4 5

Pendaftaran

Penetapan Diagnose

Pra-Perawatan

Perawatan

Tindak Lanjut


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Aktivitas pelayanan Pra R.I (Poliklinik/

UGD)

Rawat Inap (R.I)

Hari I Tgl

Hari 2 Tgl

Komplikasi /

Co- morbidity

1 2 3 4 5

Pra-Perawatan

Assessment klinis pemeriksaan/visite dokter konsultasi

Pemeriksaan penunjang laboratorium Radiologi

Dst sesuai SPM, SAK & SPO

Perawatan

Tindakan medis Pemberian obat

Dst-nya, sesuai SPM,SAK & SPO

CLINICAL PATHWAY DALAM

TAHAPAN PRA PERAWATAN & PERAWATAN


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No SOP Hari.1

Diag.Utama + Serta + Sulit +

Serta+ Sulit

1 A d m i s s i o n

2 Diagnost ic

3 Pra Therapy

4 Therapy

5 Fol low Up

6 Discharge

DUMMY TABLE (1)Clinical Pathw ay Uti l isas i


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DUMMY TABLE (2)Clinical Pathway Utilisasi

No Aktivitas SDM OBAT OVERHEAD

1 A d m i s s i o n

2 Diagnost ic

3 Pra Therapy

4 Therapy

5 Fol low Up

6 Discharge


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DUMMY TABLE (3)Clinical Pathway Utilisasi

No Aktivitas MinUtilisasi

MaxUtilisasi

Mean /MedianUtilisasi

1 A d m i s s i o n

2 Diagnost ic

3 Pra Therapy

4 Therapy

5 Fol low Up

6 Discharge


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CLINICAL PATHWAY

SYMPTOM DIAGNOSIS THERAPY FOLLOW UP

1

Activities ABC

ActivitiesABC

ActivitiesABC

ActivitiesABC

ActivitiesABC

2 3 4 5

Admission Diagnosis Pre Therapy Therapy Follow up


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Diawali dengan membuat template untukmendapatkan clinical pathway . Langkah-langkah dalam membuat clinical pathwayadalah sebagai berikut :

Membuat koding untuk memudahkan entry data.

Entry data karakteristik, identitas, tanggalmasuk dan keluar rumah sakit, lama harirawat, jenis pembayaran, diagnosa utama,penyakit penyerta, penyakit penyulit, caramasuk, status keluar dan kelas rawatan dari

masing-masing pasien. Entry data dilakukanberdasarkan kelom ok AR-DRG.

PEMBUATAN CLINICAL PATHWAY (1)


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Entry semua aktivitas yang diterima pasien dari masuksampai pulang dan pada waktu rawat jalan. Semuaaktivitas dekelompokkan berdasarkan tahap clinicalpathway.

Konfirmasi tahap clinical pathway dan variabelkegiatan dengan SPM IDI, SPM Profesi dan para

dokter dan paramedis di Rumah Sakit . Draft clinical pathway diisi berdasarkan frekuensimasing-masing kasus.

Berdasarkan nilai mean atau median didapatkan nilairata-rata masing-masing variabel dalam clinical

pathway perhari rawatan berdasarkan kelompok AR-DRG. Cleaning dan pengecekan ulang terhadap nilai

utilisasi berdasarkan tahap dalam clinical pathwaymasing-masing kelompok AR-DRG sehingga

didapatkan nilai utilisasi kelompok AR-DRGberdasarkan clinical athwa .



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Draft & Finalisasi Clinical Pathway

Setelah draft Clinical Pathway yangberbasis evidence tadi telah dibuat, makatahapan akhir dari penyusunan ClinicalPathway ini adalah Focus GroupDiscussion dengan Panel Expert ( paraspesialis ) dan Ikatan Profesi , untuk

bersama-sama menyepakati jenis dan jumlah tindakan/FORMULARIUMyang akan dipergunakan dalam Clinical

Pathway



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DUMMY TABLE (1)Clinical Pathway Cost of Treatment

Activities Day.1 Day.2 Day.3 Day..

Admission + + + +

Diagnosis + + + +

Pre Therapy + +

Therapy + + + +Follow Up

Discharge


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No Activities Day.1

PrincipalDiagnosis

Penyulit Penyerta PP

1 Nursing

2 Consultation

3 Doctor visits4 Medical Procedures

5 Nursing

6 Medical /DRUGS Treatment

7 Supporting exams

8 Nutrition

9 Physiotherapy

10 Etc

Clinical Pathway Cost of Treatment


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No Activities U DC IC TC UC U x UC

1 Admission

2 Diagnosis3 Pre Therapy

4 Therapy5 Follow Up6 Discharge

T O T A L C/DRG

DUMMY TABLE (3)Clinical Pathw ay Cos t of Treatm ent


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Cost of Treatment(Cost DRG/Casemix)

No Cost of Treatment / Activity BasedCosting

Direct Cost IndirectCostInvestasi Operasional Pemeliharaan

1 Admission

2 Diagnostic

3 Pra Therapy

4 Therapy5 Follow up

6. Discharge

INDEX

%

%

%

%

%


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Cost of Treatment Rawat Inap dan Rawat JalanNo AR-DRG KLS. III KLS. II KLS.I UTAMA VIP RAJ

1 B70A 5181485 5281384 5339924 5778045 5805053 80312 B70B 4075179 4153671 4199667 4543904 4565126 99513 B70C 1905273 1976629 2018443 2331386 2350678 987044 B70D 1848767 1863038 1871401 1933989 1937848

Perbandingan Biaya Rawat Inap KLS.IIINo AR-DRG KLS. III Tanpa Gaji Tanpa Obat Tanpa Gaji

Dan Obat1 B70A 5181485 4250350 2972007 20408722 B70B 4075179 3476706 2250808 16523343 B70C 1905273 1489521 1438879 10231274 B70D 1848767 1624600 1030735 806568

APLIKASI COST/DRG/Casemix dalam PK BLU(1)


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CLINICAL PATHWAY COST of TREATMENT


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TARIFF DETERMINANT per DRGS

TARIFF

UNIT COSTROOM & BOARD

UNIT COSTDRUGS

UNIT COSTOK

UNIT COSTMED SUPPLIES

UNIT COSTLAB

Total cost Q

COST/DRGs Margin

ACTIVITY BASED COSTING + SIMPLE DISTRIBUTION


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LAPORAN

Clinical Pathway & Cost of Treatment Diagnos is Related Group (DRGs)

Sectio Caesaria, Diare Anak & Katarak (2008)Apendictomy & Pneumonia Anak (2009 - 2010)

DINAS KESEHATANPemerintah Propinsi Daerah Khusus Ibukota Jakarta


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REKAM MEDIK DI RUMAH SAKIT


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LAPORAN

Clinical Pathway & Cost of Treatment Diagnos is Related Group (DRGs)

10 Dept International Wing2009 - 2010

RUMAH SAKITDr Cipto Mangunkusumo, Jakarta


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LAPORANClinical Pathway & Cost of Treatment

Diagnos i s Related Group (DRGs) Rumatan Methadon, 2010

RUMAH SAKIT KETERGANTUNGAN OBATCibubur - Jakarta


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DIREKTORAT JENDERAL BINA PELAYANAN MEDIKDEPARTEMEN KESEHATAN

2005


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RS wajib memp.CP, Diagnosis mengacupada ICD-10,Prosedur mengacu pd ICD-9CM Flowchart penyusunan CP

SPM Profesi Model Dummy

SPM RS

SOP Aktivitas

ICD

Surgical Medical

DRG

Case Mix

Clinical PathwayTerukur(admission to discharge)contoh :-Diare anak-Sectio Caesaria


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TUJUAN : utk meningkatkan mutu Yan pasien

memaksimalkan penggunaan sumber dayascr efisien dng mengurangi dokumentasi ygtdk diperlukan.

membantu identifikasi & klarifikasi prosesYan klinis

mendukung efektivitas klinik, audit medis &risk management


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Dalam menyusun c l in ica l pa thway (C.P) di RS peru

memadukan & menyesuaikan dng bbagai sistem ygtlh dibangun serta tlh bjalan sehingga stiap bagianyg ada di RS lebih mudah menyesuaikan & salingmendukung pd saat C.P. selesai dibuat &disosialisasikan.

Komite Medik sngt bperan dlm mbantu penyusunan& plaksanaan C.P. di RS.

Pedoman C.P. di RS diharapkan dpt mbantu RS dlmmenyusun C.P. dlm rangka mendukung plaksanaanpengembangan DRGs Casemix di RS.


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TERIMA KASIHatas perhatian & kesempatan

kerjasamanya

www.ina-drg-rr.net

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clinicalpathwaycotselasa-121111233935-phpapp02.ppt