Kilas Balik Pelaksanaan CP Nasional
Dr Amrizal Muhd Nur
Outline:
• Pendahuluan
• Format Clinical Pathways
• Clinical Pathways 15 RS Pilot
• Kesimpulan
Pendahuluan(1)
Clinical Pathway & Case-Mix
• Common conditions• High volume• High costs• Predictable outcomes
Aim: to counter-check DRG costs on selective and costly cases by doing ABC costing
Pendahuluan(2)
Components in CP?
1. Categories of care/Activities2. Time frame3. Outcomes4. Variance
Pendahuluan(3)
Time
Interventions
Variance
Cat
egor
ies
of
care
/Act
ivit
ies
Outcomes
Pendahuluan(4)
AREA OF CARE DAY 1DATE :
DAY 2 DAY 3
•ASSESSMENTS AND CONSULTATIONS
• INVESTIGATION
• TREATMENT
• MEDICATIONS
• DIET
• ACTIVITY
• TEACHING
• DISCHARGE PLANS
•VARIANCE
• Baseline for a Clinical Pathway is time (horizontal axis)• Various areas of care is on the (vertical axis)
The Experience of USA in Using CP
1. The rate of CP implementation 60%2. Reductions in the incidence of
complication3. Reductions-repeated hospitalization4. Reduced medical costs5. Minimizing of malpractice claims6. Improved patient satisfaction
The Experience of CP Implementation in
Johns Hopkins Hospital
1. Improved quality of care2. Reduced costs3. Reduced length of stay
Ferguson LE. Managed care at the Johns Hopkins Hospital.Nurs Adm Q. 1993;17(3):54–79
The Experience of Taiwan in Using CP
• 7 Benefits of CP implementation in 8 Hospital in Taiwan: 1) reducing the number of hospitalization days 2) reducing medical expenses 3) improving the quality of medical care 4) facilitating interdepartmental cooperation 5) rationalizing & standardizing medical treatment procedures 6) fostering patient satisfaction by providing health education 7) providing an evidentiary basis for medical treatment and minimizing disputes as to care
1. Average length of stay shortened, 0.89 days2. Medical expenses saved on the treatment per
patient $275 3. Patient satisfaction rose to 93.15% 4. Quality of medical care:
- The average lapse between the operation and getting-out of bed is 70.42 hours
The Experience of CP Implementation in The VM Hospital of Taipei, Taiwan
CP for Total Knee Replacement in 187 patients in the orthopedic ward
1. Average length of stay shortened, 1.06 days2. Medical expenses saved on the treatment per
patient $121 3. Patient satisfaction rose to 93.15% 4. Quality of medical care:
- The average lapse between the operation and getting-out of bed is 69.92 hours
The Experience of CP Implementation in The VM Hospital of Taipei, Taiwan
CP for Total Hip Replacement in 64 patients in the orthopedic ward
13
Aktiviti Sebelum Juli 2007
• Clinical Pathways– Finalisasi Format CP– Kirim Format Final ke POKJA dan Konsultan– Mulai mengumpul data 100 kasus setiap CP– Kirim Data 100 kasus untuk Analisis
14
Aktiviti Sesudah Juli 2007
• Clinical Pathways– Teruskan pengumpulan data setiap CP– Analisis Data CP
• Beri Feedback kpd RS
– Tambahkan CP untuk Penyakit Lain
POKJA CLINICAL PATHWAYS:CENTRE FOR CASE-MIX DEPKES
Ketua : Dr Osrizal OesmanSecretary : Dr IndriwantoAnggota : Dr Doddy Firmanda Dr Gogot Dr Bambang Dr Abd. Kadir Prof. Dr Amal Sjaf Prof. Dr Nurul Akhbar
POKJA CLINICAL PATHWAYS
NO NAMA RS JENIS KASUS PENYAKIT
01. RSU. H. Adam Malik, Medan Penyakit Dalam
02. RSU.Fatmaw ati, Jakarta Bedah Othopedi
03. RSU. Dr. Hasan Sadikin, Bandung Bedah Umum
04. RSU. Dr. M. Djamil, Padang Syaraf & outpatient
05. RSAB Harapan Kita, Jakarta Anak
06. RSU. Sanglah, Denpasar THT & Outpatient
07. RSU. Dr. M. Hoesin, Palembang Mata & Outpatient
08. RS Kanker Dharmais, Jakarta Kanker
09. RSU. Dr. Kariadi, Semarang Bedah Syaraf & Outpatient
10. RSUPN. Cipto Mangunkusumo, Jakarta Urologi & Radioterapi
11. RS. Jantung & Pemb. Darah HK, Jakarta Jantung & Pembuluh Darah
12. RSU. Prof. Dr. R.D. Kandou, Manado Kulit & Kelamin & outpatient
13. RSU. Persahabatan, Jakarta Paru-Paru
14. RSU. Dr. Sardjito, Yogyakarta Obsgyn & Radiodiagnostik
15. RSU. Dr. Wahidin Sudirohusodo, Makassar Jiw a & Penyakit Dalam
RUMAH SAKIT DAN JENIS KASUS PENYAKIT
BELUM DI TERIMA CP
RS M HOESIN, PALEMBANG1. Katarak2. Glaukoma
RS FATMAWATI, JAKARTA
1. Fraktur Tibia2. Fraktur Tibia Tertutup dengan kompartemen sindrom
RS HASAN SADIKIN, BANDUNG
1. Appendisitis Akut Tanpa Perforasi2. Hernia Inguinalis Lateralis Reponibilis
RS JANTUNG HARAPAN KITA, JAKARTA
1. Amplatzer Duct Occluder (ADO)2. Coroner Angioplasty PTCA
RS KARIADI, SEMARANG
1. Epidural Hematom2. Hidrosefalus (0-14 Tahun)
RS PERSAHABATAN, JAKARTA
1. Pneumothoraks Spontan Primer2. Pneumonia
RS SARDJITO, JOGJAKARTA
1. Bedah Sesar Elektif 2. Bedah Sesar Emergensi
RS WAHIDIN, MAKASSAR
1. Chronic Kidney Disease2. DM + Ketoasidosis
RSAB HARAPAN KITA, JAKARTA
1. Diarrhea for Children2. Asthma for Children
RS KANKER DHARMAIS, JAKARTA
1. Tonsilektomi2. OMSK Tipe Berbahaya S
RS SANGLAH, DENPASAR, BALI
RS CIPTO MANGUNKUSUMO, JAKARTA
1. Mastektomi Radikal Unilateral 2. NHL Maligna St. IIB pro Chemoterapi CHOP
1. Radioterapi Kanker Nasopharynx 2. URS Batu Ureter
RS KANDOU, MANADO
RS M JAMIL, PADANG
RS ADAM MALIK, MEDAN
1. Inflammatory Liver Disease, Unspecified 2. NIDDM with Diabetic Gangrene
1. Cerebral Infarction 2. Stroke Pendarahan
1. Kandidiasis Kutis2. Liken Planus
CLINICAL PATHWAYS IN CASE-MIX (1)
• Advantages– Reduce variations on care
• More predictable cost
– More standardization of care• Improve in quality of care
– Improve costing procedure– Increase quality of information collected
CLINICAL PATHWAYS IN CASE-MIX (2)
• Advantages– counter-check on certain DRG costs
• ABC costing
– especially on expensive and common cases
Reasons for Clinical Pathway?
1. Standardisation2. Transparency3. Accountability4. Evidence-based medicine5. Quality of care 6. Efficiency of care 7. Flexibility (Variances)8. Casemix
Hambatan ?
• perlu 100 kasus setiap Clinical Pathway (2 CP setiap RS) • RS yang belum menghantar CP, sila hantar ke e-
mail: [email protected]