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Kilas Balik Pelaksanaan CP

Nasional
Dr Amrizal Muhd Nur

Outline:

Pendahuluan
Format Clinical Pathways
Clinical Pathways 15 RS Pilot
Kesimpulan

Pendahuluan(1)

Pendahuluan(2)
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(3)

Components in CP?
1.
2.
3.
4.

Categories of care/Activities
Time frame
Outcomes
Variance

Pendahuluan(4)

Categories of
care/Activities

Time

Interventions
Outcomes
Variance

AREA OF CARE

DAY 1

DAY 2

DAY 3

DATE :
ASSESSMENTS AND
CONSULTATIONS
INVESTIGATION
TREATMENT
MEDICATIONS
DIET
ACTIVITY
TEACHING
DISCHARGE PLANS

Baseline for a Clinical Pathway is time (horizontal axis)


Various areas of care is on the (vertical axis)

VARIANCE

The Experience of USA


in Using CP
1. The rate of CP implementation 60%
2. Reductions in the incidence of
complication
3. Reductions-repeated hospitalization
4. Reduced medical costs
5. Minimizing of malpractice claims
6. Improved patient satisfaction

The Experience of CP
Implementation in
Johns Hopkins Hospital
1. Improved quality of care
2. Reduced costs
3. Reduced length of stay

Ferguson LE. Managed care at the Johns Hopkins Hospi


Nurs Adm Q. 1993;17(3):5479

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

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, 0.89 days


2. 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 Hip Replacement in 64 patients in the orthopedic ward

1. Average length of stay shortened, 1.06 days


2. 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

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

13

Aktiviti Sesudah Juli 2007


Clinical Pathways
Teruskan pengumpulan data setiap CP
Analisis Data CP
Beri Feedback kpd RS

Tambahkan CP untuk Penyakit Lain

14

POKJA CLINICAL PATHWAYS:


CENTRE FOR CASE-MIX DEPKES
Ketua
: Dr Osrizal Oesman
Secretary : Dr Indriwanto
Anggota : Dr Doddy Firmanda
Dr Gogot
Dr Bambang
Dr Abd. Kadir
Prof. Dr Amal Sjaf
Prof. Dr Nurul Akhbar

POKJA CLINICAL PATHWAYS

RUMAH SAKIT DAN JENIS KASUS PENYAKIT

BELUM DI TERIMA CP

RS M HOESIN, PALEMBANG
1. Katarak
2. Glaukoma

RS FATMAWATI, JAKARTA
1. Fraktur Tibia
2. Fraktur Tibia Tertutup dengan kompartemen sindrom

RS HASAN SADIKIN, BANDUNG


1. Appendisitis Akut Tanpa Perforasi
2. Hernia Inguinalis Lateralis Reponibilis

RS JANTUNG HARAPAN KITA, JAKARTA


1. Amplatzer Duct Occluder (ADO)
2. Coroner Angioplasty PTCA

RS KARIADI, SEMARANG
1. Epidural Hematom
2. Hidrosefalus (0-14 Tahun)

RS PERSAHABATAN, JAKARTA
1. Pneumothoraks Spontan Primer
2. Pneumonia

RS SARDJITO, JOGJAKARTA
1. Bedah Sesar Elektif
2. Bedah Sesar Emergensi

RS WAHIDIN, MAKASSAR
1. Chronic Kidney Disease
2. DM + Ketoasidosis

RSAB HARAPAN KITA, JAKARTA


1. Diarrhea for Children
2. Asthma for Children

RS KANKER DHARMAIS, JAKARTA


1. Mastektomi Radikal Unilateral
2. NHL Maligna St. IIB pro Chemoterapi CHOP

RS CIPTO MANGUNKUSUMO, JAKARTA


1. Radioterapi Kanker Nasopharynx
2. URS Batu Ureter

RS SANGLAH, DENPASAR, BALI


1. Tonsilektomi
2. OMSK Tipe Berbahaya S

RS ADAM MALIK, MEDAN


1. Inflammatory Liver Disease, Unspecified
2. NIDDM with Diabetic Gangrene

RS M JAMIL, PADANG
1. Cerebral Infarction
2. Stroke Pendarahan

RS KANDOU, MANADO
1. Kandidiasis Kutis
2. 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.
2.
3.
4.
5.
6.
7.
8.

Standardisation
Transparency
Accountability
Evidence-based medicine
Quality of care
Efficiency of care
Flexibility (Variances)
Casemix

Hambatan ?
perlu 100 kasus setiap Clinical Pathway
(2 CP setiap RS)
RS yang belum menghantar CP, sila hantar ke email:

pokjacp@yahoogroup.com

Terima Kasih
amrizal65@gmail.com
amrizal@unu.edu