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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."

"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."

"Stroke merupakan salah satu penyakit kardioserebrovaskular yang digolongkan sebagai penyakit katastropik. Seiring meningkatnya prevalensi stroke, maka beban biaya pelayanan kesehatan tentu akan meningkat. Beberapa penelitian mengenai penggunaan dabigatran dan warfarin pada pasien stroke iskemik menunjukkan bahwa dabigatran menghasilkan biaya medis langsung yang lebih tinggi dibandingkan warfarin, namun hal ini diimbangi dengan manfaat kesehatan tambahan dalam hal jumlah tahun kehidupan berkualitas yang disesuaikan (JTKD). Penelitian ini bertujuan untuk menganalisis biaya terapi dabigatran dan warfarin pada pasien stroke iskemik. Penelitian ini menggunakan desain cross sectional dengan pengumpulan data biaya berdasarkan perspektif rumah sakit. Subjek penelitian adalah pasien rawat jalan dengan diagnosis stroke iskemik yang berusia 18 tahun ke atas dan mendapat terapi dabigatran atau warfarin di Rumah Sakit Pusat Otak Nasional Jakarta pada tahun 2018-2019. Karakteristik pasien dari penelitian ini ialah pria (63%) dan berusia 55 - <65 tahun (40,7%). Berdasarkan hasil analisis, total biaya terapi dabigatran sebesar Rp1.656.412,03, dan Rp2.014.007,00 untuk terapi warfarin. Tidak ada perbedaan bermakna antara total biaya terapi dabigatran dan terapi warfarin berdasarkan uji beda Mann-Whitney (P=0,842). Oleh karena itu, dari aspek total biaya, dabigatran dapat dipertimbangkan sebagai rekomendasi terapi antikoagulan pada pasien stroke iskemik.

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Stroke is a cardioserebrovascular disease which classified as a catastrophic disease. As the prevalence of stroke increase, the burden of healthcare cost will certainly increase. Several studies on the use of dabigatran and warfarin in ischemic stroke patients showed that dabigatran resulted in higher direct medical cost compared to warfarin, but this is offset by additional health benefits in terms of quality-adjusted life-year (QALY). This study aimed to analyze total costs of dabigatran and warfarin therapy in ischemic stroke patients. This study used a cross-sectional design with cost data collection based on hospital perspective. Subjects were outpatients with diagnosis of ischemic stroke aged 18 years and over who received dabigatran or warfarin therapy at the National Brain Center Hospital in 2018-2019. Patients’ characteristics of this study were men (63%) and aged 55 - <65 years old (40,7%). Based on the analysis, a total cost of Rp1,656,412.03, was obtained for dabigatran therapy, and Rp2,014,007.00 for warfarin therapy. There was no significant differences between the total cost of dabigatran therapy and warfarin therapy based on Mann-Whitney test (P=0,842). Therefore, from the aspect of total cost, dabigatran can be considered as a recommendation for anticoagulant therapy in ischemic stroke patients."

"Saat ini warfarin adalah terapi standar yang digunakan untuk manajemen stroke jangka panjang, namun warfarin memiliki keterbatasan. Rivaroxaban telah dikembangkan untuk menjawab keterbatasan tersebut dengan keunggulan yang ada, namun memiliki harga yang lebih mahal per unitnya dibandingkan warfarin. Belum diketahui secara pasti besar total biaya terapi rivaroxaban dan warfarin pada pasien stroke iskemik. Penelitian ini dilakukan untuk menganalisis biaya terapi rivaroxaban dan warfarin pada pasien stroke iskemik rawat jalan berdasarkan perspektif rumah sakit. Penelitian ini menggunakan desain cross-sectional dengan pengambilan data secara retrospektif. Subjek penelitian ini adalah seluruh pasien stroke iskemik rawat jalan usia ≥18 tahun yang mendapatkan terapi rivaroxaban dosis 15 mg atau 20 mg atau terapi warfarin minimal 3 bulan berturut-turut di Rumah Sakit Pusat Otak Nasional Jakarta tahun 2018-2019. Hasil penelitian menunjukkan bahwa sampel penelitian didominasi oleh laki-laki (64,8%) dan kategori usia 55-<65 tahun (37,0%). Total biaya terapi rivaroxaban dan warfarin pada pasien stroke iskemik di Rumah Sakit Pusat Otak Nasional Jakarta tahun 2018-2019 berturut-turut sebesar Rp3.377.977,00 dan Rp1.470.184,57 serta ada perbedaan signifikan total biaya antara kedua kelompok terapi (p=0,002).

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Warfarin is currently the standard therapy for long-term stroke management, but warfarin has limitations. Rivaroxaban has been developed to answer these limitations with existing advantages, but the price per unit is more expensive. The total cost of rivaroxaban and warfarin therapy in ischemic stroke patients is not known yet. This study was conducted to analyze the cost of rivaroxaban and warfarin therapy in ischemic stroke outpatients based on a hospital perspective. This study used a cross-sectional design with retrospective data collection. The subjects of this study were all ischemic stroke outpatients aged ≥18 years who received 15 mg or 20 mg rivaroxaban therapy or warfarin therapy for at least 3 consecutive months at National Brain Center Hospital Jakarta in 2018-2019. The results showed the subjects were dominated by men (64.8%) and the age category of 55-<65 years (37.0%). The total cost of rivaroxaban and warfarin therapy in ischemic stroke patients at National Brain Center Hospital Jakarta in 2018-2019 was Rp3,377,977.00 and Rp1,470,184.57 respectively and there was a significant difference in the total cost between the two groups (p = 0.002)."

"Tujuan Penelitian Stroke merupakan penyebab kedua kematian secara global dan masih menjadi masalah kesehatan utama di Indonesia. Penelitian ini bertujuan untuk mengetahui kesintasan pasien stroke berdasarkan tipe stroke hemoragik dan iskemik di RSPON Jakarta. Metode Desain penelitian menggunakan kohort retrospektif. Pasien rawat inap dengan diagnosis stroke pertama dimasukkan ke dalam penelitian. Sampel terdiri dari 134 pasien stroke hemoragik dan 134 pasien stroke iskemik yang dicatat dalam rekam medis pada periode waktu 1 Januari-30 November 2018. Pasien diamati dari waktu diagnosis hingga event (meninggal) dalam kurun waktu 30 hari. Hasil Analisis Kaplan Meier menunjukkan probabilitas 30 hari kesintasan pasien stroke iskemik (91,8%) lebih tinggi dibandingkan dengan pasien stroke hemoragik (78,3%)(p<0,05). Rata-rata kesintasan pasien stroke iskemik, yaitu selama 27 hari, sedangkan pasien stroke hemoragik selama 23 hari. Hasil analisis cox regression didapatkan, risiko kematian pasien stroke hemoragik 4,05 kali lebih besar dibandingkan pasien stroke iskemik setelah dikontrol oleh umur dan diabetes melitus di RSPON Jakarta (p<0,05) dalam kurun waktu 30 hari. Kesimpulan Probabilitas kesintasan pasien stroke iskemik lebih tinggi dibandingkan pasien stroke hemoragik di RSPON Jakarta tahun 2018.

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Stroke is the second leading cause of death in the world and still a major health problem in Indonesia. The aim of this study was to identify survival of stroke patients according to hemorrhagic (HS) and ischemic (IS) stroke type in National Brain Center Hospital Jakarta. Methods A cohort retrospective study. Acute first-ever stroke inpatients were included in this study. The sample consists of 134 HS and 134 IS and recorded in medical record from January 1 to November 30, 2018. All study patients were followed-up from diagnosis time to event (death) in 30 days. Results Kaplan-Meier analysis showed that survival probability at 30 days was higher for IS (91,8%) than HS (78,3%) (p < 0,05). Mean survival time of IS (27 days) was longer than HS (23 days). Cox Regression analysis found the risk of death for HS was 4,05 times greater than the risk of death for IS after adjusted by age and diabetes mellitus in National Brain Center Hospital Jakarta (p < 0,05) at 30 days. Conclusions Survival probability IS was higher than HS within 30 days of the first-ever stroke in National Brain Center Hospital Jakarta"

"Yayasan Stroke Indonesia memperkirakan insiden stroke di Indonesia 500.000 orang pertahun dengan 125.000 meninggal pertahun dan sisanya cacat ringan maupun berat Pengobatan stroke merupakan perawatan jangka panjang karena membutuhkan waktu yang lama untuk sembuh. Besarnya biaya berobat semakin berat dirasakan oleh masyarakat berpenghasilan rendah.Pada umumnya rumah sakit di Indonesia mempunyai masalah mengenai informasi biaya yang tidak jelas yang disebabkan oleh sistem pembayaran langsung perjasa pelayanan (fee for service). Biaya pelayanan kesehatan meningkat karena belum adanya harga standar berdasarkan unit cost untuk berbagai pelayanan kesehatan yang diperjual belikan. Pengendalian biaya dari bentuk fee for service ke Prospective Payment System (PPS) perlu dilakukan. Salah satu bentuk PPS adalah Diagnosis Related Groups (DRG's). DRGs adalah sistem pembayaran perkelompok penyakit tanpa melihat tindakan yang diberikan atau lamanya perawatan di rumah sakit. Tujuan penelitian ini adalah untuk melihat bagaimana clinical pathway dan cost of treatment stroke berdasarkan DRGs di Runah Sakit Stroke Nasional Bukittinggi tahun 2005.Penelitian ini merupakan penelitian kuantitatif deskriptif dengan rancangan crossectional retrospektif Penelitian dilaksanakan dari bulan Pebruari sampai April 2006 dengan menggunakan data sekunder clad rekam medik pasien rawat inap dengan diagnosa stroke tahun 2005. Unit cost dihitung dengan menggunakan Activity Based Costing. Analisa data dilakukan secara univariat untuk melihat distribusi frekuensi, nilai mean, median, modus, nilai minimum dan nilai maksimum Pengelompokkan stroke berdasarkan AR-DRG's di Rumah Sakit Stroke Nasional Bukittinggi adalah : stroke dengan penyakit penyerta dan penyulit (B70A), stroke dengan penyakit penyerta atau penyulit (B70B), stroke murni (B70C), stroke meninggal dibawah 7 hari (B70D). Batasan hari rawat 4 Ilan dalam AR DRG tidak dapat digunakan karena pasien dengan status keluar hidup mempunyai hari rawat terendah 3 hari, sedangkan pasien dengan status keluar meninggal mempunyai hari rawat terendah 1 hari.Berdasarkan hasil penelitian diketahui clinical pathway stroke terdiri dan 5 tahap yaitu : pendaftaran, penegakkan diagnosa, terapi, pulang dan rawat jalan. Tahap terapi terdiri dari visite dokter, pemeriksaan penunjang, konsultasi dokter, Asuhan keperawatan, tindakan, rehabilitasi medik, intake makanan rendah garam dan intake obat-obatan. Banyaknya variasi obat pada stroke berhubungan dengan adanya penyakit penyerta dan penyulit.Cost of treatment Stroke di kelas III di Rumah Sakit Stroke Nasional Bukittinggi tahun 2005 adalah sebagai berikut : (1) Biaya rawat inap stroke dengan penyakit penyerta dan penyulit Rp. 5.181.485; dengan median hari rawat 14 hari sedangkan biaya rawat jalan Rp 803,121,- dengan median rawat jalan 3 kali dan total biaya adalah Rp 5.984.607; (2) Biaya rawat imp stroke dengan penyakit penyerta atau penyulit Rp 4.075,179,- dengan median hari rawat 11 hari sedangkan biaya rawat jalan Rp 995.167; dengan median rawat jalan 4 kali dan total biaya Rp 5.070.347; (3) Biaya rawat inap stroke murni Rp 1.905.273 dengan median hari rawat 10 hari sedangkan biaya rawat jalan Rp 987.047,- dan total biaya Rp 1.905.273,- (4) Biaya rawat inap stroke yang meninggal dibawah 7 hari Rp 1.848.767,- dengan median hari rawat 2 hari. Bila dilihat dari cost recovery rate rumah sakit rata-rata nilainya 58%.Dari hasil penelitian perlu dilakukan perubahan paradigma pembiayaan kesehatan dari tarif pertindakan menjadi tarif perepisode sakit Perlu dilakukan perhitungan biaya rawat inap berdasarkan Diagnosis Related Groups secara nasional sebagai dasar penetapan tarif rawat inap secara nasional.

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Indonesian Stroke Foundation estimates that the incident of stroke in Indonesia is 500.000 people per year, of which 125.000 people die per year and the rest, get light and heavy physical disability. Stroke treatment is a long-term care, which needs long recovery. The high cost of the treatment is felt hard to bear by the lower-income people.

Generally, hospitals in Indonesia have problems with unclear cost information_ This is caused by direct payment system per fee for service. The increase of health service cost is resulted in the unavailability of standard fee based on cost unit of various health service provided. Therefore, it is important to change the cost system payment from the fee for service form to the Prospective Payment System (PPS). One of the PPS form is Diagnosis Related Groups (DRG's). DRGs is per group payment system regardless the treatment provided or the length of care at hospital. The objective of this research is to see how clinical pathway and cost of treatment of stroke based on DRGs at Bukittinggi's National Stroke Hospital in 2005.

This research is a descriptive quantitative research with cross-sectional retrospective design. It was conducted from February to April 2006 using secondary data from medical record of in-patients diagnosed stroke in 2005. The cost unit was calculated using Activity Based Costing. Univariate data analysis was conducted to see the frequency distribution, mean, median, modus, minimum value and maximum value.

Stroke classified based on AR-DRG's at Bukittinggi's National Stroke Hospital are: stroke with contributing and complicating disease (B70A), stroke with contributing and complicating disease (B70B), pure stroke (B70C), and stroke causing death below 7 days (B70D). The definition of four-day treatment in AR-DRG is not used since the patients with out-alive status have the lowest treatment days of 3, while the patients with out-dead status have the lowest treatment day of 1.

Based on the study, it is known that clinical pathway comprised of five steps, namely: registering, diagnosis maintaining, therapy, going home, and out patient treatment. The therapy consists of doctor visit, supporting examination, consultation, nursery care, treatment, medical rehabilitation, low-salt food intake, and drug intake. The variety of stroke drug is related to the existence of contributing and complicating diseases.

Cost of stroke treatment in class III at Bukittinggi's National Stroke Hospital in 2005 are as follows: (1) Cost of in patient stroke with contributing and complicating diseases is Rp. 5,181,485,- with 14 treatment day median is 14 while cost of out patient service is Rp 803,121,- with the treatment day median is 3 times and total cost is Rp 5,984,607; (2) Cost of in-patient service for stroke with contributing and complicating diseases is Rp 4,075,179,- with the median of day treatment is 11 while cost of out patient service is Rp 995,167,- with the median of out patient is 4 times and total cost is Rp 5,070,347; (3) Cost of in-patient service of pure stroke is Rp 1,905,273,- with the median of day treatment is 10 while cost of out patient service is Rp 987,047,- and total cost is Rp 1,905,273; and (4) Cost of in-patient service of patients dieing below 7 days is Rp 1,848,767,- with the median of day treatment is 2. According to the cost recovery rate, the value of the hospital is 58% on the average.

The results indicate that it is important to change the paradigm of health financing from tariff per treatment to tariff per illness episode. It is also important to calculate the cost of in-patient treatment according to Diagnosis Related Groups nationally as an establishment of the in-patient tariff nationally."

"Stroke merupakan salah satu penyakit katastropik yang berdampak besar terhadap perkembangan sosio-ekonomi negara Indonesia. Setiap penyakit stroke iskemik akan menghasilkan biaya langsung medis insiden dalam jangka panjang akan menjadi signifikan terhadap beban ekonomi nasional. Penelitian mengenai analisis biaya stroke iskemik masih beragam sehingga masih perlu dilakukan penelitian. Penelitian ini bertujuan untuk menganalisis biaya terapi aspirin dan kombinasi aspirin-klopidogrel pada pasien stroke iskemik di RS Pusat Otak Nasional Jakarta. Penelitian ini menggunakan desain studi cross-sectional dengan teknik pengambilan data secara retrospektif menggunakan data biaya langsung medis yang ditinjau berdasarkan perspektif rumah sakit. Subjek penelitian adalah pasien rawat jalan dengan diagnosis stroke iskemik yang berumur 18 tahun ke atas di RS Pusat Otak Nasional Jakarta yang sudah mendapatkan terapi aspirin atau kombinasi aspirin-klopidogrel dengan penggunaan minimal tiga bulan dan tanpa mengalami perubahan terapi pada tahun 2019. Pengumpulan data dilakukan dengan mengambil data pasien dari Sistem Informasi Rumah Sakit (SIRS), data penggunaan dari instalasi farmasi, dan data biaya dari bagian keuangan rumah sakit. Berdasarkan hasil analisis, subjek penelitian didominasi oleh laki-laki (61,8%) dengan kelompok umur 55-64 tahun (38,2%). Biaya pengobatan berdasarkan perspektif rumah sakit pada pasien stroke iskemik dengan terapi aspirin sebesar Rp3.770.468,72, sedangkan untuk terapi kombinasi aspirin-klopidogrel sebesar Rp2.964.017,82. Hal ini menunjukkan total biaya terapi aspirin lebih tinggi Rp806.450,90 dibandingkan terapi kombinasi aspirin-klopidogrel, akan tetapi statistik tidak ada perbedaan signifikan nilai rerata total biaya pengobatan pasien stroke iskemik yang menggunakan terapi aspirin atau kombinasi aspirin-klopidogrel.Stroke is a catastrophic disease that has a major impact on the socio-economic development in Indonesia. Every incident of ischemic stroke will affect direct medical costs which in the long term will be significant to the national economic burden. Research of the analysis of ischemic stroke costs are still diverse so that research about it is still needed. This study aimed to analyze the cost of aspirin and the combination of aspirin-clopidogrel therapy in ischemic stroke patients at the National Brain Center Hospital Jakarta. This study used a cross-sectional design that used direct medical cost data retrospectively that were reviewed based on hospital perspective. The research subjects were outpatients who were diagnosed with ischemic stroke aged 18 years or older at the National Brain Center Hospital Jakarta that used aspirin or combination of aspirin-clopidogrel therapy for at least three months and the undergoing therapy did not change on any of the drugs in 2019. Data were collected by collecting patient data from hospital information system, the used of the drug from hospital pharmacy, and cost data from the hospital's finance department. Based on the results of analysis, the research subjects were dominated by men (61.8%) with 55 - 64 years old (38.2%). Total cost of the treatment based on hospital perspective in ischemic stroke patients used aspirin therapy was IDR 3,770,468.72, while for combination of aspirin-clopidogrel therapy was IDR 2,964,017.82. This showed that the total cost of aspirin therapy was higher amount Rp806,450.90 than the combination of aspirin-clopidogrel therapy but statistically, there was no significant difference in the average of total cost of the treatment in ischemic stroke patients used aspirin or combination of aspirin-clopidogrel therapy"

"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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"Stroke termasuk bagian dari penyakit tidak menular yang menjadi penyebab kematian dan kecacatan di seluruh dunia. Penyakit multikausal ini terjadi dipengaruhi oleh banyak faktor risiko, salah satunya karena pola makan yang berisiko.  Penelitian ini bertujuan untuk mengetahui gambaran pola konsumsi makanan berisiko pada pasien stroke di Rumah Sakit Pusat Otak Nasional. Desain penelitian ini adalah deskriptif cross-sectional dengan menggunakan kuesioner Food Frequency Questionnaire (FFQ) dan analisis data uji proporsi. Penelitian ini dilakukan pada 82 responden yang dipilih dengan menggunakan teknik purposive sampling pada pasien stroke rawat jalan di Rumah Sakit Pusat Otak Nasional Jakarta. Hasil penelitian ditemukan 50,4% pasien memiliki pola konsumsi makanan tinggi natrium yang berlebih, 50% memiliki pola konsumsi makanan tinggi lemak dan kolesterol yang berlebih, sedangkan hanya 23,3% pasien stroke yang memiliki pola konsumsi kurang sayur dan buah. Dengan demikian, pola konsumsi makanan tinggi natrium, lemak, dan kolesterol menjadi faktor risiko yang dapat mempengaruhi terjadinya stroke.

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Stroke is a non-communicable disease which can lead to death and disability. This multicausal disease is brought on by many risk factors; for instance, risky dietary patterns. This research is conducted to investigate the risky dietary patterns of stroke patients at the National Brain Center Hospital (Rumah Sakit Pusat Otak Nasional). This research is carried out using cross-sectional descriptive design; implying the use of Food Frequency Questionnaire (FFQ) and proportion testing method to collect and analyze the data. There are 82 respondents chosen using purposive sampling technique among the ambulatory stroke patients at the National Brain Center Hospital. This research finds that among the 82 stroke patients, 50,4% have an excess of natrium in their diet, 50% regularly consume foods and beverages which are high in fat and cholesterol, and 23,3% lack for fruits and vegetables intake. These findings suggest that dietary patterns which are high in natrium, fat, and cholesterol can be the risk factor for stroke."