EVALUASI IMPLEMENTASI CLINICAL PATHWAY STROKE TERHADAP LAMA HARI PERAWATAN DAN LUARAN KLINIS PASIEN STROKE NON HEMORAGIK DI RUMAH SAKIT PANTI RAPIH YOGYAKARTA

PUTRI S. MAHANANI, DR. dr. Rizaldy Pinzon, M.Kes. Sp.S.

2016 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Stroke merupakan masalah kesehatan, penyumbang kematian terbesar pada hampir seluruh negara di dunia. Di Indonesia, stroke merupakan penyebab utama kematian pada semua umur. Clinical pathway merupakan salah satu alat bantu untuk memperbaiki luaran klinis pasien stroke. Tujuan: Tujuan penelitian ini adalah mengevaluasi apakah dengan implementsi clinical pathway terbukti dapat menurunkan angka luaran klinis pasien stroke (angka kematian dan kecacatan) sekaligus dapat mengurangi lamanya hari perawatan di Rumah Sakit. Metode: Penelitian ini adalah penelitian analitik observasional dengan desain penelitian cohort retrospektif. Subyek penelitian adalah semua pasien stoke non hemoragik yang dirawat di Rumah Sakit Panti Rapih dan memenuhi kriteria inklusi dan ekskusi. Indikator luaran klinis yang dipakai adalah mortalitas dan disabilitas. Lamanya hari perawatan juga dievaluasi kaitannya dengan implementasi clinical pathway. Hasil: Jumlah subjek penelitian ini adalah 250 pasien stroke non hemoragik yang dirawat di Rumah Sakit Panti Rapih pada tahun 2014 dan 2015. Subyek tersebut dibagi menjadi 2 kelompok, yaitu 125 diberlakukan clinical pathway dan 125 lainnya yang tidak diberlakukan clinical pathway. Hasil penelitian membuktikan bahwa clinical pathway mampu menurunkan angka kematian pasien stroke non hemoragik (p=0,001). Untuk luaran klinis yang berupa disabilitas, clinical pathway belum mampu menurunkan resiko disabilitas secara signifikan. Sama halnya dengan lamanya hari perawatan di rumah sakit, terbukti clinical pathway belum mampu menurunkan lamanya hari perawatan di rumah sakit. Kesimpulan : Clinical pathway terbukti mampu menurunkan angka kematian pasien stroke non hemoragik. Akan tetapi, pada pelaksanaannya, kepatuhan tenaga medis dalam mengisi form clinical pathway masih sangat kurang. Oleh karena itu dibutuhkan komitmen bersama supaya angka kepatuhan pengisian form clinical pathway dapat ditingkatkan.

Background: Stroke is the biggest health problem contributor to mortality in almost all countries in the world. In Indonesia stroke is leading cause of death in all ages. Clinical pathway is one the tools to improve the clinical outcome of stroke patients. Objective: The purpose of this study is to evaluate whether the clinical pathway implementation shows evidence to decrease the rate of stroke patients clinical outcome (mortality and disability) as well as reduce length of hospitalisation. Method: This research is an observational analytic with cohort retrospective study design. Research subject are all non-haemorrhagic stroke patients who were threated in Panti Rapih Hospital and met the inclusion and execution criteria. The clinical outcomes indicator is used mortality and disability. The length of stays are also evaluated in relation to the implementation of clinical pathway. Result: The number of research subject were 250 non-haemorragic stroke patient were hospitalised in Panti Rapih Hospital in 2014 to 2015. The subject were devided into two groups, the first group of 125 patients applied clinical pathway and second group of 125 patients did not applied clinical pathway. The result shows that clinical pathway are able to reduce mortality of patient with nonhaemorrhagic stroke (p=0,001). For the clinical outcomes in the form of disability, clinical pathway has not been able to significantly lower the risk of disability. As well as the length of stay in hospital, it is proven that the clinical pathway has not been able to reduce it. Conclusion and recommendation: Clinical pathway has proven to reduce mortality of patient with non-haemorrhagic stroke. However, in practice the compliance with medical personal in filling out the clinical pathway form is still lacking. Therefore, it takes a shared commitment, so that the rate of compliance in filling clinical pathway form can be increased.

Kata Kunci : Clinical pathway, Stroke, Luaran klinis, Clinical pathway, Stroke, Clinical outcomes