Pengaruh Readmisi terhadap Biaya pada Pasien PPOK Eksaserbasi Akut dan Faktor yang Berhubungan dengan Readmisi

TRIRAHMI HARDIYANTI, Dr.Nanang Munif Yasin, S.Si.,M.Pharm.,Apt; Dra.Tri Murti Andayani, Sp.FRS., PhD.,Apt

2021 | Tesis | MAGISTER FARMASI KLINIK

Prevalensi penyakit paru obstruktif kronik (PPOK) yang semakin meningkat dapat menyebabkan peningkatan beban ekonomi. Peningkatan beban ekonomi tidak terlepas dari adanya pengaruh readmisi pasien dan faktor-faktor yang berhubungan seperti lama rawat inap, komorbid, dan pekerjaan. Penelitian ini merupakan penelitian analitik observasional dengan pendekatan cross sectional. Data diambil secara retrospektif melalui rekam medik dan data dari bagian keuangan yang berisi biaya perawatan pasien rawat inap PPOK eksaserbasi akut di RS Paru Respira Yogyakarta periode 1 Januari 2014 sampai 31 Desember 2019. Data readmisi diperoleh dari rekam medik, diamati dalam kurun waktu satu sampai tiga tahun setelah pasien dilakukan rawat inap. Analisis biaya dilakukan dari perspektif rumah sakit meliputi biaya medis langsung, yaitu biaya kamar, biaya keperawatan, biaya jasa pelayanan medik, biaya tindakan non medik, biaya penunjang medik, dan biaya obat serta barang medik. Analisis faktor-faktor yang berhubungan dengan readmisi dan adanya pengaruh readmisi terhadap biaya menggunakan uji Chis-square dan Mann-whitney. Penelitian ini terdiri dari 100 pasien dengan 74 pasien tanpa readmisi dan 26 pasien readmisi. Karakteristik pasien yang dominan meliputi usia > 65 tahun; berjenis kelamin laki-laki; memiliki lama rawat inap < 4 hari; memiliki komorbid >/=1; bekerja sebagai petani, buruh, dan pekerja swasta; dan anggota program BPJS kelas tiga. Sekitar 26% pasien readmisi dengan frekuensi readmisi 1-2 kali selama satu tahun. Biaya rata-rata terapi tiap pasien PPOK rawat inap readmisi dan tanpa readmisi yaitu Rp3.056.551 dan Rp2.829.114. Hasil penelitian menunjukan bahwa lama rawat inap berhubungan dengan readmisi pasien PPOK eksaserbasi akut (p = 0,004). Readmisi mempengaruhi biaya pasien PPOK eksaserbasi akut. Biaya tindakan non medis adalah biaya yang paling berpengaruh (p = 0,005).

The increasing prevalence of chronic obstructive pulmonary disease (COPD) can cause an increase in the economic burden. The increase in economic burden cannot be separated from the influence of patient readmission and related factors such as length of hospitalization, comorbidities, and work. This research is an observational analytic study with a cross sectional approach. Data were taken retrospectively through medical records and data from the finance department containing the costs of inpatient care for acute exacerbations of COPD at the Pulmonary Respira Hospital Yogyakarta for the period 1 January 2014 to 31 December 2019. Readmission data were obtained from medical records, observed within one to three years. years after the patient was hospitalized. Cost analysis is carried out from the perspective of a hospital including direct medical costs, namely room costs, nursing costs, medical service costs, non-medical treatment costs, medical support costs, and costs for drugs and medical goods. Analysis of factors related to readmission and the effect of readmission on costs using Chis-square and Mann-Whitney tests. This study consisted of 100 patients with 74 patients without readmission and 26 patients readmission. The dominant patient characteristics included age > 65 years; male gender; have a length of hospitalization < 4 days; have comorbid >/=1; work as farmers, laborers, and private workers; and members of the third class BPJS program. Approximately 26% of patients readmission with the frequency of readings 1-2 times for one year. The average cost of therapy for each COPD inpatient readmission and without readmission was Rp.3,056,551 and Rp.2,829,114, respectively. The results showed that the length of hospitalization was associated with readmission of patients with acute exacerbations of COPD (p = 0.004). Readmission affects the cost of patients with acute exacerbations of COPD. The cost of non-medical procedures was the most influential cost (p = 0.005).

Kata Kunci : PPOK eksaserbasi akut, readmisi, biaya