HUBUNGAN KEPATUHAN PELAKSANAAN CLINICAL PATHWAY TERHADAP OUTCOME TERAPI DAN TOTAL BIAYA RIIL PASIEN SEKSIO SESAREA DI RSKIA SADEWA SLEMAN

BETA HANINDITYA, Dr. Satibi, M.Sc., Apt

2019 | Tesis | MAGISTER ILMU FARMASI

Tingginya angka persalinan dan biaya memerlukan strategi penatalaksanaan terapi yang tepat bagi pasien seksio sesarea, salah satunya adalah dengan clinical pathway. Penelitian ini bertujuan untuk menganalisis apakah terdapat hubungan pelaksanaan clinical pathway terhadap outcome terapi yang terdiri dari kejadian Infeksi Luka Operasi (ILO), Length of Stay (LOS) dan intensitas nyeri, serta untuk menganalisis apakah terdapat hubungan kepatuhan pelaksanaan clinical pathway terhadap total biaya riil rawat inap pasien seksio sesarea. Penelitian ini merupakan penelitian observasional dengan rancangan penelitian cross sectional. Metode pengambilan data dilakukan secara retrospektif yang diambil dari penelusuran dokumen rekam medik pasien dan data biaya pengobatan pasien yang dilaksanakan pada bulan September 2018. Subyek yang digunakan adalah seluruh populasi pasien RSKIA Sadewa Sleman yang melakukan persalinan seksio sesarea pada periode Desember 2017 hingga Mei 2018 yang memenuhi kriteria inklusi dan eksklusi. Analisis deskriptif untuk kepatuhan pelaksanaan clinical pathway dilakukan dengan cara menilai kepatuhan setiap poin asuhan yang terdapat dalam clinical pathway seksio sesarea yang terdiri dari 12 poin asuhan dan akan dikelompokkan pada dua kategori yaitu kategori kepatuhan rendah dengan nilai rata-rata kepatuhan terhadap clinical pathway <85% dan kepatuhan baik dengan nilai rata-rata kepatuhan terhadap clinical pathway 85%. Analisis hubungan kepatuhan pelaksanaan clinical pathway terhadap outcome terapi dengan menggunakan Chi square test dan analisis hubungan kepatuhan pelaksanaan clinical pathway terhadap biaya menggunakan analisis analisis regresi non parametrik. Deskripsi kepatuhan pelaksanaan clinical pathway seksio sesarea tiap pasien menunjukkan sebanyak 686 pasien (98%) memiliki nilai rata-rata kepatuhan baik dan 14 pasien (2%) memiliki nilai rata-rata kepatuhan rendah. Deskripsi outcome 700 pasien seksio sesarea didapati 1 orang pasien mengalami ILO, LOS sesuai clinical pathway (3 hari) sebanyak 620 pasien dan 700 pasien dengan skala nyeri 3. Hasil analisis hubungan kepatuhan pelaksanaan clinical pathway terhadap outcome terapi (kejadian ILO, LOS, dan intensitas nyeri) menunjukkan adanya hubungan kepatuhan pelaksanaan clinical pathway dengan nilai p<0,05. Analisis hubungan kepatuhan pelaksanaan clinical pathway terhadap total biaya riil menunjukkan adanya hubungan kepatuhan pelaksaan clinical pathway seksio sesarea di RSKIA Sadewa terhadap total biaya riil dengan nilai p<0,05 dan nilai r 0,014.

The high rate of childbirth and cost requires management strategy for patients with cesarean section, one of which is the clinical pathway. This study aims to analyze whether there is a relationship between the implementation of the clinical pathway to the therapeutic outcome consisting of the incidence of surgical wound infection (ILO), length of stay (LOS) and pain intensity, and to analyze whether there is a relationship between the implementation of clinical pathways and total cost of care inpatient cesarean section patients. This study was an observational study with a cross sectional study design. The data collection method was carried out retrospectively taken from the search of the patient's medical record documents and patient medical cost data carried out in September 2018. The subjects used were all RSKIA Sadewa Sleman patient populations who performed cesarean section in the period December 2017 to May 2018 that met inclusion and exclusion criteria. Descriptive analysis for compliance with the implementation of clinical pathway was carried out by assessing the compliance of each care point contained in the clinical pathway form of cesarean section consisting 12 points of care and will be grouped into two categories, low compliance category with <85% clinical pathway compliance and good compliance with an average compliance value for clinical pathway 85%. Relationship analysis between clinical pathway implementation to outcome therapy using Chi square test and analysis of the relationship of compliance with clinical pathway to costs using a non parametric regression analysis. Descriptions of compliance to the implementation of clinical pathway cesarean section showed that as many as 686 patients (98%) had a good average compliance score and 14 patients (2%) had a low average compliance score. Outcome description of 700 patients with cesarean section were found 1 patient experienced ILO, LOS according to clinical pathway (3 days) as many as 620 patients and 700 patients with pain scale 3. The results of relationship analysis of compliance with clinical pathway implementation to outcome therapy (incidence of ILO, LOS, and intensity of pain) showed the existence of relationship with implementation clinical pathway compliance with p value <0.05. Relationship analysis of compliance with clinical pathway implementation to the total real costs shows that there is a relationship of compliance with cesarean section clinical pathway in RSKIA Sadewa towards the total real costs with p value <0.05 and r value 0.014.

Kata Kunci : Clinical pathway, seksio sesarea, outcome terapi, biaya riil