ROLE MODEL CARE PATHWAY PASIEN STROKE ISKEMIK PASCA AKUT PADA PELAYANAN HOMECARE RSUP Dr SARDJITO YOGYAKARTA

PARYONO, Dr. dr. Ismail Setyopranoto, Sp.S (K).; Prof. dr. Laksono Trisnantoro, M.Sc., PhD.

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang: Kurangnya kolaborasi lintas sektoral dalam pelayanan homecare pasien pasca fase akut stroke. Care pathway adalah suatu sistem yang diharapkan menjadi sebuah pedoman standar pelayanan medis berbasis bukti untuk pasien stroke iskemik pasca akut di pelayanan homecare. Tujuan: Penelitian ini dimaksudkan untuk menyusun role model care pathway pasien stroke iskemik pasca akut pada pelayanan homecare RSUP Dr Sardjito Yogyakarta. Metode: Metode penelitian ini menggunakan rancangan mix methods. pada t a h a p p e r t a m a dilakukan penelitan kualitatif fenomenologi bulan Februari 2019 dan uji cobanya pada bulan Mei sampai dengan Oktober Tahun 2019.. Data di analisis dengan menggunakan software NVIVO 12. Hasil : Hasil identifikasi pengalaman stakeholder yang terlibat dalam pelayanan homecare, didapatkan 9 tema utama, yaitu; (1) Kebijakan Pengembangan Pelayanan Homecare, (2) Sistem Pembiayaan Homecare, (3) Sistem administrasi medik (4) Program patient safety (5) Permasalahan SDM (6) Kewajiban dalam memenuhi hak- hak pasien (8) Kesejahteraan SDM dan (9) Strategi Bisnis Pelayanan Homecare . engan hasil uji coba care Pathway : cakupan kepatuhan petugas mencapai diatas 80%, kecuali petugas rehabilitasi medis (RM) yang tetap bertahan 68%; Stroke (skor NIHSS) 60% perbaikan; Skor Indeks Barthel 80% meningkat, satu pasien mengalami komplikasi decubitus, tidak ada readmission, tidak terjadi stroke ulang, angka mortalitas nol, varian tertinggi dilakukan oleh petugas rehabilitasi medis (32%); perawat (21%); petugas gizi (20%), dokter umum (16%) dan caregiver (12%) dan total biaya selama 3 bulan sebesar 4,5 - 5,5 juta rupiah lebih murah dari biaya rawat jalan di rumah sakit Kesimpulan : Peneliti telah menghasilkan suatu role model care pathway pasien stroke iskemik pasca akut pada pelayanan homecare RSUP Dr Sardjito Yogyakarta dengan mengintegrasikan pelayanan yang multi disiplin yang melibatkan DPJP serta menurunkan variansi dan memperbaiki outcome klinis pasien stroke pasca akut.

Background: Cross-sectoral collaboration in home care services for post-acute stroke patients still needs to be improved. Care pathway is a system that is expected to become a standard guideline for evidence-based medical services for post-acute ischemic stroke patients in homecare services. Aim: This study was intended to develop a care pathway rolemodel for post-acute ischemic stroke patients at homecare services at Dr Sardjito Hospital Yogyakarta. Method: This research method uses a mix methods design. in the first stage, qualitative phenomenological research was carried out in February 2019 and the trial was carried out from May to October 2019. The data were analyzed using the NVIVO 12 software. Result : The identification of the experiences of stakeholders involved in homecare services results in 9 main themes, namely; (1) Homecare Service Development Policy, (2) Homecare Financing System, (3) Medical administration system, (4) Patient safety program, (5) HR issues, (6) Obligation to fulfill patient rights, (7) controlling the quality of homecare services at Dr. Sardjito Hospital, (8) welfare of homecare human resources, and (9) business strategy in the homecare service of Dr. Sardjito Hospital as a public hospital. The results of the Care Pathway trial: the compliance of workers reached above 80%, except for medical rehabilitation workers who remained 68%; Stroke (NIHSS score) 60% improvement; Barthel Index score increased 80%, one patient had decubitus complications, no readmission, no recurrence of stroke, zero mortality, the highest variance was performed by medical rehabilitation workers (32%); nurses (21%); nutrition staff (20%), general practitioners (16%) and caregivers (12%) and the total cost for 3 months is 4.5 - 5.5 million rupiah, which is cheaper than outpatient costs at the hospital. Conclusion : This research has developed a Care Pathway Role model in homecare services by integrating multi-disciplinary services by involving the attending physician and reducing variance, improving the clinical outcomes of post- acute stroke patients.

Kata Kunci : Pasca akut stroke iskemik, care pathway, Barthel Index, homecare Korespondensi, Post acute ischemic stroke, homecare Correspondence