CRITICAL APPRAISAL DOKUMEN INTEGRATED CLINICAL PATHWAY KASUS SKIZOFRENIA DI RSJD dr.RM SOEDJARWADI

JAYUS INASTIAWAN, Dr.dr.Ronny Tri Wirasto.,Sp.KJ;Dr.dra.Sumarni.,M.Si.,Psi

2021 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar Belakang: Penerapan Integrated Clinical Pathway (ICP) dapat menjadi suatu alat komunikasi dari berbagai multidisiplin dan panduan praktek sehari-hari dalam penatalaksanaan kasus skizofrenia yang begitu kompleks. Hal yang terpenting dan mendasar yaitu memastikan bahwa integrated clincal pathway yang dipakai memenuhi standar sebagai suatu guideline, sehingga dapat memberikan luaran yang positif dalam tata laksana kasus Skizofrenia. Tujuan Penelitian: Mengetahui standar formulir Integrated Clinical Pathway Skizofrenia di RSJD dr. RM Soedjarwadi sebagai suatu guideline dan dampaknya pada luaran kasus Skiozfrenia. Metode Penelitian: Penelitian ini dilakukan dengan jenis observasional cohort retrospektif dengan rancangan deskriptif analitik. Analisis dilakukan dalam dua tahap : (1) melakukan telaah kritis formulir ICP Skizofrenia berdasarkan ICPAT dimensi 1 dan 2, (2) telaah penerapan ICP Skizofrenia pada rekam medis (RM) dengan diagnosis skiozfrenia. Peneliti membagi dua kelompok yaitu kelompok penerapan sesuai ICP sebanyak 25 subyek dan kelompok pasien penerapan yang tidak sesuai ICP sebanyak 25 subyek. Peneliti menilai dampak penerapan ICP terhadap luaran. Analisis data menggunakan uji chi square dan Mann Whitney test. Hasil penelitian: Penilaian ICPAT pada formulir Integrated Clinical Pathway skizofrenia RSJD dr. RM Soedjarwadi dimensi 1 ICPAT sebesar 100 %, sedangkan untuk dimensi 2 didapatkan nilai sebesar 73,91 % (moderate). Penerapan sesuai ICP memiliki hubungan terhadap lamanya rawat inap pasien Skizofrenia (p<0,001) dan biaya perawatan pasien skizofrenia (p<0,001). Penerapan sesuai ICP tidak memiliki hubungan terhadap readmisi (p=0.505) dan kejadian EPS (p=1,000). Kesimpulan:Integrated clinical pathway skizofrenia RSJD dr. RM Soedjarwadi merupakan suatu form ICP yang baik dan sesuai dengan ketentuan sebagai persyaratan form ICP. Dimensi pada kelengkapan dokumen suatu ICP dalam kategori moderate.Penerapan sesuai ICP Skizofrenia memiliki dampak luaran klinis yang positif pada lama rawat inap dan biaya perawatan pasien skizofrenia, tetapi tidak menunjukkan perbaikan luaran dalam hal readmisi dan kejadian efek samping EPS.

Background: The implementations of the Integrated Clinical Pathway (ICP) can be a communication tool from various multidisciplinary and daily practice guidelines in the management of schizophrenia cases that are so complicated. The most important and fundamental thing is to ensure that the integrated clinical pathway used meets the standard as a guideline, so that it can provide positive outcomes in the management of Schizophrenia cases. Objectives: To know the standard form of Integrated Clinical Pathway Schizophrenia at RM Soedjarwadi mental hospital as a guideline and its impact on the outcome of the Schizophrenia case. Methods: This study was conducted with a retrospective cohort observational type with a descriptive analytic design. The analysis was carried out in two stages: (1) a critical review of the Schizophrenia ICP form based on ICPAT dimensions 1 and 2, (2) a review of the implementation of the Schizophrenia ICP in medical records (MR) with a diagnosis of schizophrenia. The researcher divided into two groups, namely the group of patients who applied according to the ICP as many as 25 subjects and the group of patients who did not comply with the ICP as many as 25 subjects. Researchers assess the impact of the implementation of ICP on the outcome. Data analysis used chi square test and Mann Whitney test. Results: ICPAT assessment on the form of Integrated Clinical Pathway schizophrenia dr.RM Soedjarwadi mental hospital dimension 1 ICPAT is 100%, while for dimension 2 the value is 73.91% (moderate). Implementation according to ICP has a relationship with the length of stay in Schizophrenia patients (p<0.001) and the cost of care for schizophrenia patients (p<0.001). Implementation according to ICP had no relationship to readmissions (p=0.505) and EPS incidence (p=1,000). Conclusion: Integrated clinical pathway for schizophrenia RSJD dr. RM Soedjarwadi is a good ICP form and is in accordance with the provisions of the ICP form requirements. Dimensions on the completeness of an ICP document are in the moderate category. The implementation according to the Schizophrenia ICP has a positive clinical outcome impact on the length of stay and the cost of care for schizophrenic patients, but does not show any improvement in outcomes in terms of readmission and the incidence of EPS side effects.

Kata Kunci : Integrated Clinical Pathway, skizofrenia, luaran.