COMPARISON ON HEALTH SERVICE QUALITY OF PULL-THROUGH SURGERY IN HIRSCHSPRUNG’S DISEASE PATIENTS IN RSUP DR SARDJITO BEFORE AND DURING COVID-19 PANDEMIC

Megan Dawarja, Prof.dr.Gunadi.Ph.D,Sp.BA,Subsp.D.A.(K) ; Dr.dr.Guardian Yoki Sanjaya, MHlthInfo

2024 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang: Selama Pandemi COVID-19 ada beberapa sektor yang terkena dampaknya, termasuk sektor medis. Departemen Bedah Anak juga terkena dampak perubahan peraturan tersebut. Di Yogyakarta angka kejadian penyakir Hirschsrpung lebih tinggi dibandingkan angka global yaitu 1:3250 kelahiran hidup. Pasien penyakit Hirshsprung dirawat di departemen bedah dengan menggunakan operasi pull-through definitif. Beberapa penelitian telah dilakukan dengan fokus pada perubahan pemanfaaran akibat pandemi, namun penelitian lebih lanjut yang berfokus pada kualitas layanan kesehatan terhadap pasien penyakit Hirschsprung belum dilakukan. Mutu pelayanan kesehatan dapat diukur dengan beberapa instrumen, salah satunya adalah HealthQual yang dapat mencakup lima sektor mutu pelayanan kesehatan dan rekam medis. Oleh karena itu, diperlukan suatu penelitina yang membandingkan kualitas pelayanan kesehatan terhadap peasian penyakit Hirschsprung yang menjalani prosedur pull-through sebelum dan selama pandemi COVID-19 

Tujuan: Membandingkan kualitas pelayanan kesehatan pasien penyakit Hirschsprung yang menjalani prosedur pull-through di RSUP dr. Sardjito sebelum dan selama pandemi COVID-19. 

Metode: Penelitian ini merupakan penelitian komparasi. Data dikumpulkan dari rekam medis dan wawancara mendalam melalui telepon. Pengambilan data dilakukan pada periode sebelum pandemi COVID-19 Maret 2019-Februari 2020 dan pada masa pandemi COVID-19 Maret 2020-Februari 2021. Data primer yang diperoleh melalui wawancara melalui telepon akan mengukur kualitas pelayanan kesehatan pada lima spektrum yang adalah tangibilitas, keandalan, daya tanggap, jaminan, dan empati. Data yang diperoleh dari rekam medis meliputi jenis kelamin, kampung halaman, jeni penyakit  Hirshsprung, jenis operasi pull-through, usia saat diagnosis, usia saat operasi pull-through, durasi operasi, lama rawat inap di rumah sakit, dan durasi antara pulang dan rawat jalan. 

Hasil: Terdapat 39 pasien sebelum pandemi COVID-19 dan 25 pasien selama pandemi COVID-19 dikumpulkan sebagai data kuantitatif, dan 2 orang masing-masing sebelum dan selama wali pasien diwawancarai sebagai data kualititatif. Untuk jenis kelamin, kota asal, kenis penyakit hirshsprung, jenis operasi pull-through, usia saat diagnosis, usia saat operasi pull-through, lama rawat inap di rumah sakit, dan durasi antara keluar dari rumah sakit dan rawat jalan tidak menunjukan perbedaan statistik yang signifikan. Durasi operasi pada masa pandemi COVID-10 menunjukan lebih lama dibandingkan sebelum pandemi (p=0.01). Pada kedua periode secara kualitatif tidak menunjukan perbedaan kualitas, permasalahan yang sama terjadi pada kedua periode tersebut. 

Kesimpulan: Tidak ada perbedaan kualitas pelayanan kesehatan operasi pull-through pada pasien penyakit Hirschsprung di RSUP dr Sardjito sebelum dan selama masa pandemi COVID-19 kecuali durasi tindakan operasi. 

Background: During the COVID-19 Pandemic several sectors are impacted, this includes the medical sectors. Department of pediatric surgery has also been impacted by the regulation changes. In Yogyakarta the incidence of Hirschsprung disease is higher than the global number which is 1:3250 live births. Patients of Hirschsprung disease are treated by the department of pediatric surgery using the definitive pull-through surgery. Several studies have already bee conducted focusing on the utilization changes due to the pandemic, but further studies focusing on health service quality towards Hirschsprung disease patients haven't been conducted. Health service quality can be measured by several instruments, one of them is HealthQual that can cover five sectors of health service quality as well as the medical records. Therefore, a study comparing health services quality towards Hirschsprung disease patients undergo pull-through procedures before and during COVID-19 pandemic is necessary. 
Objective: To compare the health service quality of Hirschsprung disease patients undergo pull-through procedure in RSUP dr. Sardjito before and during COVID-19 Pandemic. 

Method: This study is a comparative study. Data collected from medical records and in-depth phone call interviews. Data taking will be during the period of time between of before COVID-19 pandemic March 2019-February 2020 and during COVID-19 pandemic March 2020-February 2021. Primary data obtained with phone-call interviews will measure the health service quality on five spectrums which are tangibility, reliability, responsiveness, assurance, and empathy. Data obtained from medical records will include the sex, hometown, type of Hirschsprung disease, type of pull though surgery, age at diagnosis, age at pull-through surgery, duration of surgery, length of hospital stay, and duration between discharge and outpatient clinic. 

Result: There are 39 patients reports for before COVID-19 pandemic and 25 patients reports during COVID-19 pandemic collected as quantitative data, and 2 of each before and during patients guardians are interviewed as qualitative data. For sex, hometown, type of Hirschsprung disease, type of pull through surgery, age at diagnosis, age at pull though surgery, length of hospital stay, and duration between discharge and outpatient clinic shows no significant statistical differences. Duration of operation shows that it is longer during COVID-19 pandemic compared to before the pandemic (p=0.01). During both periods qualitatively doesn't show differences in quality, same issues occur during both times. 
Conclusion: There are no differences on health service quality of pull-through surgery in Hirschsprung's disease patients in RSUP dr Sardjito before and during COVID-19 pandemic except for duration of surgery. 

Kata Kunci : Quality of Health Service, Hirschsprung’s disease, Pull-through, COVID-19 pandemic