Analisis Sistem Pelayanan Rehabilitasi Medik Pascastroke Menggunakan Kerangka the Chain of Effect In Improving Healthcare di RSUD Taman Husada

Nur Afiya Nanda, Prof. dr. Laksono Trisnantoro, M.Sc., Ph.D. ; Dr.Drs. Abdul Wahab, M.P.H ; dr. Likke Prawidya Putri, MPH, Ph.D

2026 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Stroke menjadi penyebab utama disabilitas yang memerlukan pelayanan rehabilitasi jangka panjang (SKI, 2023). Namun, pelaksanaan rehabilitasi pascastroke masih menghadapi berbagai tantangan sehingga diperlukan analisis sistem pelayanan rehabilitasi untuk mendukung continuity of care dan penguatan sistem kesehatan. Tujuan: Menganalisis sistem pelayanan rehabilitasi pascastroke di RSUD Taman Husada berdasarkan kerangka The Chain of Effect in Improving Healthcare. Metode: Penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus deskriptif embedded single-case design (Yin, 2018). Data dikumpulkan melalui wawancara mendalam terhadap 17 informan yang terdiri atas pasien dan caregiver, tenaga kesehatan, manajemen rumah sakit, BPJS Kesehatan, dan Dinas Kesehatan Kota Bontang, serta didukung oleh observasi dan telaah dokumen. Hasil: Pelayanan rehabilitasi pascastroke dinilai membantu pemulihan pasien dan telah didukung oleh kolaborasi multidisiplin, pembiayaan JKN, serta komitmen organisasi. Namun, keberlangsungan rehabilitasi jangka panjang masih dipengaruhi oleh keterbatasan kapasitas pelayanan, tingginya beban finansial rehabilitasi jangka panjang, dan belum optimalnya integrasi lintas tingkat layanan sehingga continuity of care setelah pasien pulang belum sepenuhnya didukung oleh sistem kesehatan. Kesimpulan: Continuity of care rehabilitasi pascastroke memerlukan keterlibatan aktif berbagai stakeholder melalui penguatan pembiayaan rehabilitasi jangka panjang, peningkatan kapasitas pelayanan, optimalisasi peran FKTP, pengembangan rehabilitasi berbasis komunitas, serta penguatan tata kelola melalui implementasi regulasi dan koordinasi lintas sektor agar rehabilitasi dapat terus berlangsung sesuai kebutuhan pasien.

Background: Stroke is a leading cause of disability requiring long-term rehabilitation services (SKI, 2023). However, post-stroke rehabilitation remains challenged by various barriers, highlighting the need to analyze the rehabilitation service system to support continuity of care and health system strengthening. Objective: To analyze the post-stroke rehabilitation service system at RSUD Taman Husada using The Chain of Effect in Improving Healthcare framework. Methods: This study employed a qualitative approach with a descriptive case study using an embedded single-case design (Yin, 2018). Data were collected through in-depth interviews with 17 informants, including patients and caregivers, healthcare professionals, hospital management, the Social Health Insurance Administration Agency (BPJS Kesehatan), and the Bontang City Health Office, complemented by direct observation and document review. Results: Post-stroke rehabilitation services were perceived to support patients' recovery and were strengthened by multidisciplinary collaboration, National Health Insurance (JKN) financing, and organizational commitment. However, the continuity of long-term rehabilitation was constrained by limited service capacity, a high financial burden associated with long-term rehabilitation, and suboptimal integration across levels of care. Consequently, continuity of care after hospital discharge has not yet been fully supported by the health system. Conclusion: Achieving continuity of care for post-stroke rehabilitation requires the active involvement of multiple stakeholders through strengthened long-term rehabilitation financing, enhanced service capacity, optimized roles of primary healthcare facilities, development of community-based rehabilitation, and strengthened governance through policy implementation and cross-sectoral coordination to ensure rehabilitation is sustained according to patients needs.

Kata Kunci : rehabilitasi pascastroke, continuity of care, sistem pelayanan kesehatan, rehabilitasi berbasis komunitas