CLINICAL PATHWAY DAN APLIKASI ACTIVITY BASED COSTING BEDAH SESAR DI RUMAH SAKIT UNDATA PROPINSI SULAWESI TENGAH

Siti Rahmawati, SE.,M.Si., Prof. dr. Mohammad Hakimi, SpOG(K), Ph.D.

2012 | Disertasi | S3 Kedokteran Umum

Latar belakang Komplikasi persalinan bedah sesar menjadi pilihan untuk dievaluasi dalam melakukan analisis biaya berbasis Diagnosis Related Group’s. berdasarkan Integrated Clinical Pathway Permasalahan dalam penelitian bedah sesar ini adalah (1). masih tingginya bedah sesar di Sulawesi Tengah (19,5%), masih berada diatas rata-rata nasional. (2). meningkatnya biaya bedah sesar lima sampai tujuh juta rupiah, (3) penggunaan teknologi semakin mahal, (4) prosedur yang tidak efisien lamanya length of stay, (5),. waiting list yang panjang , Tuntutan akan pelayanan yang bermutu efektifitas biaya (cost effectiveness) dan biaya terkendali, dan penetapan integrated clinical pathway dapat menjadi alternative yang terpilih di dalam penyelenggaraan bedah sesar. Tujuan Penelitian ini adalah untuk mengetahui Clinical Pathway dan Aplikasi biaya bedah sesar serta mutu pelayanan kebidanan. Metode penelitian .Rancangan penelitian adalah kohort studi Epidemologis analitik noneksperimental yang mempelajari hubungan antara faktor risiko dan efek atas penyakit. Subjek penelitian terdapat tiga kelompok yaitu: sebelum clinical pathway 62 pasien, sesudah clinical pathway 62 pasien, dan INA DRG?INA-CBG total 62 pasien. Jumlah sampel 186 pasien. Analisa data dengan metode Activity Based Costing System. Hasil Penelitian. Hasil clinical pathway dapat digunakan sebagai alat (entry point) untuk melakukan perbaikan dan revisi standar pelayanan medis dan asuhan keperawatan yang bersifat dinamis berdasarkan pendekatan Evidence Based-Medicine (EBM) dan Evidence- Based Nurse (EBN), serta dapat mengurangi length of stay, 4-6 hari, pencegahan infeksi nosokomial, kendali biaya dan meningkatkan mutu pelayanan kebidanan. Rekapitulasi biaya (1) Kelompok SPM total cost Rp. 49.063.012, unit cost yang tertinggi pada pasien penyulit dan penyerta (pre eklamsia+ hipertensi), dengan unit cost per pasien Rp. 3.260.129, (2). Kelompok SOP total cost Rp.54.168.666 dan pada pasien penyakit penyulit+penyerta (eklamsia+diabetes) unit cost Rp.2.547.520,-. (3). Kelompok INA DRG/INA CBG total cost Rp. 48.415.940,19. Dan unit cost pada pasien komplikasi berat Rp 2.849.956. Kesimpulan: Perbedaan rekapitulasi biaya menurut kelompok SPM, SOP, dan INA- DRG/ INA-CBG berpengaruh pada variabel cost yaitu nutrisi,/gizi , obat-obatan, pemeriksaan penunjang medis. Alokasi departemen produksi penunjang non medis sifatnya fixed cost dianggap konstan.Implikasi CP berpengaruh tergadap mutu dan efisiensi biaya di Rumah Sakit Undata

Background Caesarcan surgery delivey complication became a choice to evaluate in conducting cost analysis per Diagnosis Related Group. Based on Integrated Clinical Pathway, problems in this research were (1) high rate indication of Caesarcan surgery in Central Celebes (19.5%), that was still above national average (2) increase of Caesarcan surgery from IDR five million through IDR seven million (3) technology use that was increasingly high, (4) inefficient procedures reflected by length of stay (5) long waiting list (6) the excessive diagnosis test (7) limits of hospital's facilities (8) hospitals needed to to reduce unnecessary human resource cost in order not to waste cost. Integrated clinical pathway appointment and needs of quality service, effective and controlled cost, could be an alternative to choose in Caesarcan surgery activities. Research objective: this research was to know clinical pathway and Caesarcan surgery cost application and also midwife service quality in Kudata Hospital in Central Celebes Province. Research method: Reseach design was Epidedemiological analytical non-experimental cohort study which learned relationship between risk factors and disease effect. research subject of Caesarcan surgery were classified into three groups: pre- clinical pathway pf 62 patiens, post-clinical pathway of 62 patiens, and INA DRG of 62 patients. Total samples were 186 patients. Data analysis used activity based costing system method. Research result: Clinical pathway could be used as an entry point to conduct medical service standard improvement and revision and a dynamic nurturing based on Evidence Based Medicine (EBM) and Evidence-Based Nurse (EBN) approaches, and also it could reduce length of stay to 4-6 days, nososcomial infection prevention, cost control, and developed midwifery service quality. Cost recapitulation was: (1) SPM group total cost of IDR 49,063,01247; the highest unit cost in complication and participator (pre-ecclampsia and hypertension) per patient unit cost of IDR 3,260,129 (2) SOP group total cost of IDR 54,168,668,43 in complication and participator (eclampsia and diabetes) unit cost of IDR 2,547,520 (3) INA DRG group total cost of IDR 48,415,940,19; and severe complication patient unit cost of IDR 2,849,956. Conclusion: Cost recapitulation diference according to SPM, SOP, and INA DRG group affected to cost variables were nutrition, medicine and medical supporting diagnosis. The allocation of non medical supporting production department was fixed cost that was coscidered as constant.

Kata Kunci : Clinical pathway, bedah sesar, activity based costing, mutu pelayanan kebidanan