Kilas Balik Pelaksanaan CP Nasional

Dr Amrizal Muhd Nur

Outline:

• Pendahuluan

• Format Clinical Pathways

• Clinical Pathways 15 RS Pilot

• Kesimpulan

Pendahuluan(1)

Clinical Pathway & Case-Mix

• Common conditions• High volume• High costs• Predictable outcomes

Aim: to counter-check DRG costs on selective and costly cases by doing ABC costing

Pendahuluan(2)

Components in CP?

1. Categories of care/Activities2. Time frame3. Outcomes4. Variance

Pendahuluan(3)

Time

Interventions

Variance

Cat

egor

ies

of

care

/Act

ivit

ies

Outcomes

Pendahuluan(4)

AREA OF CARE DAY 1DATE :

DAY 2 DAY 3

•ASSESSMENTS AND CONSULTATIONS

• INVESTIGATION

• TREATMENT

• MEDICATIONS

• DIET

• ACTIVITY

• TEACHING

• DISCHARGE PLANS

•VARIANCE

• Baseline for a Clinical Pathway is time (horizontal axis)• Various areas of care is on the (vertical axis)

The Experience of USA in Using CP

1. The rate of CP implementation 60%2. Reductions in the incidence of

complication3. Reductions-repeated hospitalization4. Reduced medical costs5. Minimizing of malpractice claims6. Improved patient satisfaction

The Experience of CP Implementation in

Johns Hopkins Hospital

1. Improved quality of care2. Reduced costs3. Reduced length of stay

Ferguson LE. Managed care at the Johns Hopkins Hospital.Nurs Adm Q. 1993;17(3):54–79

The Experience of Taiwan in Using CP

• 7 Benefits of CP implementation in 8 Hospital in Taiwan: 1) reducing the number of hospitalization days 2) reducing medical expenses 3) improving the quality of medical care 4) facilitating interdepartmental cooperation 5) rationalizing & standardizing medical treatment procedures 6) fostering patient satisfaction by providing health education 7) providing an evidentiary basis for medical treatment and minimizing disputes as to care

1. Average length of stay shortened, 0.89 days2. Medical expenses saved on the treatment per

patient $275 3. Patient satisfaction rose to 93.15% 4. Quality of medical care:

- The average lapse between the operation and getting-out of bed is 70.42 hours

The Experience of CP Implementation in The VM Hospital of Taipei, Taiwan

CP for Total Knee Replacement in 187 patients in the orthopedic ward

1. Average length of stay shortened, 1.06 days2. Medical expenses saved on the treatment per

patient $121 3. Patient satisfaction rose to 93.15% 4. Quality of medical care:

- The average lapse between the operation and getting-out of bed is 69.92 hours

The Experience of CP Implementation in The VM Hospital of Taipei, Taiwan

CP for Total Hip Replacement in 64 patients in the orthopedic ward

13

Aktiviti Sebelum Juli 2007

• Clinical Pathways– Finalisasi Format CP– Kirim Format Final ke POKJA dan Konsultan– Mulai mengumpul data 100 kasus setiap CP– Kirim Data 100 kasus untuk Analisis

14

Aktiviti Sesudah Juli 2007

• Clinical Pathways– Teruskan pengumpulan data setiap CP– Analisis Data CP

• Beri Feedback kpd RS

– Tambahkan CP untuk Penyakit Lain

POKJA CLINICAL PATHWAYS:CENTRE FOR CASE-MIX DEPKES

Ketua : Dr Osrizal OesmanSecretary : Dr IndriwantoAnggota : Dr Doddy Firmanda Dr Gogot Dr Bambang Dr Abd. Kadir Prof. Dr Amal Sjaf Prof. Dr Nurul Akhbar

POKJA CLINICAL PATHWAYS

NO NAMA RS JENIS KASUS PENYAKIT

01. RSU. H. Adam Malik, Medan Penyakit Dalam

02. RSU.Fatmaw ati, Jakarta Bedah Othopedi

03. RSU. Dr. Hasan Sadikin, Bandung Bedah Umum

04. RSU. Dr. M. Djamil, Padang Syaraf & outpatient

05. RSAB Harapan Kita, Jakarta Anak

06. RSU. Sanglah, Denpasar THT & Outpatient

07. RSU. Dr. M. Hoesin, Palembang Mata & Outpatient

08. RS Kanker Dharmais, Jakarta Kanker

09. RSU. Dr. Kariadi, Semarang Bedah Syaraf & Outpatient

10. RSUPN. Cipto Mangunkusumo, Jakarta Urologi & Radioterapi

11. RS. Jantung & Pemb. Darah HK, Jakarta Jantung & Pembuluh Darah

12. RSU. Prof. Dr. R.D. Kandou, Manado Kulit & Kelamin & outpatient

13. RSU. Persahabatan, Jakarta Paru-Paru

14. RSU. Dr. Sardjito, Yogyakarta Obsgyn & Radiodiagnostik

15. RSU. Dr. Wahidin Sudirohusodo, Makassar Jiw a & Penyakit Dalam

RUMAH SAKIT DAN JENIS KASUS PENYAKIT

BELUM DI TERIMA CP

RS M HOESIN, PALEMBANG1. Katarak2. Glaukoma

RS FATMAWATI, JAKARTA

1. Fraktur Tibia2. Fraktur Tibia Tertutup dengan kompartemen sindrom

RS HASAN SADIKIN, BANDUNG

1. Appendisitis Akut Tanpa Perforasi2. Hernia Inguinalis Lateralis Reponibilis

RS JANTUNG HARAPAN KITA, JAKARTA

1. Amplatzer Duct Occluder (ADO)2. Coroner Angioplasty PTCA

RS KARIADI, SEMARANG

1. Epidural Hematom2. Hidrosefalus (0-14 Tahun)

RS PERSAHABATAN, JAKARTA

1. Pneumothoraks Spontan Primer2. Pneumonia

RS SARDJITO, JOGJAKARTA

1. Bedah Sesar Elektif 2. Bedah Sesar Emergensi

RS WAHIDIN, MAKASSAR

1. Chronic Kidney Disease2. DM + Ketoasidosis

RSAB HARAPAN KITA, JAKARTA

1. Diarrhea for Children2. Asthma for Children

RS KANKER DHARMAIS, JAKARTA

1. Tonsilektomi2. OMSK Tipe Berbahaya S

RS SANGLAH, DENPASAR, BALI

RS CIPTO MANGUNKUSUMO, JAKARTA

1. Mastektomi Radikal Unilateral 2. NHL Maligna St. IIB pro Chemoterapi CHOP

1. Radioterapi Kanker Nasopharynx 2. URS Batu Ureter

RS KANDOU, MANADO

RS M JAMIL, PADANG

RS ADAM MALIK, MEDAN

1. Inflammatory Liver Disease, Unspecified 2. NIDDM with Diabetic Gangrene

1. Cerebral Infarction 2. Stroke Pendarahan

1. Kandidiasis Kutis2. Liken Planus

CLINICAL PATHWAYS IN CASE-MIX (1)

• Advantages– Reduce variations on care

• More predictable cost

– More standardization of care• Improve in quality of care

– Improve costing procedure– Increase quality of information collected

CLINICAL PATHWAYS IN CASE-MIX (2)

• Advantages– counter-check on certain DRG costs

• ABC costing

– especially on expensive and common cases

Reasons for Clinical Pathway?

1. Standardisation2. Transparency3. Accountability4. Evidence-based medicine5. Quality of care 6. Efficiency of care 7. Flexibility (Variances)8. Casemix

Hambatan ?

• perlu 100 kasus setiap Clinical Pathway (2 CP setiap RS) • RS yang belum menghantar CP, sila hantar ke e-

mail: pokjacp@yahoogroup.com

Terima Kasihamrizal65@gmail.com

amrizal@unu.edu