Clinical pathway & cot selasa

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Clinical pathway & cot selasa

  1. 1. C linical Pathway & Cost of Treatment(Conceptual Thinking & Application) Ronnie Rivany ® Health & Hospital Economics Pusat Kajian Ekonomi & Kebijakan Kesehatan FKMUI
  2. 2. JASTIFIKASI• Standarisasi tarif RS ?• Belum ada Clinical Pathway sebagai penjaga mutu & sebagai basis layanan MUTU dan basis perencanaan/perhitungan biaya• Sistem, Kebijakan dan Prosedur yang tidak jelas dan tidak konsisten serta belum terintegrasi• Buku Tarif Departemen Kesehatan 2007 (?)
  3. 3. Major Diagnostic Categories (AR-DRG v 5,2, 2006)1 Diseases and disorders of the nervous system2 Disease and disorders of the eye3 Disease and disorders of the ear, nose, and throat4 Disease and disorders of the respiratory system5 Disease and disorders of the circulatory system6 Disease and disorders of the digestive system7 Disease and disorders of the hepatobiliiary system and pancreas8 Disease and disorders of the musculoskeletal system and connective tissue9 Disease and disorders of the skin, subcutaneous tissue, and breast10 Endocrine, nutritional, and metabolic diseases and disorders11 Disease and disorders of the kidney and the urinary tract12 Disease and disorders of the male reproductive13 Disease and disorders of the female reproductive system14 Pregnancy, childbirth, and the purperium15 Newborn and other neonates with conditions originating in the perinatal period16 Disease and disorders of blood and blood forming organs and immunological disorders17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm18 Infectious and parasitic disease (systemic or unspecified sites)19 Mental diseases and disorders20 Alcohol/drug use and alcohol/drug- induced organic mental disorders21 Injuries, poisoning, and toxic effects of drugs22 Burns23 Factors influencing health status and other contact with health services
  4. 4. DRG Numbering• The format = A DD S• A = Pre MDC DRG’s ; B = nervous system DRG; O = Reproductive System; Z = DRG’s relating to other health factors; 9 = the error DRG’s• DD = DRG’s partition; – Range 01 – 39 Surgical Partition – Range 40 – 59 Other Partition – Range 60 – 99 Medical Partition• S = split indicator – A = highest resources DRG – B = second highest resources
  5. 5. General Logic, All acute admited patien Diagnosis Related Group’s Principal diagnosisMajor diagnostic category # 1 MDC # 2 MDC # 3 MDc # 4 Yes No Surgical Partition of MDC # 1 Medical Partition of MDC # 1 What procedure Procedure Procedure Procedure Procedure Custer A Cluster B Cluster C Cluster D What age group’s Over Under XProcedure cluster A over age X Procedure cluster A under age XSignificant secondary condition ? Yes No Procedure cluster A Procedure cluster A Over Age X, with CC Over Age X, without CC
  6. 6. INDONESIAN DRG’s
  7. 7. INDONESIAN DRG’s• Pola pikir – ICD tetap – MDC untuk sementara tetap – Clinical Pathway bisa dibuat – DRG di konfirmasi + bisa dibuat – Casemix di konfirmasi + bisa dibuat – Costing dilakukan dengan pendekatan Activity Based Costing + Simple Distribution
  8. 8. POLA PIKIR INDONESIAN DRG’s (1) INA - DRG 1.Konfirmasi DRG 2.Hitung Cost/DRG Clinical Pathway & Casemix Activity Based Costing
  9. 9. POLA PIKIR INDONESIAN DRG’s (2) ICD MDC 1 DRG DRG DRG 2 COST CASEMIX TARIF COST TARIF
  10. 10. Clinical Pathway• Anticipated Recovery Pathway (ARPs)• Multidisciplinary Pathways of Care (MPCs)• Care Protocols• Integrated Care Pathways• Pathways of Care• Care Packages• Collaborative Care Pathways• Care Maps• Care Profiles
  11. 11. Konsep perencanaan pelayanan terpadu yang merangkum setiaplangkah yg diberikan kepada pasien berdasarkan standar yanmed, standar asuhan keperawatan&standar pelayanan tenaga kesehatan lainnya , yg berbasis bukti dng hasil yg dpt diukur dan dalam jangkawaktu tertentu selama di rumah sakit
  12. 12. Major Diagnostic Categories (Pedoman Tarif ?? DEPKES,2007)1 Diseases and disorders of the nervous system2 Disease and disorders of the eye3 Disease and disorders of the ear, nose, and throat4 Disease and disorders of the respiratory system5 Disease and disorders of the circulatory system6 Disease and disorders of the digestive system7 Disease and disorders of the hepatobiliiary system and pancreas8 Disease and disorders of the musculoskeletal system and connective tissue9 Disease and disorders of the skin, subcutaneous tissue, and breast10 Endocrine, nutritional, and metabolic diseases and disorders11 Disease and disorders of the kidney and the urinary tract12 Disease and disorders of the male reproductive13 Disease and disorders of the female reproductive system14 Pregnancy, childbirth, and the purperium15 Newborn and other neonates with conditions originating in the perinatal period16 Disease and disorders of blood and blood forming organs and immunological disorders17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm18 Infectious and parasitic disease (systemic or unspecified sites)19 Mental diseases and disorders20 Alcohol/drug use and alcohol/drug- induced organic mental disorders21 Injuries, poisoning, and toxic effects of drugs22 Factors influencing health status and other contact with health services23 Medical Outpatient Visit
  13. 13. HUBUNGAN C.P & DRG/CASEMIX ICD MDC Clinical PathwayDRG DRG DRG COST CASEMIX TARIF COST TARIF
  14. 14. Clinical Pathway in Hospital
  15. 15. Pengembangan Konsep Clinical Pathway International Classification of Disease (ICD) Major Diagnostic Categories (MDC)ClinicalPathway Surgical / Other / Medical Diagnosis Related Groups (DRG’s) Casemix
  16. 16. Format dasar Clinical PathwayAktivitas pelayanan Pra R.I Rawat Inap (R.I) (Poliklinik/ Hari I Hari 2 Komplikasi UGD) Tgl Tgl / Co- morbidity 1 2 3 4 5PendaftaranPenetapan DiagnosePra-PerawatanPerawatanTindak Lanjut
  17. 17. CLINICAL PATHWAY DALAM TAHAPAN PRA PERAWATAN & PERAWATAN Aktivitas pelayanan Pra R.I Rawat Inap (R.I) (Poliklinik/ UGD) Hari I Hari 2 Komplikas Tgl Tgl i/ Co- morbidity 1 2 3 4 5Pra-PerawatanAssessment klinis•   pemeriksaan/visite dokter•   konsultasiPemeriksaan penunjang•   laboratorium•   Radiologi•   Dst sesuai SPM, SAK & SPOPerawatan•  Tindakan medis•   Pemberian obatDst-nya, sesuai SPM,SAK & SPO
  18. 18. DUMMY TABLE (1) Clinical Pathway UtilisasiNo SOP Hari.1 Diag.Utama + Serta + Sulit + Serta + Sulit1 Admission2 Diagnostic3 Pra Therapy4 Therapy5 Follow Up6 Discharge
  19. 19. DUMMY TABLE (2) Clinical Pathway UtilisasiNo Aktivitas SDM OBAT OVERHEAD1 Admission2 Diagnostic3 Pra Therapy4 Therapy5 Follow Up6 Discharge
  20. 20. DUMMY TABLE (3) Clinical Pathway UtilisasiNo Aktivitas Min Max Mean / Utilisasi Utilisasi Median Utilisasi1 Admission2 Diagnostic3 Pra Therapy4 Therapy5 Follow Up6 Discharge
  21. 21. CLINICAL PATHWAYSYMPTOM DIAGNOSIS THERAPY FOLLOW UP 1 2 3 4 5Admission Diagnosis Pre Therapy Therapy Follow upActivities Activities Activities Activities Activities ABC ABC ABC  ABC  ABC
  22. 22. PEMBUATAN CLINICAL PATHWAY (1)• Diawali dengan membuat template untuk mendapatkan clinical pathway. Langkah- langkah dalam membuat clinical pathway adalah sebagai berikut :• Membuat koding untuk memudahkan entry data.• Entry data karakteristik, identitas, tanggal masuk dan keluar rumah sakit, lama hari rawat, jenis pembayaran, diagnosa utama, penyakit penyerta, penyakit penyulit, cara masuk, status keluar dan kelas rawatan dari masing-masing pasien. Entry data dilakukan berdasarkan kelompok AR-DRG.
  23. 23. PEMBUATAN CLINICAL PATHWAY (2)• Entry semua aktivitas yang diterima pasien dari masuk sampai pulang dan pada waktu rawat jalan. Semua aktivitas dekelompokkan berdasarkan tahap clinical pathway.• Konfirmasi tahap clinical pathway dan variabel kegiatan dengan SPM IDI, SPM Profesi dan para dokter dan paramedis di Rumah Sakit .• Draft clinical pathway diisi berdasarkan frekuensi masing-masing kasus.• Berdasarkan nilai mean atau median didapatkan nilai rata-rata masing-masing variabel dalam clinical pathway perhari rawatan berdasarkan kelompok AR- DRG.• Cleaning dan pengecekan ulang terhadap nilai utilisasi berdasarkan tahap dalam clinical pathway masing-masing kelompok AR-DRG sehingga didapatkan nilai utilisasi kelompok AR-DRG berdasarkan clinical pathway.
  24. 24. PEMBUATAN CLINICAL PATHWAY (3) Draft & Finalisasi Clinical Pathway• Setelah draft Clinical Pathway yang berbasis evidence tadi telah dibuat, maka tahapan akhir dari penyusunan Clinical Pathway ini adalah Focus Group Discussion dengan Panel Expert ( para spesialis ) dan Ikatan Profesi , untuk bersama-sama menyepakati jenis dan jumlah tindakan/FORMULARIUM yang akan dipergunakan dalam Clinical Pathway
  25. 25. DUMMY TABLE (1)Clinical Pathway Cost of TreatmentActivities Day.1 Day.2 Day.3 Day …..Admission + + + +Diagnosis + + + +Pre Therapy + +Therapy + + + +Follow UpDischarge
  26. 26. DUMMY TABLE (2) Clinical Pathway Cost of TreatmentNo Activities Day.1 Principal Penyulit Penyerta PP Diagnosis1 Nursing2 Consultation3 Doctor visits4 Medical Procedures5 Nursing6 Medical /DRUGS Treatment7 Supporting exams8 Nutrition9 Physiotherapy10 Etc
  27. 27. DUMMY TABLE (3)Clinical Pathway Cost of TreatmentNo Activities U DC IC TC UC U x UC1 Admission2 Diagnosis3 Pre Therapy4 Therapy5 Follow Up6 Discharge TOTAL C/DRG
  28. 28. Cost of Treatment (Cost DRG/Casemix)No Cost of Treatment / Direct Cost IndirectCost Activity Based Investasi Operasional Pemeliharaan INDEX Costing1 Admission %2 Diagnostic %3 Pra Therapy %4 Therapy %5 Follow up %6. Discharge
  29. 29. APLIKASI COST/DRG/Casemix dalam PK BLU(1)Cost of Treatment Rawat Inap dan Rawat JalanNo AR-DRG KLS. III KLS. II KLS.I UTAMA VIP RAJAL 1 B70A 5181485 5281384 5339924 5778045 5805053 803121 2 B70B 4075179 4153671 4199667 4543904 4565126 995167 3 B70C 1905273 1976629 2018443 2331386 2350678 987047 4 B70D 1848767 1863038 1871401 1933989 1937848Perbandingan Biaya Rawat Inap KLS.IIINo AR-DRG KLS. III Tanpa Gaji Tanpa Obat Tanpa Gaji Dan Obat 1 B70A 5181485 4250350 2972007 2040872 2 B70B 4075179 3476706 2250808 1652334 3 B70C 1905273 1489521 1438879 1023127 4 B70D 1848767 1624600 1030735 806568
  30. 30. CLINICAL PATHWAY            COST of TREATMENT
  31. 31. TARIFF DETERMINANT per DRG’S TARIFF Margin COST/DRG’s UNIT COST UNIT COST UNIT COST UNIT COST UNIT COST ROOM & BOARD DRUGS   LAB MED SUPPLIES OKTotal cost Q ACTIVITY BASED COSTING + SIMPLE DISTRIBUTION
  32. 32. LAPORAN Clinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s)Sectio Caesaria, Diare Anak & Katarak (2008)Apendictomy & Pneumonia Anak (2009 - 2010) DINAS KESEHATAN Pemerintah Propinsi Daerah Khusus Ibukota Jakarta
  33. 33. REKAM MEDIK DI RUMAH SAKIT
  34. 34. LAPORANClinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s) 10 Dept – International Wing 2009 - 2010 RUMAH SAKIT Dr Cipto Mangunkusumo, Jakarta
  35. 35. LAPORANClinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s) Rumatan Methadon, 2010 RUMAH SAKIT KETERGANTUNGAN OBAT Cibubur - Jakarta
  36. 36. DIREKTORAT JENDERAL BINA PELAYANAN MEDIK DEPARTEMEN KESEHATAN 2005
  37. 37. • RS wajib memp.CP, Diagnosis mengacu pada ICD-10,Prosedur mengacu pd ICD- 9CM Flowchart penyusunan CP ICD SPM Profesi Model Dummy Surgical Medical SPM RS Clinical Pathway Terukur(admissi on to discharge) DRG contoh : -Diare anak SOP Aktivitas -Sectio Caesaria Case Mix
  38. 38. TUJUAN :• utk meningkatkan mutu Yan pasien• memaksimalkan penggunaan sumber daya scr efisien dng mengurangi dokumentasi yg tdk diperlukan.• membantu identifikasi & klarifikasi proses Yan klinis• mendukung efektivitas klinik, audit medis & risk management
  39. 39.  Dalam menyusun clinical pathway (C.P) di RS peru memadukan & menyesuaikan dng b’bagai sistem yg tlh dibangun serta tlh b’jalan sehingga stiap bagian yg ada di RS lebih mudah menyesuaikan & saling mendukung pd saat C.P. selesai dibuat & disosialisasikan. Komite Medik sngt bperan dlm m’bantu penyusunan & plaksanaan C.P. di RS. Pedoman C.P. di RS diharapkan dpt m’bantu RS dlm menyusun C.P. dlm rangka mendukung plaksanaan pengembangan DRG’s Casemix di RS.
  40. 40. TERIMA  KASIHatas perhatian & kesempatan kerjasamanya www.ina-drg-rr.net

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