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ANTIMICROBIAL STEWARDSHIP STRATEGY TO REDUCE LENGTH OF STAY AND COST OF ANTIBIOTIC CONSUMPTION: A SYSTEMATIC REVIEW Damayan, Anak Agung Istri Agung Sri Stuti; Maharjana, Ida Bagus Nyoman; Nurwahyuni, Atik
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: Reducing the cost of care and length of stay for patient in hospital are important to monitor the benefits of implementing an antimicrobial management program. An antimicrobial management program is a strategy to decrease Antimicrobial Resistance (AMR) that affect to the treatment of the patient. One of the antimicrobial management programs is Antimicrobial Stewardship Programs (ASP). This study aims to determine the appropriate strategies in the application of Antimicrobial Stewardship Programs (ASP) that can reduce the length of stay and cost of antibiotic consumption for patient in hospital.Methods: This study was a systematic review that used PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Data obtained from Electronic databases ProQuest and Medline (PubMed) that published five years times span. By using keywords such as antimicrobial stewardship, antimicrobial resistance, length of stay, length of the hospital and patient cost to find the relevant journal. Results:  The search found 3,541 studies, of which 26 studies were included in the systematic review. After excluded the article review, there were 9 studies that used quasi-experimental, observational cohort studies and Randomized Control Trial (RCT). These studies conducted majority in Europe and USA, only 1 study that conducted in Asia. Analysis of the studies found out that 6 of 9 studies mentioned if ASP can reduce the length of stay of the patient in hospital. Only 3 of 9 studies that examined the effect of ASP in cost of care and these 3 studies mentioned ASP can reduce the cost of care. Conclusion: This study showed that implementing ASP can reduced the length of stay and antibiotics consumption among patient in hospital by manage the antimicrobial use, conduct audits and feedback in an appropriate step, and intravenous to oral switch program.
EFFECTIVENESS OF CAESAREAN SECTION CLINICAL PATHWAY TOWARDS HOSPITAL LENGTH OF STAY: A SYSTEMATIC REVIEW Daruki, Maria Wahyu; Nurwahyuni, Atik; Bachtiar, Adang
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: Improving quality and efficiency in hospital services can be done by using Clinical Pathway (CP). CP can decrease the hospital length of stay and cost. In indonsia, the increasing number of Caesarean Section (SC) affects to the Length of Stay (LOS) in hospital. This study aims to examine the effectiveness of clinical pathway in caesaren section to length of stay in the hospital. Methods: This study was a systematic review used PRISMA guidelines. Data obtained from Electronic journal databases Pubmed and ProQuest that published between 2014 until 2019 and used English language. By using keywords such as clinical pathway, childbirth labor, and length of stay to find the relevant journal. Results: The search found out 4,937, studies from 2 journal databases. The articles that not suitable with the criteria inclusion must be exclude. Totally, 6 studies were analyzed in this study. 1 study explained the affect of increasing length of stay in the National Health Insurance, 2 studies mentioned that CP was not affected to the length of stay in hospital and 3 studies mentioned that CP was reduced the length of stay in hospital. Conclusion: Clinical pathway in Caesarean section can reduced the length of stay in hospital. The hospital should implement the clinical pathway in caesarean section to increase the quality of hospital service and reduce the cost.
REDUCED LENGTH OF STAY IN CHILDREN WITH DIARRHEA FOLLOWING IMPLEMENTATION OF CLINICAL PATHWAY Suwedia, I Nyoman Gede Bayu Wiratama; Nurwahyuni, Atik
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: Diarrhea or Acute Gastroenteritis (AGE) is a dissease that common found in toddlers at emergecy room. The complication of diarrhea such as dehydration may go undetected by parents will affect the treatment and length of stay in the hospital. Decreasing the length of stay in the hospital can be done by implementing clinical pathways. This study aims to examine the effect of implementing clinical pathways on length of stay in children with diarrhea. Methods: This study was a systematic review that used PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Data obtained from Electronic databases Proquest and Scopus that published between 2009-2019 and used English. By using keywords such as clinical pathway, gastroenteritis, and length of stay to find the relevant articles. Results: The search found 610 studies, of which 6 studies were included in the systematic review. These studies conducted majority in USA and 1 study in Australia. Analysis of the studies found out that implemented clinical pathway can decrease length of stay 0.4 days (95% CI 0.04 to 0.7, p <0.01). The decreased of length of stay can increased 2.5% (CI 0.25% to 4.38%) used of medical beds then the bed can be more effective and used by other patients. Conclusion: Implementing clinical pathway in the treatment process of diarrhea towards children not only reduce the length of stay in hospital but also useful in providing patient diagnosed and reduce the bed use per day and year.
THE VARIATION OF CAESARIAN SECTION COSTS IN INDONESIAN HOSPITALS: A NARRATIVE REVIEW Tetriyadi, Tetriyadi; Nurwahyuni, Atik
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: In providing services, hospital, as one of the health care providers, must be able to regulate the number of costs obtained in accordance with the proportion/variation. The costs incurred by hospitals in providing complete personal health services consist of various cost components, including service fees, pharmacy costs, accommodation costs, action costs, investigation fees, and administrative costs. The cost calculation is one of the strategic steps that must be taken in marketing because it will be used for pricing. Caesarean Section (CS) surgery is one of the largest services and costs a lot in the hospital; careful planning is needed. This study aims to look at the variation in the cost components of CS services in Indonesia based on hospital level, hospital ownership. Methods: This study is a quantitative research Narrative Review by analyzing twenty hospitals in six provinces representing Indonesia from the thesis found in lib.ui database. The analysis in this study is the amount of proportion/variation in the cost components with the type of hospital and hospital ownership. Meanwhile, the criteria for selected hospitals are government-owned and private hospitals with types A, B, C and D. To be able to compare these data and avoid inflation differences, it is necessary to do data collection or valuation presentation (VP). The chosen cases were the usual CS without emergency and complication Results: There was a wide variation in CS service cost components, namely medical services (25% - 90%), accommodation (2% -39%), investigations (1% -36%) and drugs and BHP (2% -50%) both in government and private hospitals. Government-owned type B hospitals and government and private type C costs for medical services are greater than 44%. Conclusion: There are variations in the cost components of CS services at hospital types B and C. There is a need for government efforts to make regulations regarding the magnitude of the ideal cost component as a reference for all hospitals in Indonesia.
THE ACCURACY OF DIAGNOSIS, PROCEDURES AND CODING COMPLETENESS AND THEIR CORRELATION WITH INA-CBG CLAIMS Yuliani, Yuliani; Nurwahyuni, Atik
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: Since 1 January 2014, the INA-CBG system has been applied as a method of payment for outpatient and inpatient services. Indonesian-Case Based Groups (INA-CBG) tariff is the amount of payment claimed by the Health Social Security Administering Agency (BPJS) to the hospitals for a package of services based on the classification of diagnoses and procedures of diseases. The inequality in the number of claims received by the hospital compared to the resources used will be unbeneficial to the hospital. The purpose of this study is to identify the correlation of incompleteness and inaccuracy of diagnosis, procedures, and coding to the number of INA-CBG claims at hospitals in Indonesia. Method: The research method is the literature review. The authors found five articles cited by Google Scholar published in journals and two theses taken from the Library of Universitas Indonesia that include ?factors that influence INA-CBGs claim amounts at hospitals? or related concepts in the title or abstract. Articles and theses published from 2014 to 2018 were search using the following terms in the title or abstract: ?accuracy, completeness, diagnosis, coding, INA-CBG claims.?.Result: The authors found seven articles that met our criteria: Two studies used qualitative approach, three studies were quantitative studies, two studies used a mix method. From these studies, there were five practical considerations that were considered as the factors that influenced the number of INA-CBGs claims at hospitals in Indonesia: completeness of filling a medical resume, accuracy of coding, accuracy in filling medical resumes, the accuracy of information systems, and completeness of claim administration document.Conclusion: The study has indicated the factors that influence the amount of INA-CBG claims in hospitals in Indonesia, mainly, the factor of completeness of medical resumes and the factor of accuracy in coding by the coders. The completeness of a medical filling resume which is highly dependent on physician compliance and accuracy coding. All the human resources who have a role in coding and claims, need to improve their capability on it, through a workshop, or any other education funded by the hospital. Coder certification must be done. Hospital has to develop hospital management information system for acceleration in coding and claim.
Determinan Ketahanan Pangan Rumah Tangga di Daerah Pedesaan di Indonesia (Analisis Data Susenas Tahun 2017) Dilla Syamola; Atik Nurwahyuni
Media Kesehatan Masyarakat Indonesia Vol. 15 No. 1: MARET 2019
Publisher : Faculty of Public Health, Hasanuddin University, Makassar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (22.294 KB) | DOI: 10.30597/mkmi.v15i1.5880

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Food is a basic human need for life while food security is a guarantee for humans to live healthy andproductive work, around 800 million people do not have access to adequate food. Emphasizing food security asan important public health problem. This study uses secondary data from the 2017 National Social Survey (Susenas),this study aims to prove the determinants of household food security in rural areas in Indonesia in 2017.Thecross-sectional study design where data was collected at the same time, and obtained by the Linear Probabilitymodel (LPM) logit and probit models. Estimated results with probit tests show food security is positively relatedto education level, economic status and raskin with estimated coefficients of 0,112, 0.118 and 0,218. The level ofeducation and economic status is significantly related to food security (p value <0,01), but raskin is not significant(p value=0.561). Estimation results show that food security is negatively related to work status, number of familymembers and PKH with estimated coefficients of -0,188, -0,650 and -0,091. Working status, the number of familymembers and PKH are significantly related to food security. Economic status is an important factor for producingquality food in a family.
Pengaruh Pemanfaatan Dana Bantuan Operasional Kesehatan terhadap Upaya Kesehatan Anak melalui Posyandu di Indonesia Berdasarkan Data IFLS Tahun 2014 Nia Priyatiningsih; Atik Nurwahyuni
Media Kesehatan Masyarakat Indonesia Vol. 15 No. 3: SEPTEMBER 2019
Publisher : Faculty of Public Health, Hasanuddin University, Makassar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (303.641 KB) | DOI: 10.30597/mkmi.v15i3.6286

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Health Operational Aid Fund (BOK) is an effort of the Indonesian government to reduce mortality ofnewborns and toddlers, where in 2017 mortality rate of newborns reached 15 per 1000 live births and 32 per1000 live births for toddlers. BOK funds are used as operational costs for health workers/cadres in carrying outpromotional and preventive activities outside the building. This study aims to explain the effect of BOK funds onchild health efforts through on Integrated Health Center (IHC). This study used a secondary data study of 2014IFLS, with a cross-sectional study design and logit econometric model approach. Respondents in this study wasparents who have children aged 0-59 months, number of respondents was 4,417. Data processing used the STATAapplication. Results of study showed that children who were brought to IHC were significantly associated withp-value <0.1 on maternal education status, economic status and BOK Fund. Educational status has a p-valueof 0.087, economic status has a p-value of 0.019, and BOK funds have a p-value of 0.0001. BOK funds do notdirectly affect children’s health, but the utilization of BOK fund by health workers/cadres can provide awarenessof mothers who have toddlers to maintain children’s health through on IHC.
ANALISIS KEPATUHAN DOKTER DALAM MERESEPKAN OBAT FORMULARIUM NASIONAL DI RUMAH SAKIT MULTAZAM MEDIKA TAHUN 2018 Evie Ni&#039;matunnisa; Atik Nurwahyuni
JKM (Jurnal Kesehatan Masyarakat) Cendekia Utama Vol 9, No 1 (2021): JKM (Jurnal Kesehatan Masyarakat) Cendekia Utama
Publisher : STIKES Cendekia Utama Kudus

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31596/jkm.v9i1.797

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Pelayanan farmasi yang bermutu merupakan salah satu indikator untuk menilai kinerja rumah sakit dalam hal kendali mutu dan biaya. Pada lokasi tempat penelitian didapatkan gambaran peresepan obat pasien BPJS diluar formularium nasional sehingga mengakibatkan peningkatan biaya paket. Tingkat kepatuhan dokter dalam meresepkan obat formularium nasional di RS Multazam Medika tahun 2018 adalah 79,4%, dimana tingkat kepatuhan terendah terjadi di UGD (58,4%), dan poli syaraf (68,4%). Pada wawancara terdapat hubungan antara pengetahuan, informasi, sikap dan motivasi yang mempengaruhi faktor kepatuhan. Metode yang dipakai dalam penelitian ini adalah dengan metode kuantitatif untuk mengetahui persentase kepatuhan dokter dalam meresepkan obat formularium nasional.
Analisis Pembiayaan Kesehatan Bersumber Pemerintah di Kota Serang Tahun 2014 – 2016 Estherlina Sitorus; Atik Nurwahyuni
Jurnal Kebijakan Kesehatan Indonesia Vol 6, No 3 (2017)
Publisher : Center for Health Policy and Management

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (581.523 KB) | DOI: 10.22146/jkki.v6i3.29661

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ABSTRACTBackground:This study aims to obtain information about health financing based on sources and utilization of funds derived from the government in Serang City year 2014-2016, as well as commitment from the local government of Serang City towards health financing by using approach District Health Account (DHA. The results showed that the total budget for health financing funded by the government in Serang City from 2014-2016 has increased in 2014 amounting to Rp 61,759,128,963, in year 2015 it was amounting to Rp 77,302,110,763 and in year 2016 of Rp 88,278,652,111. The proportion of APBD Serang City in the Year 2014 was 6.02%, Year 2015 was 6.99% and Year 2016 was 7.79%. This shows the commitment of Serang City government to funding the health sector. From the perspective of Health financing by function, the largest percentage is health system governance functions and for curative services. From the perspective of the program, many is allocated for health system strengthening program 59,55% -67,43%. While from the perspective of budget, most is allocated for the operational expense (83.68% -93.57%). With limited resources while increasing health needs, it will require the efficient use of existing resources as well as the selection of effective health program activities, and the need to make health budgeting policy as the basis or reference of health budget planning in Serang City. Keywords: Health Financing, DHA, Health Expenditure ABSTRAKPenelitian ini bertujuan untuk memperoleh informasi tentang pembiayaan kesehatan berdasarkan sumber dan pemanfaatan dana yang berasal dari pemerintah di Kota Serang Tahun 2014- 2016, serta komitmen dari pemerintah Daerah Kota Serang terhadap pembiayaan kesehatannya dengan menggunakan pendekatan District Health Account (DHA). Hasil penelitian menunjukan bahwa total anggaran untuk pembiayaan kesehatan bersumber pemerintah di Kota Serang dari Tahun 2014-2016 mengalami peningkatan yaitu pada Tahun 2014 sebesar Rp 61.759.128.963, Tahun 2015 sebesar Rp 77.302.110.763dan Tahun 2016 sebesar Rp 88.278.652.111. Jika dilihat dari persentase APBD Kota Serang pada Tahun 2014 sebesar 6,02%, Tahun 2015 sebesar 6,99% dan Tahun 2016 sebesar 7,79%. Hal ini menunjukan komitmen pemerintah Kota Serang terhadap pendanaan sektor kesehatannya. Pembiayaan kesehatan berdasarkan fungsi, persentase terbesar untuk fungsi tata kelola sistem kesehatan dan untuk pelayanankuratif. Berdasarkan program, banyak terealisasi untuk program penguatan Sistem kesehatan 59,55%-67,43%, berdasarkan mata anggaran, paling besar untuk belanja operasional (83,68%- 93,57%). Dengan sumber daya yang terbatas sedangkan kebutuhan kesehatan yang terus meningkat, maka diperlukan efisensi penggunaan sumber daya yang ada serta pemilihan program kegiatan kesehatan yang efektif, serta perlunya dibuat kebijakan penganggaran kesehatan sebagai dasar atau acuan perencanaan anggaran kesehatan di Kota Serang. Kata Kunci: Pembiayaan Kesehatan, DHA, Belanja Kesehatan
The Completeness and accuracy of clinical coding for diagnosis and medical procedure on the INA-CBGs claim amounts at a hospital in South Jakarta Cicih Opitasari; Atik Nurwahyuni
Health Science Journal of Indonesia Vol 9 No 1 (2018)
Publisher : Sekretariat Badan Penelitian dan Pengembangan Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22435/hsji.v9i1.464

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Abstrak Latar belakang: Kelengkapan resume dan ketidaktepatan koding masih menjadi penyebab terbesar pengembalian berkas klaim dari BPJS. Penelitian ini bertujuan untuk melakukan analisis kelengkapan dan ketepatan koding diagnosis dan prosedur terhadap besaran klaim di satu rumah sakit (RS) Pemerintah di Jakarta Selatan. Metode: Penelitian observasional yang dilakukan dengan penelusuran rekam medis (RM) bulan November 2017 dan wawancara mendalam terhadap 7 informan yang terdiri dari manajemen, koder, dokter penanggung jawab pasien (DPJP) dan verifikator RS. Ketepatan koding didapatkan dengan membandingkan pengkodean oleh koder RS dan koder standar. Analisis data dilakukan dengan analisis konten. Hasil: Dari 105 sampel rekam medis didapatkan angka ketidaklengkapan resume terbanyak pada pemeriksaan penunjang (12,2%), ketidaksesuaian pengisian pada diagnosis sekunder mencapai 68,6% dan ketidaktepatan koding paling tinggi pada diagnosis utama (21,9%). Rerata klaim INA-CBGs yang dihasilkan koder RS lebih rendah dari koder standar dengan selisih klaim sebesar 4%. Hal tersebut disebabkan adanya ketidakpatuhan dokter dan tidak semua dokter mendapatkan pelatihan pengkodean. Proses pencatatan RM masih banyak didelegasikan kepada residen. Pemeriksaan resume oleh verifikator dan pengkodean oleh koder masih kurang pemahaman tentang diagnosis dalam konsep INA-CBGs. Kesimpulan: Ketidaklengkapan resume dan ketidaktepatan koding di RS menyebabkan klaim INA-CBGs yang diterima lebih rendah rata-rata 4% sehingga dapat mengurangi pendapatan RS. (Health Science Journal of Indonesia 2018;9(1):14-8) Kata kunci: Ketidaktepatan koding, diagnosis dan prosedur, klaim rendah Abstract Background: Coding inaccuracy and inadequate physician documentation are still the major problem of BPJS claims that resulting potential loss of hospital finance. This study aims to analyze the completeness and accuracy of diagnosis and procedure coding on the INA-CBGs claim amounts at one government hospital in South Jakarta. Methods: This observational study was conducted through medical record review during the period of November 2017 and in-depth interview involved 7 informants consist of hospital management, coders, responsible physicians and hospital verifiers. Re-coding was carried out by standar coder and the results were compared with hospital coders outcome. Content analysis was used to analyze the data. Results: The review of 105 medical record found incomplete documentation for supporting medical examination variable (12.2%), inconsistency documentation of secondary diagnoses were the highest, at 68.6% and the most frequent for inaccurate coding was primary diagnoses at 21.9%. The claims generated by hospital coders are lower than standard coder by an average 4%. The indepth interview revealed low physicians compliance on the documentation standard procedure and lack of coding training for physician. The process of the documentation practice was still delegated to the resident physicians. The discharge summary review by verifier and coding by the coders was still lack of understanding of the diagnosis in the INA-CBGs concept. Conclusion: Incomplete discharge summary and inaccurate coding of diagnosis and procedure generate loss of hospital revenue by an average 4%. (Health Science Journal of Indonesia 2018;9(1):14-8) Keywords: Inaccuracy of clinical coding, diagnosis and procedure, lower claim
Co-Authors Adang Bachtiar Adik Wibowo Adik Wibowo Ambarita, Anna Tirawani Amelia Intan Amila Megraini Andre Yunianto Anis Sakinah Utami Anugrah Aulia Ulil Amri Arif Awaludin Ashar Asri Hikmatuz Zahroh Athiyah Athiyah Athiyah, Athiyah Atmiroseva, Atmiroseva Ayu Novia Kurnia Ayunda Oktavia Baros, Wan Aisyiah Benjamin Saut Cicih Opitasari Citra Jaya Cyntiya Rahmawati Cyntiya Rahmawati Daeli, Widi Astutty Casimira Damaryanti, Laksmi Damayan, Anak Agung Istri Agung Sri Stuti Daruki, Maria Wahyu Dedy Revelino Diah Fitri Novita Sari Diah Melly Marlyana Diah Melly Marlyana Dian Agnesa Sembiring Dian Elawati Dilla Syamola Emmy Ridhawaty Mangunsong Erdayani Erdayani Ery setiawan Ery Setiawan Setiawan Erzan Dhanalvin Estherlina Sitorus Evie Ni&#039;matunnisa Fachmi Idris Fadliyah, Hilyatul Fadllil Kaafi Faradiba Faradiba Farhana Farhana Farianti, Yuli Febriadi, Yudi Felicitas Nia Aryani Firda Jusela Firdinand Genoveva Maditias Dwi Pertiwi Giusman, Reli Helmi Wahyuningsih Henri Azis Hilyatul Fadliyah Hilyatul Fadliyah Ida Bagus N Maharjana Idris, Salman Mauluddin Ilham Isnin Dolyanov Kurnia Sari Kurnia Sari Kurnia, Ayu Novia Latanza Shima Madya, Sri Denti On Mangunsong, Emmy Ridhawaty Mardiati Nadjib Marshia Rehatalanit May Rabiulyati Mazda Novi Mukhlisa Megraini, Amila Mirza Aulia Mukhlisa, Mazda Novi Mundiharno Mundiharno Nadjib, Mardiati Natalia Melani Nia Priyatiningsih Nopiana Nopiana Pantri Widyastuti Pantri Widyastuti Prastuti Soewondo Pujiyanto Pujiyanto - Pulungan, Nopiana Pusposari Purwoko Rabiulyati, May Rasinta Ria Ginting Ratih Meireva Soeroso Rejeki, Vera Marietha Meinar Reli Giusman Rira Martaliza Rizki Asriani Putri Rybob Khomes Salman Mauluddin Idris Saly Salim Alatas Sayekti, Sekar Arum Handarbeni Sekar Arum Handarbeni Sayekti Sembiring, Dian Agnesa Silvia Vinawaty Soetedja Siti Raudatus Solihah Sri Denti On Madya Sri Denti On Madya Suherman, Suherman Suwedia, I Nyoman Gede Bayu Wiratama Tetriadi Tetri Tetriadi Tetriadi, Tetriadi Tetriyadi, Tetriyadi Tri Priyo Anggoro Tri Priyo Anggoro Vera Marietha Meinar Rejeki Wahyuningsih, Helmi Wan Aisyiah Baros Widi Astutty Casimira Daeli Widi Astutty Casimira Daeli Widyastuti, Pantri Yenny Nariswari Harumansyah Yoam, Crefinda Hanna Ananda Yuli Farianti Yuliani Yuliani Yunita Yunita Yunita Yunita