"Analisis Peran Case Manager dalam Kendali Mutu dan Kendali Biaya Pelayanan Rawat Inap Bedah di Rumah Sakit Universitas Indonesia Tahun 2022" by Natasya C. Viano and Purnawan Junadi
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Abstract

Patient Service Management is carried out by the case manager to create quality services with efficient cost. This study aims to evaluate the role of case managers in quality and cost control of surgical inpatients with JKN assurance at the UI Hospital in 2022. This study uses the concept of Donabedian and KARS guidelines. Quality control is seen from Length of Stay (LOS), patient satisfaction, compliance with clinical pathway, compliance with doctor visits, and delays in elective surgery. Cost control is seen from the difference between INA-CBG's claims and hospital bills and cost formulations. Secondary data were collected from medical records and document reviews. The data were processed with Microsoft Excel. The three common procedures were conducted with Focus Group Discussion (FGD) and interviews to find out the role of case managers. It was found that the role of the case manager at UI Hospital had improved compared to 2021. The case manager's performance is good based on the difference in overall surgical patient claims, LOS control, the level of patient satisfaction, the level of compliance with doctor visits, and the level of compliance with the clinical pathway. Only the level of delay in elective surgery at UI Hospital has not reached the target.

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Bahasa Abstract

Manajemen Pelayanan Pasien merupakan peran yang dijalankan oleh case manager agar tercipta pelayanan yang bermutu dengan biaya yang efisien. Penelitian ini bertujuan untuk mengevaluasi peran case manager terhadap kendali mutu dan kendali biaya pelayanan rawat inap bedah dengan penjaminan JKN di RS UI tahun 2022. Penelitian menggunakan pendekatan sistem menurut Donabedian dan pedoman Komisi Akreditasi Rumah Sakit (KARS). Kendali mutu dilihat dari Length of Stay (LOS), tingkat kepuasan pasien, kepatuhan penerapan clinical pathway, kepatuhan visit dokter, dan penundaan operasi elektif. Kendali biaya dilihat dari selisih klaim dan tagihan RS dan formulasi biaya tindakan. Pada penelitian ini, data kuantitatif diambil dari data sekunder melalui data rekam medis pasien, hasil telaah dokumen dari berkas tagihan pasien, tarif INA-CBG’s, data laporan operasi, dan data Komite Mutu Rumah Sakit. Data diolah dengan Microsoft Excel dan didapatkan tiga tindakan terbanyak, yaitu Odontektomi, Sectio Caesaria (SC), dan AV shunt. Studi kualitatif, dilakukan dengan Focus Group Discussion (FGD) untuk mendapatkan formulasi pembiayaan tindakan dan wawancara mendalam. Hasil penelitian mendapatkan bahwa peran case manager di RS UI sudah mengalami perbaikan dibandingkan tahun 2021 berdasarkan perbaikan tren biaya, kinerja case manager sudah baik berdasarkan selisih klaim, pengendalian LOS, tingkat kepuasan pasien, tingkat kepatuhan visit dokter, dan tingkat kepatuhan terhadap clinical pathway. Hanya tingkat penundaan operasi elektif di RS UI yang masih belum tercapai target.

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