Perbedaan Perhitungan Unit Cost dengan Menggunakan Metode Activity Based Costing (ABC) dan Metode Double Distribution (DD) untuk Pasien TB Paru Kategori 2 di Instalasi Rawat Jalan dan Rawat Inap Rumah Sakit Paru

Background: Indonesia is at 5th rank of 22 countries that have a high burden of TB and contribute to the number of TB cases in the world amounted to 4.7%. Tuberculosis management is not easy, it requires a long time and a large cost. Currently hospitals determine tariffs based on Double Distribution (DD) Method. Unit cost of health services can also be calculated by Activity Based Costing (ABC) Method, which is based on activities. Objective: To determine the unit cost calculation by ABC method and DD Method of Category 2 pulmonary TB in Outpatient and Inpatient Installation of Lung Hospital. Methods: Descriptive analytic using secondary data and Purposive Sampling methods. The study was conducted at Lung Hospital Bandung during September to December 2013 by using medical records within a period of 2 years in January 2011 to December 2012. Results and Discussion: The calculation of the unit costs averages using the ABC method for category 2 Pulmonary TB patient in outpatient Installation was Rp 611,321; for patient in emergency care unit was Rp 713 852; for hospitalized patients that come through the outpatient installation was Rp 5,037,309 and through emergency care unit was Rp 4,398,415. The unit cost averages using DD methods for category 2 Pulmonary TB in outpatient Installation was Rp 421 621; for patient in emergency care unit was Rp 734 170; for hospitalized patient that come through the outpatient installation was Rp 1,727,213 and through emergency care unit was Rp 1,846,337. The quantity of drugs given to outpatients is for 2 weeks while ALOS for hospitalized patients is 9.2 days.Conclusions: Unit costs calculation using ABC method is more financially profitable for the Hospital than using DD method. Hospital management should have a good recording and reporting system that support integration of inter-service and support units to be able to perform a comprehensive unit cost calculations. Hospital management should conduct periodic evaluation of compliance with SOPs and rational drug use. Latar Belakang: Indonesia menduduki rangking ke-5 dari 22 negara-negara yang mempunyai beban tinggi untuk TB dan memberikan kontribusi jumlah kasus TB di dunia sebesar 4,7%. Penatalaksanaan TB tidak mudah, membutuhkan waktu yang lama dan membutuhkan biaya yang besar. Saat ini berbagai rumah sakit menentukan tarif pelayanan berdasarkan metode DD. Perhitungan biaya satuan pada pelayanan kesehatan dapat juga dilakukan dengan menggunakan metode Activity Based Costing (ABC) yang didasarkan pada aktivitas. Tujuan : Mengetahui perhitungan unit cost dengan metode ABC dan metode DD di Instalasi Rawat Jalan dan Rawat Inap TB Paru Kategori 2 di Rumah Sakit Paru. Metode Penelitian: Deskriptif analitik menggunakan data sekunder dan metoda Pusposive Sample. Penelitian dilakukan di Rumah Sakit Paru Bandung selama bulan September sampai dengan Desember 2013 dengan menggunakan data rekam medis dalam kurun waktu 2 tahun yaitu pada bulan Januari 2011 sampai dengan Desember 2012. Hasil dan Diskusi: Perhitungan biaya satuan rata-rata dengan metode ABC untuk pasien rawat jalan TB Paru Kategori 2 sebesar Rp 611.321; untuk pasien rawat darurat TB Paru Kategori 2 sebesar Rp 713.852; untuk pasien rawat inap yang masuk melalui instalasi rawat jalan sebesar Rp 5.037.309 dan instalasi rawat darurat sebesar Rp 4.398.415. Biaya satuan rata-rata dengan metode DD untuk pasien rawat jalan TB Paru Kategori 2 sebesar Rp 421.621; untuk pasien rawat darurat TB Paru Kategori 2 sebesar Rp 734.170; untuk pasien rawat inap yang masuk melalui instalasi rawat jalan sebesar Rp 1.727.213 dan instalasi rawat darurat sebesar Rp 1.846.337. Banyak nya obat yang diberikan untuk pasien rawat jalan yaitu untuk 2 minggu sedangkan ALOS untuk pasien rawat inap yaitu 9,2 hari. Kesimpulan: Perhitungan biaya satuan dengan menggunakan metode ABC lebih menguntungkan secara financial bagi Rumah Sakit dibandingkan dengan metode DD. Manajemen rumah sakit sebaiknya memiliki sistem pencatatan dan pelaporan yang rapih, terintegrasi antar unit pelayanan dan unit penunjang untuk dapat melakukan perhitungan biaya satuan dengan baik. Manajemen rumah sakit melakukan evaluasi berkala terhadap kepatuhan SOP dan penggunaan obat rasional

Closed midshaft clavicle fractures : an evidence-based triage management algorithm.

AIMS: The management of mid-shaft clavicle fractures (MSCFs) has evolved over the last three decades. Controversy exists over which specific fracture patterns to treat and when. This review aims to synthesize the literature in order to formulate an appropriate management algorithm for these injuries in both adolescents and adults. METHODS: This is a systematic review of clinical studies comparing the outcomes of operative and nonoperative treatments for MSCFs in the past 15 years. The literature was searched using, PubMed, Google scholar, OVID Medline, and Embase. All databases were searched with identical search terms: mid-shaft clavicle fractures (± fixation) (± nonoperative). RESULTS: Using the search criteria identified, 247 studies were deemed eligible. Following initial screening, 220 studies were excluded on the basis that they were duplicates and/or irrelevant to the research question being posed. A total of 27 full-text articles remained and were included in the final review. The majority of the meta-analyses draw the same conclusions, which are that operatively treated fractures have lower nonunion and malunion rates but that, in those fractures which unite (either operative or nonoperative), the functional outcomes are the same at six months. CONCLUSION: With regard to the adolescent population, the existing body of evidence is insufficient to support the use of routine operative management. Regarding adult fractures, the key to identifying patients who benefit from operative management lies in the identification of risk factors for nonunion. We present an algorithm that can be used to guide both the patient and the surgeon in a joint decision-making process, in order to optimize patient satisfaction and outcomes.Cite this article: Bone Jt Open 2022;3(11):850-858

Factors Influencing Disability Inclusion in General Eye Health Services in Bandung, Indonesia: A Qualitative Study

The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 27) and users with disabilities (n = 12). A theoretical framework on the introduction of innovations in health care was used to guide data collection and thematic analysis. Factors related to the characteristics of the innovation (I-SEE) (e.g., infrastructure, equipment, engagement of people with disabilities, inclusive communication), service provider characteristics (e.g., motivation, attitudes, training), organizational characteristics (e.g., supervision, indicators, data), and the socio-political context of I-SEE (policy, motivation of users, family support, costs, transport) were essential for supporting the introduction process. Additionally, stakeholders proposed strategies for enhancing the introduction of I-SEE (e.g., awareness, collaborations). While there are specific disability related factors, most factors influencing the introduction of disability inclusive eye health were similar to introducing any innovation in general health care. Strategies for disability inclusion should be included from the planning phase of an eye health program and are reasonably simple to adapt