UPAYA PENURUNAN BERKAS KLAIM KEMBALI RAWAT INAP BPJS KESEHATAN MENGGUNAKAN SIX SIGMA (Studi di Rumah Sakit Universitas Airlangga)

Pengelolaan berkas klaim merupakan salah satu aspek terpenting pada revenue cycle rumah sakit. BPJS (Badan Pengelola Jaminan Sosial) Kesehatan melakukan pembayaran pelayanan yang telah dilakukan berdasarkan berkas klaim yang diajukan rumah sakit. Pengajuan berkas klaim yang kurang dikelola dengan baik berdampak pada meningkatnya jumlah berkas klaim kembali dari BPJS Kesehatan. Terdapat tingginya rata-rata defek berkas klaim kembali rawat inap BPJS Kesehatan di RS UNAIR pada bulan April – Desember 2018 sebesar 11,8% per bulan (target < 5%). Penelitian ini bertujuan untuk memberikan rekomendasi dalam upaya penurunan berkas klaim rawat inap BPJS Kesehatan menggunakan Six Sigma di RS UNAIR. Penerapan six sigma diketahui dapat memperbaiki defek yang terjadi dari suatu proses dengan menentukan CTQ (critical to quality). Penelitian ini menggunakan rancang bangun penelitian action research menggunakan pendekatan six sigma (Define – Measure – Analyze – Improve – Control) untuk menurunkan berkas kembali rawat inap di RS UNAIR. Pada hasil, dilakukan penggambaran alur, pengukuran CTQ, hingga melakukan analisis akar penyebab masalah dari isu strategis menggunakan 5 why’s. Usulan solusi dirumuskan dan diberikan skor pada matrix prioritas solusi. Setelah dilakukan intervensi, terjadi penurunan dari berkas kembali dari BPJS Kesehatan, baik secara jumlah berkas sebesar 31,8% (151 berkas pada Oktober – Desember 2018 menjadi 103 berkas pada Maret 2019) maupun secara nominal sebesar 43,9% (Rp.1.087.754.700 menjadi Rp.610.611.800). Hasil perhitungan DPMO dan nilai sigma menunjukkan perbaikan pada semua tahap dengan penurunan tertinggi ada pada tahap koding. Rekomendasi yang diberikan dalam upaya penurunan berkas klaim kembali rawat inap BPJS Kesehatan di RS UNAIR yaitu melakukan revisi form lama (checklist berkas klaim dan resume medis), membuat form baru (form MOI), dan redesign alur pengelolaan berkas klaim rawat inap BPJS Kesehatan di RS UNAIR. Review penyebab terbanyak berkas kembali rawat inap perlu dilakukan secara berkala dilanjutkan analisis akar penyebab masalah berdasarkan hasil tersebut hingga perumusan solusi

Development of a Patient Safety-training Program for Health Workers in Indonesia: Perspectives of Health Workers and Hospital Stakeholders

Various patient safety training has been developed internationally to further enhance the awareness and knowledge of patient safety for health professionals. However in Indonesia, the existing training is not established based on the needs of health workers. Therefore the study aim was to explore the insights from health workers, Provincial Health Office/City Health Office (PHO/CHO) and professional organizations regarding patient safety training by using the WHO’s framework in designing training. Methods: This study was qualitative research with a cross-sectional design using focus group discussion involved 16 participants from public and private hospitals, CHO/PHO and professional organizations in East Java. Data analysis was performed using thematic analysis to identify coding or themes that emerged from the focus group discussions. Results: Through consensus, the patient safety training were grouped into basic and advanced level training. Program related to effective communication was important topics that need to be prioritized especially from the hospital’s perspective. While from the hospital stakeholders perspective, topics related to building patient safety culture is prioritized. Practice-based learning is considered as better training design instead of knowledge-based. Conclusion: In conclusion, this study succeeded in identifying the needs associated with training in patient safety. There are various viewpoints from health professionals and hospital stakeholders on the criteria of patient safety training for health workers that need to be considered in developing training

Development of a Patient Safety-training Program for Health Workers in Indonesia: Perspectives of Health Workers and Hospital Stakeholders

Introduction: Various patient safety training has been developed internationally to further enhance the aware�ness and knowledge of patient safety for health professionals. However in Indonesia, the existing training is not established based on the needs of health workers. Therefore the study aim was to explore the insights from health workers, Provincial Health Office/City Health Office (PHO/CHO) and professional organizations regarding patient safety training by using the WHO’s framework in designing training. Methods: This study was qualitative research with a cross-sectional design using focus group discussion involved 16 participants from public and private hospi�tals, CHO/PHO and professional organizations in East Java. Data analysis was performed using thematic analysis to identify coding or themes that emerged from the focus group discussions. Results: Through consensus, the patient safety training were grouped into basic and advanced level training. Program related to effective communication was important topics that need to be prioritized especially from the hospital’s perspective. While from the hospital stakeholders perspective, topics related to building patient safety culture is prioritized. Practice-based learning is considered as better training design instead of knowledge-based. Conclusion: In conclusion, this study succeeded in identifying the needs associated with training in patient safety. There are various viewpoints from health professionals and hospital stakeholders on the criteria of patient safety training for health workers that need to be considered in developing training

Age, neutrophil lymphocyte ratio, and radiographic assessment of the quantity of lung edema (RALE) score to predict in-hospital mortality in COVID-19 patients: a retrospective study

Background: Available data suggest that case fatality rate of COVID-19 patients in Surabaya is higher than global cases. Thus, it is important to identify risk factors to prevent the mortality. This study aimed to assess the factors associated with hospital mortality of COVID-19 patients, and develop a prediction score based on these findings. Methods: We analyzed 111 patients, who were diagnosed with COVID-19 based on reverse-transcriptase polymerase chain reaction. The following patient characteristics were obtained from records: age, gender, type of symptoms, onset of symptoms, neutrophil lymphocyte ratio (NLR), absolute lymphocyte count, chest x-ray abnormalities, lung involvement, type of lesion, radiographic assessment of the quantity of lung edema (RALE) score, and mortality. Data were analyzed using SPSS 25.0. Results Multivariate analysis showed that age >50 years (p=0.043), NLR score >5.8 (p=0.016) and RALE score >2 (p=0.002) can predict the mortality of COVID-19 patients in the hospital. ROC curve analysis of the score ability to predict mortality showed an area under the curve of 0.794. The cut-off point is 4.5, with a sensitivity of 96.7% and specificity of 49.4% to predict the mortality of COVID-19 patient in the hospital. Conclusions Age, NLR score and RALE score were associated with mortality of COVID-19 patients in the hospital and might be used as a predictor for mortality of COVID-19 patients in health care centre where radiologists are available. The prediction score may be useful for frontline physicians to effectively manage patients with a higher score to prevent mortality

Age, neutrophil lymphocyte ratio, and radiographic assessment of the quantity of lung enema (RALE) score to predict in-hospital mortality in COVID-19 patients: a retrospective study

Abstract Background: Available data suggest that case fatality rate of COVID-19 patients in Surabaya is higher than global cases. Thus, it is important to identify risk factors to prevent the mortality. This study aimed to assess the factors associated with hospital mortality of COVID-19 patients, and develop a prediction score based on these findings. Methods: We analyzed 111 patients, who were diagnosed with COVID-19 based on reverse-transcriptase polymerase chain reaction. The following patient characteristics were obtained from records: age, gender, type of symptoms, onset of symptoms, neutrophil lymphocyte ratio (NLR), absolute lymphocyte count, chest x-ray abnormalities, lung involvement, type of lesion, radiographic assessment of the quantity of lung edema (RALE) score, and mortality. Data were analyzed using SPSS 25.0. Results Multivariate analysis showed that age >50 years (p=0.043), NLR score >5.8 (p=0.016) and RALE score >2 (p=0.002) can predict the mortality of COVID-19 patients in the hospital. ROC curve analysis of the score ability to predict mortality showed an area under the curve of 0.794. The cut-off point is 4.5, with a sensitivity of 96.7% and specificity of 49.4% to predict the mortality of COVID-19 patient in the hospital. Conclusions Age, NLR score and RALE score were associated with mortality of COVID-19 patients in the hospital and might be used as a predictor for mortality of COVID-19 patients in health care centre where radiologists are available. The prediction score may be useful for frontline physicians to effectively manage patients with a higher score to prevent mortality