DOCTOR’S COMPLIANCE TO CLINICAL PATHWAY OF ISCHAEMIC STROKE: A CASE OF PRIVATE HOSPITAL IN INDONESIA
Abstract. Clinical Pathways (CP) is a complex, multidisciplinary and integrated service planning concept based on the best clinical practice for a group of patients with a specific diagnosis in accordance with Evidence Based Medicine. CP is a disease management tool that is widely used in hospitals, a relatively new field in health services. Evaluation of CP after implementation is an important step to assess hospital management performance. The positive effect of the CPimplemention is to reduce medical costs, Length of Stay (LOS) significantly, and variations in services that are not needed; improve patient satisfaction and quality of care. The Effectiveness of CP will be maximized, if there are organizational support, commitment and compliance from the doctor to the implementation of CP in stroke management. The aim of this article was to analyze the commitment and perceptions of doctors on organizational support and the level of doctor’s compliance with the implementation of CP. This study uses a quantitative method, carried out inpatients unit ofprivate hospital in Indonesia, with the data sample of 27 CPsinpatientswith Ischemic Stroke during 2018 and the respondents were 10 doctorswho provide medical care to inpatients with IS. Data collection using form instruments of CP ISto obtain LOS and complications; organizational support and commitment is obtained using a questionnaire. Data analysis with univariate analysis for descriptive statistics of each variable (commitment, organizational support, LOS, complications). The results of the statistical analysis showed that the doctor's commitment to the implementation of CP was 71.9%, the doctor's perception of organizational support in implementing CP was 67.67%; doctor's adherence to CP implementation based on the accuracy of LOS in IS cases without variants was 100%, based on the accuracy of laboratory examinations was 100%, based on the accuracy of radiological examination (head CT scan non contrast) was 91.3%. The average LOS was 3.93 days, maximum LOS: 8 days which is 1 patient. 4 patients with variants (complications). The cost of inpatient BPJS compared to INA CBGs rates is overcost of 33.3%.
Keywords: Clinical Pathways, doctor’s compliance, commitment, organizational support
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