| Summary: | Introduction. Some problems occurred, after the implementation of the DRG in
the Sardjito Hospital Yogyakarta. One is them is a discrepancy between the real
health care cost and INA-CBGs tariff. This establishes the gap. Gap was caused
by incompatibility use drug formularies, incompatibility laboratory use,
incompatibility using other medical support services with standard INA-CBGs,
errors diagnosis coding classification INA-CBGs, LOS lengthy, incomplete
medical records and more. Studies to investigate the cause of the gap will help
hospitals to control expenditure financing. Modeling gap with several factors is
used to help efficiency planning of clinical care of patients JAMKESMAS. The
gap modeling will be used to construct clinical decision support systems. Clinical
decision support systems are used by clinician in medical care planning that did
not cause financial loss to the hospital and the patient.
Objective. 1) This study was analyze the factors that influence the gap of Acute
Lymphoblastic Leukemia (ALL) diagnosis. ALL is the diagnosis with the highest
rates of visits and gap. 2) Constructing Clinical Decision Support System (DSS)
applications that can help clinician provide health services with efficient cost. 3)
Evaluate the level of clinician acceptance of clinical decision support systems
applications.
Methods. This research is quantitative and qualitative in-depth interviews and
focus group discussions. The sample was medical records of ALL patients in
2009-2010 in Sardjito Hospital. To analyze the factors that influence the gap
using ridge regression analysis, in order to eliminate the effects of
multicollinearity among the independent variables. To analyze the level of
acceptance of DSS application using path analysis. The analysis is based on
data about the clinician's perception of the application. Clinician sample size was
31 residents.
Results. The diagnosis of ALL have outlier values of gap as much as 8.1%. ALL
patients were included in the group of chemotherapy without complication
comorbidity (without CC)and Length of Stay (LOS) high (> 5 days) about 20.8%.
It causes chemotherapy without CC have extreme values (outliers) of gap. The
main factors that affect the gap is the cost of medicine / medical equipment and
medical support costs. This occurred in the group of patients chemotherapy with
CC and chemotherapy with major CC. While the chemotherapy without CC, the
main factors affecting the gap is the cost of accommodation. Clinician acceptance
of the DSS application is affected by the ease of application used. Benefits of the
application of INA-CBGs and useful applications to have only small influence,
whereas clinician knowledge about the INA-CBGs do not affect the interest of
clinicians using the application
Conclusion. Heterogeneity gap values found in patients without CC with the
highest factor affecting gap was cost of acomodation. Cost of acomodation is
related to the length of patients treated in the chemotherapy group without CC.
Based on the results of FGD with clinicians, the cause of the high days of
treatment in patients with chemotherapy without CC is indiscipline clinicians fill
medical records so that the classification grouping CBG should be shifted from
CBG chemotherapy with CC / MCC, but classified in the chemotherapy group
without CC. Highest gap in the chemotherapy group with CC and MCC, with the
highest factors that affect the gap is cost of medicine/medical equipment. DSS
applications have acceptance rate of 61.3% and was highest influence on the
ease of application used.
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