Journal of Health Policy and Management (JHPM)
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Unit Cost Analysis In Heart Failure Inpatients Using The Time Driven Activity Based Costing Method At Type D Hospital In Sragen
Full text linkBackground: Heart failure is one of the most common non-communicable diseases in adults. The number of cases of patients admitted to hospitals due to heart failure is quite large, resulting in a high frequency of hospitalizations and high patient treatment costs. Cost calculation is very important for health care providers in order to conduct financial evaluations. One way to calculate costs in hospitals is to use unit cost analysis. The purpose of the study was to determine the unit cost of treatment for heart failure patients in inpatient settings, especially in Type D hospitals in Sragen.
Subjects and Method: This study is a qualitative type study using a case study approach to unit cost to calculate the inpatient treatment rate of patients with chronic heart failure using the Time Driven Activity Based Costing method. Furthermore, the difference with the INA CBGs rate is seen. There are two sources of data in this study, namely primary data from interview results from sources directly in the field and secondary data from financial report data and clinical pathway data for inpatient services for patients with chronic heart failure in hospitals.
Results: The unit cost of treatment of heart failure patients in the inpatient installation using the Time Driven Activity Based Costing method at type D hospitals in Sragen amounted to Rp 2,186,089. The difference in heart failure treatment costs in the type D hospital inpatient installation in Sragen using the Time Driven Activity Based Costing method with the patient treatment rate based on INA-CBG'S is Rp 250,211 (10%).
Conclusion: The unit cost of treatment of heart failure patients in the inpatient installation using the Time Driven Activity Based Costing method is Rp 2,186,08
Meta-Analysis: Factors Reducing Health Workers' Willingness to Leave Work
Full text linkBackground: Employees are the most important human resource in a company because they have a direct influence on institutional operations in achieving organizational goals. The main problem in health service management is a shortage of health workers due to turnover or intention to leave work. This research aims to analyze the factors that reduce the desire to leave among health personnel.
Subjects and Method: This research uses a meta-analysis based on PICO as follows; population: health workers; intervention: satisfied autonomy, good working environment, length of service > 5 years, low workload; comparison: autonomy not satisfied, poor working environment, length of service < 5 years, high workload; outcome: intention to leave work. Data was obtained from the PubMed, Google Scholar, Science Direct databases published from 2013-2022. The keywords in the article search are "Autonomy", "Work Environment", "Work Experience", "Workload", "Intention to Out", "Turnover Intention". "Cross Sectional". Article selection used PRISMA Flowchart and results were analyzed using Review Manager 5.4 software.
Results: This study was conducted on 14 articles from Ethiopia, Ghana, California, Peru with a sample size of 9,555 professional health workers. Meta-analysis results concluded that satisfied work autonomy (aOR=0.22; CI 95%=0.06 to 0.85; p=0.030), low workload (aOR=0.60; CI 95%=0.46 to 0.78; p<0.001), had the desire out of work low. The meta-analysis results of the work environment were good (aOR=0.51; CI 95%=0.23 to 1.14; p=0.100), work experience >5 years (aOR=0.51; CI 95%=0.23 to 1.14; p=0.100) was not significantly influenced.
Conclusion: Satisfied job autonomy and low workload reduce the intention to leave work among health workers. Health workers' desire to leave work is not significantly influenced by work experience or work environment
Meta-Analysis: Effects of Computer Skill and Management Support on Readiness to Use Electronic Medical Record in Health Workers
Full text linkBackground: Electronic Medical Record (EMR) is an information technology that has proven its benefits in improving service quality. This study aims to analyze the effect of computer skills and management support on health workers' willingness to use EMR.
Subjects and Method: This research is a systematic review and meta-analysis study using the PRISMA diagram and PICO model. Population: health workers, Intervention: computer skills and management support, Comparison: low computer skills and no management support, Outcome: willingness to use EMR. The articles used came from Google Scholar, Pubmed, and Elsevier which were published from 2013 - 2023. The keywords used in the search were (computer skills OR Management support) AND (“willingness to use” OR “willingness to utilize” OR “readiness to implement”) AND (EMR OR electronic medical record) AND “odds ratio” AND “cross-sectional study” AND (“health personnel” OR “health workers” OR “health professionals”). The inclusion criteria for this study were full paper articles with cross-sectional studies. The analysis used was multivariate with adjusted Odds Ratio. Eligible articles were analyzed using the Revman 5.3 application.
Results: Meta-analysis was conducted on 11 articles with a cross-sectional research design. Health workers who have high computer skills were 2.62 times more likely to use EMR than health workers who have low computer skills (aOR= 2.62; 95% CI= 1.92 to 3.57; p= 0.050). Health workers who received Management support were 1.87 times more likely to use EMR than health workers who did not have Management support (aOR= 1.87; 95% CI= 1.40 to 2.51; p= 0.030).
Conclusion: Computer skills and management support influence the willingness to use EMR among health workers
Analysis of BPJS Mandiri Participant Contribution Payment Compliance Inpatient Service Fines at Dr Mohamad Saleh Probolinggo Regional Hospital
Full text linkBackground: The National Health Insurance Program (JKN) through BPJS Kesehatan is an initiative to equalize the quality of health services for all levels of society. Contributions are an essential factor in the success of a national social security system. The importance of paying BPJS contributions regularly is so that participants get adequate health service guarantees. The study aims to analyze the compliance of BPJS Mandiri participant contribution payments who are subject to inpatient service fines at Dr. Mohamad Saleh Probolinggo Regional Hospital.
Subjects and Method: An observational study with a cross-sectional approach was conducted in the inpatient unit of Dr. Mohamad Saleh Hospital, Probolinggo, in May and June 2023. A total of 100 patients were selected for this study. The dependent variable was compliance. The independent variables were knowledge, income, number of family members, perception of illness, access to health services. Data were collected using a questionnaire and analyzed using factor analysis, t-test, f-test and multiple linear regression.
Results: The regression coefficient of knowledge variable is 0.018, income is 0.823, number of family members is 0.375, perception of illness is -0.021, access to health services is -0.128. Compliance of contribution payments is influenced by income variable with sig 0.002, number of family members with sig (0.000) and access to health services with sig (0.007).
Conclusion: Compliance in payment of BPJS Mandiri participants who are subject to inpatient service fines is influenced by income, number of family members, access to health services. The most dominant factor is income
Patient Safety Culture in Hospitals based on Agency For Health Care Research And Quality (AHRQ)
Full text linkBackground: The first step towards patient safety is to build a good patient safety culture. Patient safety culture measurements can be used as evaluations to improve quality and patient safety. This study aims to determine an overview of patient safety culture in hospitals.
Study Method: It was a descriptive observational study with a cross-sectional study conducted in July 2022 - September 2022. This study was conducted at Panembahan Senopati Hospital with a total population of 974 hospital employees and selected 383 study samples by using simple random sampling. The dependent variable in the study was patient safety culture. The independent variables in this study were information disclosure, feedback and communication about patient safety incidents, management support for patient safety, non-punitive response to errors, organizational learning and continuous improvement, staffing, staff expectations of supervisor/management attitudes and actions in encouraging patient safety, cooperation within the unit, frequency of incident reporting, overall perception on safety, handoff and transition, and cross units cooperation. The data collection technique used was the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire developed by the Agency for Health Care Research Quality (AHRQ) consisting of 12 dimensions of patient safety culture. The study data were analyzed using descriptive analysis technique.
Result: The positive value of patient safety culture fell into the medium category (72.12%). The dimensions of patient safety culture with strong categories (>75%) were cooperation within the unit, expectations and actions of managers in promoting patient safety, organizational learning, management support for patient safety, and cross units cooperation. The dimensions of patient safety culture in the medium category (50% - 75%) were employee perceptions of patient safety, feedback and communication on errors, open communication, frequency of incident reporting, handoffs and transitions, and non-punitive responses to errors. The dimension of patient safety culture with weak category (< 50%) was staffing.
Conclusion: The strength areas of patient safety culture are organizational aspects, aspects of management support for patient safety, aspects of cross units cooperation, aspects of cooperation within units, and expectations and actions of managers in promoting patient safety. While the areas that still require development are staffing aspects, open communication aspects, and incident reporting frequency, thus their improvement must be prioritized.
Keywords: AHRQ, patient safety, safety culture
Correspondence:
Christiana Sri Wahyuningsih. Panembahan Senopati General Hospital Bantul, Jl. Dr. Wahidin Sudiro Husodo, Trirenggo, Bantul, Bantul, Yogyakarta. Email: [email protected]. Mobile: +628128778392
Unraveling the Success Factors and Challenges in Implementing the COVID-19 Vaccination Program: A Case Study of the Community Health Center in Palembang
Full text linkBackground: The escalating number of COVID-19-positive cases and mortality within the community has prompted the government to prioritize vaccination efforts. However, the vaccination target has not yet reached optimal, particularly in Palembang. This study aims to evaluate the implementation of the COVID-19 vaccination program at the Community Health Center in Palembang through a descriptive qualitative approach.
Subjects and Method: The data were obtained through in-depth interviews, observations, and document reviews conducted at the Community Health Center between November 25, 2021, and December 30, 2021. A total of ten informants were selected using consecutive sampling.
Results: The findings of this study indicate consistency in various aspects of the input component, including the vaccine team, funding sources, types of vaccines, storage facilities, other support systems, and planning methods. However, due to a lack of data integration among the data management entities, the Community Health Center and Health Office face challenges in accurately determining vaccine targets. The vaccination coverage in Palembang stood at 87.08% for the first dose and 68.52% for the second dose. Unfortunately, delays in achieving vaccine coverage, particularly among specific groups such as older people, have hindered the development of expected herd immunity. There have been no reports of severe adverse events following immunization (AEFIs) within the community.
Conclusion: The COVID-19 vaccination program in Palembang was implemented well. However, data management entities must prioritize data integration to fulfill vaccination targets
Meta-Analysis: Effectiveness of mHealth Utilization on Antenatal Care
Full text linkBackground: An antenatal visit is the presence of pregnant women at health facilities to check their pregnancy and get information about their pregnancy. The use of mobile health interventions (mHealth) such as SMS, voice messages, videos, and interactive mobile phones can provide behavioral support and health education needs of pregnant women. This study aims to determine the effectiveness of the use of mHealth on the improvement of antenatal visits.
Subject and Method: Systematic reviews and meta-analyses were conducted using PRISMA guidelines and PICO models which included Population = pregnant women; Intervention= mHealth, Comparison= does not use mHealth; Outcome= antenatal visit. Articles are collected through databases such as Google Scholar, PubMed, BMJ, Plos One, Plos Digital Health, JMIR, JPHIA, HSPRJ, JIO, Journal of Midwifery and Traditional Health. Keywords used: mHealth or Telemedicine or Phone or Mobile Phones or Mobile Telephone or Short Message Service or Whatsapp Group, Antenatal Visite or Antenatal Care or Pregnancy or Pregnant or Prenatal or Mother Health. A total of 13 articles that met the inclusion criteria were meta-analyzed and assessed using RevMan 5.3.
Results: Meta-analyses from Tanzania, Kenya, India, Brazil, Peru, Bangladesh, Nigeria, Uganda, and Indonesia showed that pregnant women who used mHealth services were 2.94 times more likely to have antenatal visits compared to not using mHealth and the effect was statistically significant (OR= 2.94; CI95%= 2.19 to 3.94; p <0.001).
Conclusion: The use of mHealth may increase antenatal visits
Meta-Analysis: Effect of Training and Needle Recapping on Needle Stick Injury in Health Workers
Full text linkBackground: Health Personnel are at risk of contracting diseases from blood/body fluids (bloodborne pathogens) in various ways, one of which is through needle stick injuries or what is known as needle stick injury. Recapping of needles and lack of training are factors in unsafe actions that can risk work accidents. This study aims to analyze the effect of training and recapping of needles on the incidence of needle stick injuries in Health personnal using meta analysis.
Subjects and Methode: This study is a systematic review and meta-analysis study using the PRISMA diagram. Article searches were carried out based on eligibility criteria using the PICO Model. Population: Health personnal, Intervention: training and not recapping of needles, Comparison: no training and recapping of needles, Outcome: Occurrence of needle stick injury work accidents. The articles used came from Google Scholar, PubMed, Science Direct and ProQuest published from 2013 – 2023. The keywords used in the search were “Training OR Safety Training OR Infection Prevention Training AND Recapping of Needle AND Needle Stick Injury OR Needle Stick Injuries OR Needle Stick and Sharp Injury OR Percutaneous injuries AND Healthcare Workers OR Health Professionals”. The inclusion criteria for this study were full paper articles with cross-sectional studies. The analysis used was multivariate with adjusted Odds Ratio. Eligible articles were analyzed using the Revman 5.3 application.
Results: Meta-analysis was carried out on 13 articles originating from the African and Asian continents with a cross-sectional study design. The results of the analysis show that Health personnal who receive training have a risk of experiencing NSI 0.56 times compared to those without training. Although this relationship was not statistically significant (aOR = 0.56; Cl 95% = 0.26 to 1.17; p = 0.120). Recapping of needles has an effect on increasing the incidence of needle stick injuries in health personnel by 2.04 compared to not recapping of needles and this result is statistically significant (aOR=2.04; 95% CI = 1.50 to 2.78; p<0.001)
Conclusion: Training and recapping of needles influence the incidence of needle stick injuries in health worker
Effects of Training and Supervision on Work Performance among Health Workers in Hospital: Meta-Analysis
Full text linkBackground: Performance in an organization is carried out by all existing human resources, both leaders and workers. There are several factors that can affect human resources in carrying out their performance, both factors that come from within human resources and those that come from outside themselves. The purpose of this study was to analyze the effect of training and supervision on the performance of health workers in hospitals, using a meta-analysis of primary studies conducted by previous authors.
Subjects and Method: This article was prepared using a systematic review and meta-analytic study. This research was conducted using the PICO model. The meta-analytic study was carried out by searching for articles from databases in electronic form using Google scholar, PubMed, Science direct, and Springerlink. An article search was conducted from 1 to 18 February 2023. The keywords used were “Performance” AND “Training” AND “supervision” AND “health workers” AND “Multivariate” AND “Cross-Sectional”. The inclusion criteria for this study were complete articles using cross-sectional research, published years from 2013-2023. Analysis of the articles in this study used RevMan 5.3 software.
Results: A total of 10 cross-sectional studies from Africa and Asia were selected for systematic review and meta-analysis. The results of the meta-analysis show that training can improve performance and supervision can improve performance. Health workers who received training had a large influence on improving performance by 1.68 compared to those who did not receive training (aOR= 1.68; 95% CI= 1.37 to 2.05; p= 0.001). Supervised health workers had an influence on improving performance 2.38 times compared to unsupervised health workers (aOR= 2.38; 95% CI= 1.57 to 3.61; p= 0.009).
Conclusion: Training can improve performance and supervision can improve health worker performance.
Keywords: Performance, training, supervision, health workers
Correspondence:
Antina Luturmas, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: antinaluturmas@gmail.com. Mobile: +628238720408
A Meta Analysis: Effectiveness of Telemedicine to Improve Self-Care in Patients with Hearth Failure
Full text linkBackground: Modern and sophisticated self-care education programs such as web-based methods and wireless networks can make changes in patient behavior to improve self-care management. Telemedicine is a potential alternative to continue providing patient health services by minimizing the risk of exposure and physical contact. This study aims to investigate relevant primary studies in order to assess the effectiveness of telemedicine to improve self-care in heart failure patients.
Subjects and Method: This study used a systematic review and meta-analysis with PICO namely, P: Patients with heart failure, I; using telemedicine, C: not using telemedicine, O: increasing self care for heart failure patients. By searching for articles in 3 databases namely PubMed, Google Scholar, Cochrane which were published from 2013 to 2023, entering the following keywords (“Heart Failure” OR “congestive heart failure”) AND (Telemedicine OR “electronic health record” OR mHealth OR “ mobile health” OR “mobile app” OR “telehealth” OR “healthcare system information”) AND “self care” AND “randomized controlled trials”. Articles were selected using PRISMA flow and data analysis using the Review Manager 5.3 application.
Results: Meta-analysis was carried out on 9 primary studies using RCT study designs from several countries such as Canada, the United States, Colombia, Australia, Hong Kong, Finland with a total sample size of 1.018. The processed meta-analysis data found that telemedicine is effective for improving self-care in heart failure patients, and is statistically close to significant. Heart failure patients who received telemedicine-based education had an average self-care value of 0.33 SMD units higher than those who did not receive the intervention (SMD= 0.33; 95% CI= 0.15 to 0.52; p= 0.004).
Conclusion: Telemedicine is effective for improving self care in heart failure patients.
Keywords: Heart Failure, Self Care, Telemedicine.
Correspondence:
Audria Ersananda, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah. Email: [email protected]. Mobile: 082233999407