Table 1 shows the average age of patients at Haji Hospital is 51.15 years (29–70 years), while the average age of patients at Labuang Baji Hospital is 44.35 years (17–73 years). Forty-five percent of patients from both hospitals graduated from High School. Many patients were housewives, as many as 35% at Haji Hospital and 45% at Labuang Baji Hospital. In both hospitals, most of patients were diagnosed with pulmonary tuberculosis, 30% at Haji Hospital and 55% at Labuang Baji Hospital.
Table 1
Characteristics of Respondents at Haji Hospital (n = 20) and Labuang Baji Hospital (n = 20)
Characteristic | Haji Hospital (n = 20) | Labuang Baji Hospital (n = 20) | p |
M (± SD) | Min-Max | M (± SD) | Min-Max |
Age (Years) | 51.15 (± 12.75) | 29–70 | 44.35 (± 18.52) | 17–73 | 0.164 |
Length of Stay (Day) | 4.10 (± 1.99) | 1–8 | 6.15 (± 2.83) | 3–12 | 0.011* |
| n | % | n | % | |
Sex | | | | | |
Male | 13 | 65 | 7 | 35 | 0.056 |
Female | 7 | 35 | 13 | 65 |
Education | | | | | |
Not attending school | 1 | 5 | 0 | 0 | < 0.001* |
Elementary school | 7 | 35 | 3 | 15 |
Junior high school | 1 | 5 | 3 | 15 |
Senior high school | 9 | 45 | 9 | 45 |
College | 2 | 10 | 5 | 25 |
Occupation | | | | | |
Self employed | 4 | 20 | 2 | 10 | 0.021* |
Labor/Farmer/Fisherman | 5 | 25 | 2 | 10 |
Housewife | 7 | 35 | 9 | 45 |
Student | 0 | 0 | 3 | 15 |
Other | 4 | 20 | 4 | 20 |
Primary Medical Diagnosis | | | | | |
Pulmonary tuberculosis | 6 | 30 | 11 | 55 | < 0.001* |
Pneumonia | 4 | 20 | 3 | 15 |
Dyspepsia | 6 | 30 | 1 | 5 |
Typhoid fever | 2 | 10 | 4 | 20 |
COPD | 0 | 0 | 1 | 5 |
Normal Delivery | 2 | 10 | 0 | 0 |
Note: M = Mean; SD = Standard Deviation; n = Frequency; %= Percentage; Min = Minimum; Max = Maximum |
Table 2 shows that compliance with ICP implementation by PCP at Haji Hospital and Labuang Baji Hospital is still quite low. The mean adherence at Haji Hospital was only 50.02% and of the five diagnoses, the highest compliance with ICP implementation was in normal delivery diagnosis at 75.3%, while the lowest in pneumonia diagnosis was 43.2%. From the interview results, the lack of ICP filling because this is considered to increase the responsibility of PCP, the lack of health workers such as clinical Pharmacist in the treatment room, and the method of filling ICP that has not been socialized to all PCP. Then compliance at Labuang Baji Hospital was 44.46%, the highest compliance in the diagnosis of typhoid fever and COPD 47.8% and the lowest in pneumonia 35.6%. This is also because the lack of health workers and PCP considers filling ICPs to increase their responsibility.
Table 2
Compliance with ICP Implementation at Haji Hospital and Labuang Baji Hospital (n = 40)
No | Mandatory items in ICP | PCP | Haji Hospital (n = 20) | Labuang Baji Hospital (n = 20) |
Pulmonary TBC (n = 6) | Pneumonia (n = 4) | Dyspepsia (n = 6) | Typhoid fever (n = 2) | Normal Delivery (n = 2) | Pulmonary TBC (11) | Pneumonia (n = 3) | Dyspepsia (n = 1) | Typhoid fever (n = 4) | COPD (n = 1) |
IC | IC | IC | IC | IC | IC | IC | IC | IC | IC |
C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) | C (%) | NC (%) |
1 | Initial Assessment | Physician | 50 | 50 | 75 | 25 | 77.8 | 22.2 | 50 | 50 | 100 | 0 | 54.5 | 45.5 | 50 | 50 | 66.7 | 33.3 | 50 | 50 | 50 | 50 |
Nurse | 86.1 | 13.9 | 100 | 0 | 38.9 | 61.1 | 100 | 0 | - | - | 83.3 | 16.7 | 100 | 0 | 33.3 | 66.7 | 100 | 0 | 100 | 0 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
2 | Laboratory/Radiology Examination | 86 | 86 | 14 | 47.2 | 52.8 | 36 | 64 | 25 | 75 | 20 | 80 | 100 | 0 | 66.7 | 33.3 | 16.7 | 83.3 | 30 | 70 | 100 |
3 | Consultation | Physician | 100 | 0 | 75 | 25 | 100 | 0 | 0 | 100 | 0 | 100 | 81.8 | 18.2 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 |
4 | Advanced Assessment | Physician | 100 | 0 | 62.5 | 37.5 | 77.8 | 22.2 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 66.7 | 33.3 | 100 | 0 | 100 | 0 |
Nurse | 100 | 0 | 62.5 | 37.5 | 100 | 0 | 100 | 0 | - | - | 100 | 0 | 50 | 50 | 100 | 0 | 100 | 0 | 66.7 | 33.3 |
Dietitian | 16.7 | 83.3 | 25 | 75 | 5.6 | 94.4 | 100 | 0 | - | - | 45.5 | 54.5 | 0 | 100 | 100 | 0 | 100 | 0 | 100 | 0 |
Pharmacist | 0 | 100 | 0 | 100 | 8.3 | 91.7 | 50 | 50 | - | - | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
5 | Diagnosis | Physician | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 |
Clinical Nutritionist | 10 | 90 | - | - | 0 | 100 | 100 | 0 | - | - | 0 | 100 | - | - | 0 | 100 | 0 | 100 | 0 | 100 |
Nurse | 22.2 | 77.8 | 18.2 | 81.8 | 14.3 | 85.7 | 22.2 | 77.8 | - | - | 22.2 | 77.8 | 30.3 | 69.7 | 14.3 | 85.7 | 19.4 | 80.6 | 33.3 | 66.7 |
Dietitian | 38.9 | 61.1 | 75 | 25 | 4.2 | 95.8 | 87.5 | 12.5 | 100 | 0 | 9.1 | 90.9 | 0 | 100 | 50 | 50 | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
6 | Discharge Planning | Physician | 44.4 | 55.6 | - | - | - | - | - | - | - | - | 48.5 | 51.5 | - | - | - | - | - | - | 0 | 100 |
Nurse | 52.4 | 47.6 | 25 | 75 | 56.7 | 43.3 | 0 | 100 | - | - | 51.9 | 48.1 | 57.1 | 42.9 | 20 | 80 | 100 | 0 | 0 | 100 |
Pharmacist | 0 | 100 | 0 | 100 | - | - | 0 | 100 | - | - | 0 | 100 | 0 | 100 | - | - | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 66.7 | 33.3 | - | - | - | - | - | - | - | - | - | - |
7 | Integrated Education | Physician | 50 | 50 | 45 | 55 | 16.7 | 83.3 | 100 | 0 | 100 | 0 | 40.3 | 59.7 | 40 | 60 | 50 | 50 | 50 | 50 | 0 | 100 |
Nurse | 59.3 | 40.7 | 13.5 | 86.5 | 45.2 | 54.8 | 44.4 | 55.6 | - | - | 42.4 | 57.6 | 38.5 | 61.5 | 42.9 | 57.1 | 16.7 | 83.3 | 33.3 | 66.7 |
Dietitian | 16.7 | 83.3 | 75 | 25 | 5.6 | 94.4 | 100 | 0 | 100 | 0 | 9.1 | 90.9 | 0 | 100 | 0 | 100 | 75 | 25 | 33.3 | 66.7 |
Pharmacist | 0 | 100 | 0 | 100 | 16.7 | 83.3 | 0 | 100 | - | - | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
8 | Integrated information and education form filling | | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 |
9 | Medical Therapy: | Physician | 100 | 0 | 75 | 25 | 83.3 | 16.7 | 100 | 0 | 50 | 50 | 54.5 | 45.5 | 0 | 100 | 100 | 0 | 100 | 0 | 100 | 0 |
- Injection | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 0 | 100 | 0 | 100 | 0 | 100 | 100 | 0 | 100 | 0 | 100 | 0 |
- Intravenous fluids | 33.3 | 66.7 | 25 | 75 | 50 | 50 | 50 | 50 | 100 | 0 | 36.4 | 63.6 | 0 | 100 | 100 | 0 | 50 | 50 | 0 | 100 |
- Oral Medication | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 100 | 0 |
- Additional medication | 100 | 0 | 75 | 25 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 75 | 25 | 100 | 0 |
10 | Management/ Intervention | Physician | 94.4 | 5.6 | 50 | 50 | 100 | 0 | 33.3 | 66.7 | 50 | 50 | 97 | 3 | 66.7 | 33.3 | 50 | 50 | 50 | 50 | 75 | 25 |
Nurse | 25 | 75 | 13.3 | 86.7 | 16.7 | 83.3 | 20 | 80 | - | - | 23.6 | 76.4 | 28.9 | 71.1 | 12.5 | 87.5 | 17.5 | 82.5 | 46.2 | 53.8 |
Dietitian | 16.7 | 83.3 | 37.5 | 62.5 | 4.2 | 95.8 | 0 | 100 | 0 | 100 | 52.3 | 47.7 | 0 | 100 | 100 | 0 | 6.3 | 93.7 | 75 | 25 |
Pharmacist | 16.7 | 83.3 | 0 | 100 | 100 | 0 | 0 | 100 | - | - | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
11 | Monitoring & Evaluation | Physician | 54.2 | 45.8 | 66.7 | 33.3 | 38.9 | 61.1 | 100 | 0 | 100 | 0 | 56.8 | 43.2 | 100 | 0 | 33.3 | 66.7 | 100 | 0 | 71.4 | 28.6 |
Nurse | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | - | - | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 |
Dietitian | 33.3 | 66.7 | 62.5 | 37.5 | 0 | 100 | 0 | 100 | 33.3 | 66.7 | 31.8 | 68.2 | 0 | 100 | 75 | 25 | 31.3 | 68.7 | 75 | 25 |
Pharmacist | 5.6 | 94.4 | 0 | 100 | 16.7 | 83.3 | 25 | 75 | - | - | 0 | 100 | 0 | 100 | 33.3 | 66.7 | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
12 | Mobilization/ Rehabilitation | Physician | 66.7 | 33.3 | 0 | 100 | 33.3 | 66.7 | 0 | 100 | 100 | 0 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 |
Nurse | 83.3 | 16.7 | 37.5 | 62.5 | 33.3 | 66.7 | 0 | 100 | - | - | 0 | 100 | 33.3 | 66.7 | 0 | 100 | 0 | 100 | 50 | 50 |
Physiotherapist | - | - | 0 | 100 | - | - | - | - | - | - | - | - | 0 | 100 | - | - | - | - | - | - |
13 | Outcome | Physician | 58.3 | 41.7 | 50 | 50 | 72.2 | 27.8 | 100 | 0 | 100 | 0 | 59.1 | 40.9 | 75 | 25 | 33.3 | 66.7 | 100 | 0 | 66.7 | 33.3 |
Nurse | 24.1 | 75.9 | 14.6 | 85.4 | 21.4 | 78.6 | 22.2 | 77.8 | - | - | 21.2 | 78.8 | 30.6 | 69.4 | 14.3 | 85.7 | 19.4 | 80.6 | 22.2 | 77.8 |
Dietitian | 50 | 50 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 100 | 0 | 0 | 100 | 0 | 100 |
Pharmacist | 0 | 100 | 0 | 100 | 16.7 | 83.3 | 50 | 50 | - | - | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 |
Midwife | - | - | - | - | - | - | - | - | 100 | 0 | - | - | - | - | - | - | - | - | - | - |
14 | Discharge Criteria | Physician | 50 | 50 | 50 | 50 | 72.2 | 27.8 | 100 | 0 | 100 | 0 | 52.3 | 47.7 | 66.7 | 33.3 | 66.7 | 33.3 | 100 | 0 | 60 | 40 |
15 | Pre-Discharge Education | Nurse | 44.4 | 55.6 | 25 | 75 | 100 | 0 | 83.3 | 16.7 | - | - | 100 | 0 | 55.6 | 44.4 | 0 | 100 | 75 | 25 | 100 | 0 |
Midwife | - | - | - | - | - | - | - | - | 37.5 | 62.5 | - | - | - | - | - | - | - | - | - | - |
| | Overall | 52.2 | 47.8 | 43.1 | 56.9 | 49.0 | 51.0 | 55.5 | 44.5 | 75.2 | 24.8 | 44.3 | 55.7 | 35.6 | 64.4 | 46.8 | 53.2 | 47.8 | 52.2 | 47.8 | 52.2 |
| | Mean Overall | 55.02 | 44.46 |
As shown in Table 3, clinical quality assessment based on patient medical outcomes with each indicator in each diagnosis. In dyspeptic patients at Haji Hospital, majority of patients found 3 (50%) no pain on the second day, 4 (66.7%) patients had stable and improved condition on the second day (66.7%), but on normal lab result indicators are 4 (66.7%) No check listed by PCP. Meanwhile, there was only one dyspeptic patient at Labuang Baji Hospital with no pain outcomes on the fourth day (100%), stable and improved condition on the fourth day (100%), and lab results are also not check listed by the PCP. Furthermore, patients with a diagnosis of typhoid fever, with indicators of upright diagnosis according to anamnesis and physical examination there were 2 (100%) on the first day at the Haji Hospital and for indicators a definitive diagnosis was obtained Salmonella typhi or paratyphoid from the supporting examination was 2 (100%) on the second day.
Table 3
Clinical Quality at Haji Hospital and Labuang Baji Hospital (N = 40)
No | Indicator (Outcome) | Clinical Quality |
Haji Hospital (n = 20) | Labuang Baji Hospital (n = 20) |
Diagnosis of the disease | n (%) | Days | ICP Compliant | Diagnosis of the disease | n (%) | Day | ICP Compliant |
1 | Day 1–5: | Dyspepsia (n = 6) | | | | Dyspepsia (n = 1) | | | |
| No pain | | 3 (50) | 2 | Compliant | | 1 (100) | 4 | Compliant |
| 2 (33.3) | 3 | Compliant |
| 1 (16.7) | 4 | Compliant |
Stable and improved condition | | 4 (66.7) | 2 | Compliant | | 1 (100) | 4 | Compliant |
| 1 (16.7) | 3 | Compliant |
| 1 (16.7) | 5 | Compliant |
Normal lab results | | 2 (33.3) | 3 | Compliant | | 1 (100) | - | No check listed by PCP |
| 4 (66.7) | - | No check listed by PCP |
2 | Day 1: | Typhoid fever (n = 2) | | | | Typhoid fever (n = 4) | | | |
| Diagnose determined based on anamnesis and physical assessment | | 2 (100) | 1 | Compliant | | 4 (100) | 1 | Compliant |
Day 2–5: | | | | | | | | |
A definitive diagnosis of salmonella typhi or paratyphi was obtained from the supporting examination | | 2 (100) | 2 | Compliant | | 3 (75) | 2 | Compliant |
| 1 (25) | 3 | Compliant |
3 | Day 1–7: | Pulmonary tuberculosis (n = 6) | | | | Pulmonary tuberculosis (n = 11) | | | |
| Reduced complaints | | 3 (50) | 2 | Compliant | | 2 (18.2) | 4 | Compliant |
| 1 (16.7) | 3 | Compliant | | 2 (18.2) | 5 | Compliant |
| 1 (16.7) | 4 | Compliant | | 2 (18.2) | 6 | Compliant |
| 1 (16.7) | 5 | Compliant | | 2 (18.2) | 7 | Compliant |
| | 3 (27.3) | 10 | Not Compliant (Prolonged LOS) |
Improved appetite | | 1 (16.7) | 2 | Compliant | | 1 (9.1) | 7 | Not Compliant (Prolonged LOS) |
| | 1 (9.1) | 8 | Not Compliant (Prolonged LOS) |
| 5 (83.3) | - | No check listed by PCP | | 1 (9.1) | 10 | Not Compliant (Prolonged LOS) |
| | 8 (72.7) | - | No check listed by PCP |
4 | Day 1–7: | Pneumonia (n = 4) | | | | Pneumonia (n = 3) | | | |
| Reduced complaints | | 2 (50) | 2 | Compliant | | 2 (66.7) | 3 | Compliant |
2 (50) | 4 | Compliant | 1 (33.3) | 6 | Compliant |
Improved lab results: Normal number of leukocytes | 4 (100) | - | No check listed by PCP | 1 (33.3) | 6 | Compliant |
2 (66.7) | - | No check listed by PCP |
Improved chest x-ray results | 4 (100) | - | No check listed by PCP | 1 (33.3) | 3 | Compliant |
1 (33.3) | 6 | Compliant |
1 (33.3) | - | No check listed by PCP |
No fever within 48 hours, axila temperature < 37.5ºC | 3 (75) | 1 | Compliant | 2 (66.7) | 3 | Compliant |
1 (25) | 2 | Compliant | 1 (33.3) | 6 | Compliant |
5 | Day 1–7: | Normal Delivery (n = 2) | | | | Normal Delivery (n = 0) | | | |
| Normal vital signs | | 2 (100) | 1 | Compliant | | - | - | - |
Controlled bleeding | 2 (100) | 1 | Compliant | - | - | - |
No postpartum urinary retention | 2 (100) | 1 | Compliant | - | - | - |
Good contractions | 2 (100) | 1 | Compliant | - | - | - |
6 | Day 1–7: | COPD (n = 0) | | | | COPD (n = 1) | | | |
| Reduced dyspnea | | - | - | - | | 1 (100) | 8 | Not Compliant (Prolonged LOS) |
Reduced cough | - | - | - | 1 (100) | 9 | Not Compliant (Prolonged LOS) |
Improved appetite | - | - | - | 1 (100) | - | No check listed by PCP |
Independent activity daily life | | - | - | - | | 1 (100) | - | No check listed by PCP |
Reduced wheezing | - | - | | 1 (100) | 8 | Not compliant (Prolonged LOS) |
Normal vital signs | - | - | | 1 (100) | 1 | Compliant |
Meanwhile Table 3 also depicts that at Labuang Baji Hospital, there were 4 (100%) on the first indicator and for the second indicator there were 3 (75%) on the second day. In the diagnosis of a Pulmonary TB at Haji Hospital, the majority of 3 (50%) patients ' complaints were less on the second day, but for indicators of improved appetite there were 5 (83.3%) ICP No check listed by PCP. Meanwhile, at Labuang Baji Hospital, there were 3 (27.3%) patients whose complaints were reduced on the 10th day, which means that they are not in accordance with ICP because the patient's LOS is elongated. This is because the patient's condition is weak since the beginning of hospital admission and the patient has variants, namely Diabetes Mellitus (DM) and hypertension. Then, for the second indicator of pulmonary tuberculosis, namely improved appetite, there were 5 (83.3%) from Haji Hospital and 8 (72.7%) from Labuang Baji Hospital whose ICP was No check listed by PCP. Furthermore, the diagnosis of Pneumonia at Haji Hospital there were 2 (50%) patients whose complaints reduced on the second day and there were 3 (75%) patients who were fever-free within 48 hours on the first day, for indicators of improvement of lab results and thorax photos there are 4 (100%) for which ICP is No check listed by PCP. Meanwhile, at Labuang Baji Hospital, there were 2 (66.7%) patients whose complaints decreased on the third day and there were 2 (66.7%) patients who were fever-free within 48 hours on the third day, while for indicators of improvement in lab results and ICP thorax photos are not checked by PCP. Normal delivery patients are only found at Haji Hospital with 2 (100%) meeting the indicators on each medical outcome on the first day. Then, for the diagnosis of a COPD is only available at Labuang Baji Hospital. There are six indicators, namely tightness reduced by 1 (100%) patient on day eight, cough reduced by 1 (100%) on day nine. It is not compatible with ICP due to the patient's weakened condition during treatment so that the LOS is elongated. Then for indicators of improved appetite and able to perform activity of daily living independently, there was 1 (100%) patient whose ICP was not checked by PCP.
Table 4 shows the LOS of patients found that in Haji Hospital in patients with dyspeptic diagnosis there are 1 (50%) patients in class 1 care who have LOS not according to ICP standards (1–5 days) That is 8 days, this is due to the general condition of patients who are weak since the beginning of hospital admission with complaints of heartburn accompanied by nausea and complaints starting It decreases after the fifth day of treatment but still occurs occasionally until the patient goes home. Meanwhile, dyspeptic patients at Labuang Baji Hospital in class 1 care have LOS in accordance with ICP standards (1–5 days), which is 3 days. Then for the diagnosis of typhoid fever in both hospitals showed all patients had LOS according to ICP (1–6 days) which is a range of 3–6 days of treatment. Patients with a diagnosis of Pulmonary TB at Haji Hospital there were 1 (16.7%) patient with LOS 9 days because during treatment the patient's general condition worsened which made the patient transferred to be treated at HCU for 2 days until his condition stabilizes again. Meanwhile, at Labuang Baji Hospital, there are patients who have LOS not in accordance with ICP in each class of treatment. There is 1 (100%) patient in grade 1 who has a 9-days LOS due to a weak general condition and the patient has a history of DM and hypertension. Patients in grade 2 had an 11-day LOS due to a weak general state and complaints that lasted for quite a long time. Patients in grade 3 there are 1 (11.1%) patient with the highest LOS which is 12 days due to the patient's general condition is weak and complaints are reduced but still experienced until the patient goes home. In Pneumonia Diagnosis, patients from both hospitals have ICP-compliant LOS. Then, in normal delivery patients at Haji Hospital, both class 2 and 3 patients have LOS according to ICP and even patients go home early because of stable conditions. Meanwhile, COPD patients at Labuang Baji Hospital have LOS not according to ICP, which is 9 days because the patient's general condition is weak, and BMI is lacking.
Table 4
Patient Length of Stays at Haji Hospital and Labuang Baji Hospital (N = 40)
No | Diagnosis | ICP-based LOS (Days) | Length of Stay (LOS) |
Haji Hospital (n = 20) | Labuang Baji Hospital (n = 20) |
Ward Class | n (%) | Day | ICP Compliant | M ± SD | Ward Class | n (%) | Day | ICP Compliant | M ± SD |
1 | Dyspepsia (n = 7) | 1–5 | Class 1 (n = 2) | 1 (50) | 2 | Compliant | 5.00 ± 4.24 | Class 1 (n = 1) | 1 (100) | 3 | Compliant | 3.00 |
1 (50) | 8 | Not Compliant |
Class 3 (n = 4) | 1 (25) | 2 | Compliant | 3.50 ± 1.29 | - | - | - | - | - |
1 (25) | 3 | Compliant |
1 (25) | 4 | Compliant |
1 (25) | 5 | Compliant |
2 | Typhoid fever (n = 6) | 1–6 | Class 3 (n = 2) | 1 (50) | 3 | Compliant | 4.00 ± 1.41 | Class 1 (n = 1) | 1 (100) | 5 | Compliant | 5.00 |
Class 2 (n = 1) | 1 (100) | 6 | Compliant | 6.0 |
1 (50) | 5 | Compliant | Class 3 (n = 2) | 1 (50) | 4 | Compliant | 5.00 ± 1.41 |
1 (50) | 6 | Compliant |
3 | Pulmonary TB (n = 17) | 1–7 | Class 3 (n = 6) | 1 (16.7) | 3 | Compliant | 5.33 ± 2.25 | Class 1 (n = 1) | 1 (100) | 9 | Not Compliant (DM & Hypertension) | 9.00 |
2 (33.3) | 4 | Compliant | Class 2 (n = 1) | 1 (100) | 11 | Not Compliant | 11.00 |
Class 3 (n = 9) | 2 (22.2) | 3 | Compliant | 6.11 ± 3.33 |
1 (16.7) | 5 | Compliant | 2 (22.2) | 4 | Compliant |
1 (16.7) | 7 | Compliant | 2 (22.2) | 5 | Compliant |
1 (11.1) | 9 | Not Compliant |
1 (16.7) | 9 | Not Compliant | 1 (11.1) | 10 | Not Compliant |
1 (11.1) | 12 | Not Compliant |
4 | Pneumonia (n = 7) | 1–7 | Class 3 (n = 4) | 1 (25) | 3 | Compliant | 4.25 ± 0.957 | Class 2 (n = 1) | 1 (100) | 5 | Compliant | 5.00 |
1 (25) | 4 | Compliant | Class 3 (n = 2) | 1 (50) | 4 | Compliant | 5.50 ± 2.12 |
2 (50) | 5 | Compliant | 1 (50) | 7 | Compliant |
5 | Normal Delivery (n = 2) | 1–7 | Class 2 (n = 1) | 1 (100) | 1 | Compliant | 1.00 | - | - | - | - | - |
Class 3 (n = 1) | 1 (100) | 1 | Compliant | 1.00 | - | - | - | - | - |
6 | COPD (n = 1) | 1–7 | - | - | - | - | - | Class 2 (n = 1) | 1(100) | 9 | Not compliant | 9.00 |
Note: n: Frequency; M: Mean; SD: Standard Deviation |
Table 5 above shows the hospital cost of patients at Haji Hospital which varies from each diagnosis and class of patient care. Of the five diagnoses above, the highest hospital cost is for Pulmonary TB patients in class 3 care of IDR 4,584,800 higher than the INA-BCGs rate so that there is a difference in loss of IDR 323,100 because the patient's LOS is extended to 9 days. Meanwhile, the lowest hospital cost for dyspeptic patients in class 3 care is IDR 529,000 according to the INA-BCGs rate so that there is a profit difference of IDR 898,400. The implementation of ICP at Haji Hospital shows its effect on hospital patient costs, where hospitals get the difference in profit in all disease diagnoses in each class of care.
Table 5
Hospital Costs at Haji Hospital (n = 20)
No | Diagnosis | Ward Class | INA-CBG Tariff (IDR) | Hospital Cost |
Hospital Expenses (IDR) | Differences in INA-CBG Tariff and Hospital Expenses (IDR) | INA-CBG Compliant |
1. | Dyspepsia (n = 6) | Class 1 (n = 2) | 1.998.400 | 844.000 | 1.154.400 | Compliant |
2.899.000 | -900.600 | Not compliant (Prolonged LOS up to 8 days) |
Class 3 (n = 4) | 1.427.400 | 529.000 | 898.400 | Compliant |
970.500 | 456.900 | Compliant |
1.274.000 | 153.400 | Compliant |
1.450.000 | -22.600 | Not compliant |
2. | Typhoid (n = 2) | Class 3 (n = 2) | 2.229.100 | 790.000 | 1.439.100 | Compliant |
| 1.352.500 | 876.600 | Compliant |
3. | Pulmonary TB (n = 6) | Class 3 (n = 6) | 4.260.700 | 1.730.000 | 2.530.700 | Compliant |
1.413.000 | 2.847.700 | Compliant |
2.622.000 | 1.638.700 | Compliant |
2.207.000 | 2.053.700 | Compliant |
3.302.000 | 958.700 | Compliant |
4.584.800 | -323.100 | Not compliant (Prolonged LOS up to 9 days) |
4. | Pneumonia (n = 4) | Class 3 (n = 4) | 3.550.100 | 1.232.000 | 2.318.100 | Compliant |
| | 1.298.000 | 2.252.100 | Compliant |
| | 1.788.000 | 1.762.100 | Compliant |
| | 1.813.000 | 1.737.100 | Compliant |
5. | Normal Delivery (n = 2) | Class 2 (n = 1) | 2.753.300 | 1.539.000 | 1.214.300 | Compliant |
| | Class 3 (n = 1) | 2.363.300 | 1.308.000 | 1.055.300 | Compliant |
Note: n: Frequency; IDR: Indonesian Rupiah; M: Mean; ±SD: Standard Deviation |
Table 6 shows that the highest hospital cost is found in COPD patients in class 2 care of IDR 6,903,838 higher than the INA-BCG-s rate so that there is a difference in loss of IDR 2,554,638 because patient’s LOS extends to 9 days. Then for the lowest hospital cost found in Dyspepsia patients in class 1 care of IDR 1,577,273 according to the INA-BCGs rate so that there is a profit difference of 421,127. Overall, these results show that the implementation of ICP at Labuang Baji Hospital can provide benefits for hospitals. Although there are patients who have costs exceeding the rates of INA-BCGs, in almost all diagnoses, hospitals experience a mean difference in profit in each class of care for both class 1, grade 2, as well as grade 3. It's just that in the diagnosis of pulmonary tuberculosis in class 1 care, the hospital experienced a difference in losses.
Table 6
Hospital Cost at Labuang Baji Hospital (n = 20)
No | Diagnosis | Ward Class | INA-CBG Tariff (IDR) | Hospital Cost |
Hospital Expenses (IDR) | Differences in INA-CBG Tariff and Hospital Expenses (IDR) | INA-CBG Compliant |
1. | Dyspepsia (n = 1) | Class 1 (n = 1) | 1.998.400 | 1.577.273 | 421.127 | Compliant |
Class 2 (n = 0) | 1.712.900 | - | - | - |
Class 3 (n = 0) | 1.427.400 | - | - | - |
2. | Thypoid fever (n = 4) | Class 1 (n = 1) | 3.120.700 | 2.453.520 | 667.180 | Compliant |
Class 2 (n = 1) | 2.674.900 | 2.880.242 | − 205.342 | Not compliant |
Class 3 (n = 2) | 2.229.100 | 2.330.314 | − 101.214 | Not compliant |
| 1.810.942 | 418.158 | Compliant |
3. | Pulmonary TBC (n = 11) | Class 1 (n = 1) | 5.965.000 | 6.259.033 | − 294.033 | Not compliant (prolonged LOS up to 9 days) |
Class 2 (n = 1) | 5.112.900 | 4.196.995 | 915.905 | Compliant |
Class 3 (n = 9) | 4.260.700 | 1.679.597 | 2.581.103 | Compliant |
2.019.687 | 2.241.013 | Compliant |
2.047.303 | 2.213.397 | Compliant |
2.819.596 | 1.441.104 | Compliant |
1.934.896 | 2.325.804 | Compliant |
3.689.566 | 571.134 | Compliant |
4.347.342 | − 86.642 | Not compliant (prolonged LOS up to 9 days) |
2.635.377 | 1.625.323 | Compliant |
| 3.892.473 | 368.227 | Compliant |
4. | Pneumonia (n = 3) | Class 2 (n = 1) | 4.260.100 | 2.645.207 | 1.614.893 | Compliant |
Class 3 (n = 2) | 3.550.100 | 2.719.558 | 830.542 | Compliant |
| | 4.020.200 | − 470.100 | Not compliant |
5. | COPD (n = 1) | Class 2 (n = 1) | 4.349.200 | 6.903.838 | − 2.554.638 | Not compliant (prolonged LOS up to 9 days) |
Note: n: Frequency; IDR: Indonesia Rupiah; M: Mean; ±SD: Standard Deviation |
Figures 1 and 2 show that most patients are satisfied with the service after the implementation of ICP at Haji Hospital. In the service item, health workers (nurses) have the highest percentage of satisfaction at 83.6%. This is because patients feel that nurses provide care as needed and nurses are easy to find. Meanwhile at Labuang Baji Hospital shows that patients feel very satisfied in the category of health workers, namely Physicians (70.9%), but in the category of inpatient rooms patients feel quite satisfied (7.3%). From the results of interviews with patients, this is because patients feel that the facilities and cleanliness in the inpatient room are not good.