Department of Public Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia.
Glob Health Action. 2008 Dec 17;1. doi: 10.3402/gha.v1i0.1831.
The Directly Observed Treatment Short-course (DOTS) expansion strategy through Public-Private Mix (PPM) is in progress at an international level as well as in Indonesia. The number of hospitals involved in PPM has been rapidly scaling up, requiring the assessment of quality of implementation.
The paper presents the assessment of quality in implementing DOTS strategy in hospitals in Indonesia and emphasises the challenge of achieving high process quality in managing adult TB cases seen in the outpatient unit.
A multiple-case study, involving eight general hospitals in Yogyakarta and Central Java provinces. The cases are comprised of public and private hospitals as well as teaching and non-teaching hospitals. Using the Donabedian's model, the quality of DOTS strategy implementation in hospitals was assessed in three aspects, i.e. structure, process and outcome. Data were collected through self-administered questionnaires, focus group discussions, interviews, observation and documents.
The study revealed the importance of process, i.e. mainly commitment and case holding process, to the treatment success rate, treatment completion rate and default rate.
A systemic approach and structural support from the hospital is critical in this endeavour. Process improvement in the implementation of DOTS strategy in hospitals should be given more emphasis in hospital PPM-DOTS.
直接观察治疗短期疗程（DOTS）通过公私混合（PPM）的扩展战略正在国际上以及印度尼西亚进行。参与 PPM 的医院数量迅速增加，这需要对实施质量进行评估。
本文介绍了印度尼西亚医院实施 DOTS 战略的质量评估，并强调了在门诊部门管理成人结核病病例时实现高流程质量的挑战。
一项多案例研究，涉及日惹和中爪哇省的八家综合医院。这些案例包括公立和私立医院以及教学和非教学医院。使用 Donabedian 模型，从结构、过程和结果三个方面评估了医院中 DOTS 战略实施的质量。数据通过自填式问卷、焦点小组讨论、访谈、观察和文件收集。
研究表明，过程（主要是承诺和病例管理过程）对治疗成功率、治疗完成率和失访率至关重要。
医院需要系统的方法和结构支持。在医院 PPM-DOTS 中，应更加重视 DOTS 战略实施过程的改进。
