Aladin Aladin, Taifur Werry Darta, Aljunid Syed Mohamed, Ocviyanti Dwiana
Department of Obstetrics and Gynecology, Andalas University, Padang, West Sumatra, Indonesia.
Department of Economics, Andalas University, Padang, West Sumatra, Indonesia.
Clinicoecon Outcomes Res. 2024 May 30;16:461-469. doi: 10.2147/CEOR.S447249. eCollection 2024.
As with several countries around the world, cesarean section rates are increasing also in Indonesia, raising issues of quality and cost-effectiveness of health care, especially with the shift from a fee-for-service to a prospective payment system. For hospital services to be effective (quality control) and efficient (cost control), clinical pathways are essential. However, no studies have been done to develop a clinical pathway for cesarean sections (CS) in the INA-CBG system that is both effective and efficient.
To develop clinical pathways for CS that are both effective and efficient by determining unit costs and tariffs for CS services, reviewing procedures and outcomes, and assessing performance efficiency and effectiveness.
Using a sample of 110 patients undergoing cesarean sections consecutively recruited in 11 hospitals of West Sumatra (6 public hospitals and 5 private institutions), this mixed (qualitative and quantitative) study aimed at developing clinical guidelines for childbirth delivery modes responding both to criteria of efficacy and efficiency.
Of 110 patients, 50 patients (45%) had efficient CS, 85 patients (77%) had effective CS, and 40 patients (36.4%) had both effective and efficient CS. A comprehensive clinical pathway for CS procedure was created by investigating 40 patients who underwent effective and efficient CS using interviews, a Delphi study, and professional advice.
Hospitals can adopt the effective and efficient clinical pathway for CS protocol to prevent cost-related losses (efficient) while retaining the quality of the service (effective).
与世界上其他几个国家一样，印度尼西亚的剖宫产率也在上升，这引发了医疗保健质量和成本效益方面的问题，尤其是在从按服务收费转向前瞻性支付系统的情况下。为了使医院服务有效（质量控制）且高效（成本控制），临床路径至关重要。然而，尚未开展研究来为INA-CBG系统中的剖宫产制定既有效又高效的临床路径。
通过确定剖宫产服务的单位成本和收费标准、审查程序和结果以及评估绩效效率和效果，制定既有效又高效的剖宫产临床路径。
采用在西苏门答腊的11家医院（6家公立医院和5家私立机构）连续招募的110例接受剖宫产手术的患者作为样本，这项混合（定性和定量）研究旨在制定符合疗效和效率标准的分娩方式临床指南。
在110例患者中，50例患者（45%）的剖宫产手术高效，85例患者（77%）的剖宫产手术有效，40例患者（36.4%）的剖宫产手术既有效又高效。通过对40例接受了有效且高效剖宫产手术的患者进行访谈、德尔菲研究和专业咨询，创建了剖宫产手术的综合临床路径。
医院可以采用有效且高效的剖宫产临床路径方案，以防止与成本相关的损失（高效），同时保持服务质量（有效）。
