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Pembiayaan Kasus subakut
dan kronik INA CBGsTim NCC Kemkes RI
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Unbundled Components: Compilations
Core
CBG +
Special
Procedures+
Special
Investigations+
Special
Prosthesis+Special
Drugs
Sub-Acute
Group
+
Chronic
Group
/
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Tarif INACBGs kasus kronis
Jamkesmas
Selama ini merupakan tarif paket ditambah tarif
costperday untuk fase subakut dan kronis
Tarif costperday fase subakut( hari ke 35- 103) :
Rp 90.000
Tarif costperday fase kronik( hari ke 104-180) :
Rp 45.000
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Tarif INA CBGs kasus kronis BPJS
Merupakan tarif paket sesuai kode kasusnya,
ditambah tarif costperday utk fase subakut
dan kronis
Fase subakut : hari ke 43-103
Fase kronis : hari ke 104-180
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Tarif INA CBGs kasus kronis BPJS
Besaran tarif subakut : 0,375 x RIW x UC x LOS
Besaran tarif kronis : 0,25 x RIW x UC x LOS
RIW ( Resource Intensity Weight ) merupakanbobot dari intensitas sumber daya yg
digunakan utk merawat pasien kronis,
merupakan perbandingan skor WHO DAS
pasien dibanding total skor WHO DAS
UC ( Unit Cost )
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WHO DAS 2.0 dlm INA CBGs
Merupakan instrumen yg digunakan utk
mengukur skor disabilitas pasien kronis
Skor tsb merupakan dasar perhitungan dari RIW
Assesment bisa dilakukan oleh petugas terlatih :
dr spesialis DPJP, dr umum dan perawat
Tanda tangan /tanggung jawab oleh DPJP
Bukan sbg dasar untuk pemulangan pasien
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Why measure Disability?
For Prediction of
patients needs
level of care
outcome of care Prognosis health conditions
Length of hospitalization
receipt of disability benefits work performance
social integration
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Why Measure Disability?
For healthcare and policy decision
Identify health needs of community
Design treatment and intervention
Evaluate outcome and effectiveness
Sett health priorities
Allocate health resources
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WHO- DAS 2.0
Six Domains
Cognitive: Understanding and Communicating
Mobility: Moving and getting around Self-Care: Hygine, dressing, eating, staying alone
Getting Along: Interacting with other people
Life Activities: Domestic responsibilities, leisure,
work and school
Participation: Joining in community cctivities
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Modes of Administer WHO-DAS
Interview Interviews to be done by doctors or nurses
Face-to-Face preferred in INA-CBG
Can use telephone interview as well Proxy
Third party answer the questions
Views from Family Members, Carers or other observers such asnurses or other health workers
May be use in INA-CBG if patient cannot response
Self-Administered Filled-up by individual
Use pencil-paper-version
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Development of WHO-DAS
First developed by WHO in 1988
To assess functioning mainly for psychiatric patients
Developed further by WHO Collaborating Centre inGroningen, Netherlands
Developed to reflect ICF
Refinement done by WHO and US Institues
NIH- National Institute of Health NIMH- National Institute of Mental Health
NIAAA National Institute of Alcohol Abuse and Alcoholism
NIDA National Institute of Drug Abuse
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Development of WHO-DAS
Process of Development
Collaborative approach at international level
Ensure applicability in all health settings
Extensive review of existing instruments
More than 300 tools reviewed
Cross Cultural Applicability Studies
Explore nature and practive of health statusassessement in different cultures
Use Qualitative Methods (FGD, Key-Informants, etc)
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Development of WHO-DAS
Process of Development
Reliability and Validity field studies
Cover 4 different groups
General Population
Population with Physical Problem
Population with Mental or Emotional Problem
Population with problems of Drug Abuse and Addiction
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Final Structure of WHO-DAS
Three Versions
36 Items
12 Items
12+24 Items
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36-Item Version
Most detailed version
Each item when positively endorsed will be
followed by questions on number of days with
the disability
Three format: interviewer-administered, self-
administered and proxy-administered
Average Interview time:20 minute
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12-Item Version
brief assessments of overall functioning
Use when time constraints
explains 81% of the variance of the 36-itemversion
five minutes
interviewer-administered, self administeredand proxy-administered
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12+24-item version
hybrid of the 12-item and 36-item versions
Respondents screen for problems in specific domains
Based on positive responses to the initial 12 items,
respondents may be given up to 24 additionalquestions
administered by interview or computer-adaptive
testing (CAT). 20 minutes.
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Why use WHO-DAS?
Based on strong theoretical concepts
Good psychometric properties
Numerous applications Direct link to the ICF
Cross-cultural comparability
Ease of use and availability Public domain
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WHO- DAS 2.0
Six Domains
D1-Cognitive: Understanding and Communicating
D2-Mobility: Moving and getting around D3-Self-Care: Hygiene, dressing, eating, staying
alone
D4-Getting Along: Interacting with other people
D5-Life Activities: Domestic responsibilities,
leisure, work and school
D6-Participation: Joining in community cctivities
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Components of WHO-DAS Tool
Three Components
Questionnaire
Flashcard 1
Flashcard 2
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Questionnaire
Four parts
Introduction
Section 1: Face sheet
Section 2: Demographic and Background Info
Section 3: Preamble
Section 4: Core Questions
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WHO-DAS: Introduction
Brief information on WHO-DAS
Reminder that users has to be trained to use
WHO-DAS
List of different versions of WHO-DAS
Contact address of responsible person in WHO
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WHO-DAS: Section One
Instruction not to read the sentences (bold and italic) to
the respondents
Read the sentences in blue
Face sheet
Respondents ID No.
Interviewers ID No.
Assessment time point (1,2, 3,.)
Interview Date
Living situation:
Independent living in community (1)
Assisted living (2)
Hospitalised (3)
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WHO-DAS: Section Two
Demographic and Background Information (5
Items)
Gender (as observed)
Age
Years of education
Current Marital Status
Work Status
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WHO-DAS: Section Three
Preamble
What to say to respondents on the interview
Hand Flashcard #1 to respondents
Point to Flashcard #1
Hand Flashcard #2 to respondents
Read aloud the scale
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WHO-DAS: Section Four
Core questions
S1-S12
Show Flashcard #2
H1-H3
Number of days of disability
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WHO- DAS 2.0- 12 Items
(Score 1-5): Interview
In the past 30 days, how much difficulty did you have in:
S1 Standing for long periods such
as 30
minutes? (D2)
None Mild Moderate Severe Extreme or
cannot do
S2 Taking care of your household
responsibilities? (D5)
None Mild Moderate Severe Extreme or
cannot doS3 Learning a new task, for
example, learning how to get to
a new place?(D1)
None Mild Moderate Severe Extreme or
cannot do
S4 How much of a problem did your
have joining in community
activities (for example,
festivities, religious or otheractivities) in the same way as
anyone else can?(D6)
None Mild Moderate Severe Extreme or
cannot do
S5 How much has you have been
emotionally affected by your
health condition?(D6)
None Mild Moderate Severe Extreme or
cannot do
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WHO- DAS 2.0- 12 Items
(Score 1- 5): Interview
In the past 30 days, how much difficulty did you have in:
S6 Concentrating on doingsomething for ten minutes?
(D1)
None Mild Moderate Severe Extreme or
cannot do
S7 Walking a long distance suchas a kilometer [or equivalent]?
(D2)
None Mild Moderate Severe Extreme orcannot do
S8 Washing your whole body?(D3)
None Mild Moderate Severe Extreme or
cannot do
S9 Getting dressed? (D3) None Mild Moderate Severe Extreme orcannot do
S10 Dealing with people you donot know? (D4)
None Mild Moderate Severe Extreme or
cannot do
S11 Maintaining a friendship? (D4) None Mild Moderate Severe Extreme orcannot do
S12 Your day-to-day work? (D5) None Mild Moderate Severe Extreme orcannot do
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Core Question H1-H3
H 1 : Overall, in the past 30 days, how many dayswere these difficulties present?
H2 : In the past 30 days, for how many days were
you totally unable to carry out your usualactivities or work because of any healthcondition?
H3 : In the past 30 days, not counting the days
that you were totally unable, for how many daysdid you cut back or reduce your usual activities orwork because of any health condition?
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Scoring Scheme-WHO-DAS
1 to 5;
None = 1 (Not disable)
Extreme/Cannot Do = 5 (Totally Disable)
Minimum Total Score = 12 (No Disability)
Maximum Total Score = 60 (12 x 5) (Total
Disability)
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Flashcard #1
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Flashcard #2
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Conclusion
Measuring disability is important exercise in
health system to support policy decision
WHO-DAS 2.0 is a robust, valid and reliable
generic disability assessment tool supported
by strong research and development
WHO-DAS 12-Item version is used in INA-CBG
for resource allocation
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TERIMA KASIH
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