Pembiayaan Kasus subakut dan kronik INA CBGs

Tim NCC Kemkes RI

Unbundled Components: Compilations

Core CBG

Special Procedures

Special Investigations + Sub-Acute Group

Special Prosthesis

Special Drugs

/
Chronic Group

Tarif INA CBGs 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

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

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 ) merupakan bobot dari intensitas sumber daya yg digunakan utk merawat pasien kronis, merupakan perbandingan skor WHO DAS pasien dibanding total skor WHO DAS UC ( Unit Cost )

WHO-DAS 2.0
WHO Disability Assessment Schedule General measure of functioning and disability Can be Linked to ICF Classification Can be used
Monitoring treatment outcome in clinical practice Population surveys Effects measurements of Clinical Trial

Three versions:
12 items, 36 items and 12+24 items

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

Why measure Disability?

For Prediction of
patient s 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

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 as nurses 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 in Groningen, 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 status assessement 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, selfadministered 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-item version five minutes interviewer-administered, self administered and 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 additional questions 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

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
Respondent s ID No. Interviewer s ID No. Assessment time point (1,2, 3,.) Interview Date
Independent living in community (1) Assisted living (2) Hospitalised (3)
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Living situation:

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) Taking care of your household responsibilities? (D5) Learning a new task, for example, learning how to get to a new place?(D1) How much of a problem did your have joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?(D6) How much has you have been emotionally affected by your health condition?(D6) None Mild Moderate Severe Extreme or cannot do Extreme or cannot do Extreme or cannot do Extreme or cannot do

S2 S3

None None

Mild Mild

Moderate Moderate

Severe Severe

S4

None

Mild

Moderate

Severe

S5

None

Mild

Moderate

Severe

Extreme or cannot do

WHO- DAS 2.0- 12 Items (Score 1- 5): Interview

In the past 30 days, how much difficulty did you have in: S6 S7
Concentrating on doing something for ten minutes? (D1) Walking a long distance such as a kilometer [or equivalent]? (D2) Washing your whole body? (D3) Getting dressed? (D3) Dealing with people you do not know? (D4)
None Mild Moderate Severe Extreme or cannot do Extreme or cannot do

None

Mild

Moderate

Severe

S8
S9 S10 S11 S12

None
None None

Mild
Mild Mild

Moderate
Moderate Moderate

Severe
Severe Severe

Extreme or cannot do
Extreme or cannot do Extreme or cannot do Extreme or cannot do Extreme or cannot do

Maintaining a friendship? (D4) None Your day-to-day work? (D5)

None

Mild Mild

Moderate Moderate

Severe Severe

Core Question H1-H3

H 1 : Overall, in the past 30 days, how many days were these difficulties present? H2 : In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition? H3 : In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition?

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)

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