SISTEM PENDUKUNG KEPUTUSAN KLINIS DALAM PELAKSANAAN INA-CBG DI RSUP DR. SARDJITO YOGYAKARTA (MODEL PENERIMAAN TEKNOLOGI OLEH KLINISI)

Introduction. Some problems occurred, after the implementation of the DRG in the Sardjito Hospital Yogyakarta. One is them is a discrepancy between the real health care cost and INA-CBGs tariff. This establishes the gap. Gap was caused by incompatibility use drug formularies, incompatibility laboratory use, incompatibility using other medical support services with standard INA-CBGs, errors diagnosis coding classification INA-CBGs, LOS lengthy, incomplete medical records and more. Studies to investigate the cause of the gap will help hospitals to control expenditure financing. Modeling gap with several factors is used to help efficiency planning of clinical care of patients JAMKESMAS. The gap modeling will be used to construct clinical decision support systems. Clinical decision support systems are used by clinician in medical care planning that did not cause financial loss to the hospital and the patient. Objective. 1) This study was analyze the factors that influence the gap of Acute Lymphoblastic Leukemia (ALL) diagnosis. ALL is the diagnosis with the highest rates of visits and gap. 2) Constructing Clinical Decision Support System (DSS) applications that can help clinician provide health services with efficient cost. 3) Evaluate the level of clinician acceptance of clinical decision support systems applications. Methods. This research is quantitative and qualitative in-depth interviews and focus group discussions. The sample was medical records of ALL patients in 2009-2010 in Sardjito Hospital. To analyze the factors that influence the gap using ridge regression analysis, in order to eliminate the effects of multicollinearity among the independent variables. To analyze the level of acceptance of DSS application using path analysis. The analysis is based on data about the clinician's perception of the application. Clinician sample size was 31 residents. Results. The diagnosis of ALL have outlier values of gap as much as 8.1%. ALL patients were included in the group of chemotherapy without complication comorbidity (without CC)and Length of Stay (LOS) high (> 5 days) about 20.8%. It causes chemotherapy without CC have extreme values (outliers) of gap. The main factors that affect the gap is the cost of medicine / medical equipment and medical support costs. This occurred in the group of patients chemotherapy with CC and chemotherapy with major CC. While the chemotherapy without CC, the main factors affecting the gap is the cost of accommodation. Clinician acceptance of the DSS application is affected by the ease of application used. Benefits of the application of INA-CBGs and useful applications to have only small influence, whereas clinician knowledge about the INA-CBGs do not affect the interest of clinicians using the application Conclusion. Heterogeneity gap values found in patients without CC with the highest factor affecting gap was cost of acomodation. Cost of acomodation is related to the length of patients treated in the chemotherapy group without CC. Based on the results of FGD with clinicians, the cause of the high days of treatment in patients with chemotherapy without CC is indiscipline clinicians fill medical records so that the classification grouping CBG should be shifted from CBG chemotherapy with CC / MCC, but classified in the chemotherapy group without CC. Highest gap in the chemotherapy group with CC and MCC, with the highest factors that affect the gap is cost of medicine/medical equipment. DSS applications have acceptance rate of 61.3% and was highest influence on the ease of application used