Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals.

Background: Hospitals are required to improve the quality of health services provided to patients. Purpose: Evaluating and comparing the healthcare quality received by insured patients hospitalized in two Indonesian regional public hospitals. Methods: Secondary data analysis used the 2019 and 2020 Indonesian National Health Insurance e-claim databases of Hospital A and Hospital B. Descriptive and crosstabs analyses were used to determine INA-CBGs diagnoses that were categorized as high volume, high risk, and high cost. Results: The admissions that caused financial loss at the Hospital A were 21.1% in 2019 and 19.8% in 2020, while 30.3% in 2019 and 27.5% at the Hospital B. More than 60% of these admissions were placed in the 3rd class of inpatient wards of the two hospitals. Of these admissions, < 5% at the Hospital A and >5% at the Hospital B were readmitted within 30 days, although more than 90% were previously discharged based on physicians' approval. Conclusions: Inadequate healthcare quality received by insured patients. Hence, an integrated clinical pathways based professional nursing practice model is highly recommended to increase patient outcomes and decrease 30 days hospital readmission rates.

Postgraduate nurse education in Indonesia and Australia: A comparative analysis.

BACKGROUND: Indonesia and Australia are neighbouring countries; however, their nursing systems are very different and there is limited migration between countries. AIM: As part of a larger study, the aim was to undertake a comparative analysis of postgraduate nurse education in Indonesia and Australia. DESIGN: Detailed literature review across academic and grey literature and semi-structured interviews with key stakeholders in Indonesia (n = 52) and Australia (n = 13) representing education, governments, professional nursing organisations, and rural, remote and urban health care providers. FINDINGS: Three key categories of comparison were identified: Higher Education System, Education Offerings, and Specialist practice and education standards. Regulation of higher education was found to generally be comparable. Postgraduate nursing specialisations are available in both countries, but there are currently more offerings in Australia. Furthermore, nurse practitioner education and graduate entry pathways into nursing are only currently available in Australia. Journal publications are required for graduation from masters and doctoral programmes in Indonesia, but not Australia. CONCLUSIONS: While there are many areas of similarity, postgraduate nurse education is more diverse in Australia, while there are growing opportunities for new developments in Indonesia. This analysis identifies areas for future consideration around postgraduate education development in both countries, along with possibilities for future collaboration. Furthermore, comparative analysis provided a useful foundation on mapping key elements.

Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis.

OBJECTIVE: This study aimed to evaluate the health care quality among insured patients hospitalized in the Indonesian mother and child hospital. METHOD: A secondary data analysis was performed to evaluate the health care services received by the insured patients hospitalized in the Indonesian mother and child hospital. Data were extracted from the BPJS health insurance e-claim database from January 1 to December 31, 2019 and from January 1 to June 30, 2020. A descriptive and bivariate analysis were used to examine total patients and hospital admissions; INACBGs diagnoses, procedures by severity; types of inpatient wards; length of stay; discharge status; hospital costs; and 30-day readmissions. RESULTS: Total inpatient unit admissions were 2870 in 2019 and 1533 in 2020. From total hospital admissions in 2019 and 2020, over 50% were admitted to the 3rd class of inpatient units, less than 10% had length of stays more than 5 days, and over 98% were discharged based on physician approval. However, hospital readmissions were also found for about 20.1% in 2019 and 2.9% in 2020 and about 42.9% in 2019 and 61.3% in 2020 were found causing hospital financial losses. Older patients, longer hospital stays, inpatient ward class 1 & 2, high hospital tariff, inadequate clinical pathway implementation, lack of interprofessional collaboration, and ineffective nurse manager supervision were identified as contributing factors to the hospital financial losses. CONCLUSION: Integrated clinical pathways with interprofessional collaboration that are implemented through professional nursing practice model are suggested for health care quality improvement.

Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis

Objective: This study aimed to evaluate the health care quality among insured patients hospitalized in the Indonesian mother and child hospital. Method: A secondary data analysis was performed to evaluate the health care services received by the insured patients hospitalized in the Indonesian mother and child hospital. Data were extracted from the BPJS health insurance e-claim database from January 1 to December 31, 2019 and from January 1 to June 30, 2020. A descriptive and bivariate analysis were used to examine total patients and hospital admissions; INACBGs diagnoses, procedures by severity; types of inpatient wards; length of stay; discharge status; hospital costs; and 30-day readmissions. Results: Total inpatient unit admissions were 2870 in 2019 and 1533 in 2020. From total hospital admissions in 2019 and 2020, over 50% were admitted to the 3rd class of inpatient units, less than 10% had length of stays more than 5 days, and over 98% were discharged based on physician approval. However, hospital readmissions were also found for about 20.1% in 2019 and 2.9% in 2020 and about 42.9% in 2019 and 61.3% in 2020 were found causing hospital financial losses. Older patients, longer hospital stays, inpatient ward class 1 & 2, high hospital tariff, inadequate clinical pathway implementation, lack of interprofessional collaboration, and ineffective nurse manager supervision were identified as contributing factors to the hospital financial losses. Conclusion: Integrated clinical pathways with interprofessional collaboration that are implemented through professional nursing practice model are suggested for health care quality improvement. (AU)

Development and evaluation educational videos of diabetic foot care in traditional languages to enhance knowledge of patients diagnosed with diabetes and risk for diabetic foot ulcers.

AIM: This study aimed to develop an educational video for diabetic foot care in the traditional languages (Buginese and Makassarese) and evaluate the change in the patients' knowledge level after they viewed the video. METHODS: The study was performed in the following three phases: development of the video content using a Delphi Study that involved wound-care nurses, evaluation of the video's content validity by the expert panel, and evaluation of the video in the community setting by showing it to patients who spoke the traditional languages, were diagnosed with diabetes mellitus (DM), and were at risk of diabetic foot ulcers (DFU). RESULTS: Five themes emerged from the Delphi study, including observation of pre-ulcer signs, washing feet, cutting toenails, wearing socks, and checking footwear. Content validity evaluation recommended these items to be constructed for video education using the traditional languages. Evaluation in the community setting confirmed that there was a significant improvement (p = 0.001) in the knowledge about foot care among patients diagnosed with diabetes and at risk of DFU. CONCLUSION: This study produced an educational video that used the trans-cultural approach by using traditional languages to overcome the communication barrier in the process of knowledge transfer. We found that the educational video in traditional languages enhanced the patients' knowledge about diabetic foot care and thus could enable them to detect the risks for DFU and prevent DFU.

Ethical issues in action-oriented research in Indonesia.

BACKGROUND: Action-oriented research is one of the most frequent research types implemented to transform community health in Indonesia. Three researchers and 11 graduate students from a developed country in East Asia conducted a fieldwork program in a remote area in South Sulawesi Province. Although the project was completed, whether or not the international standards for human subject research were applied into that study remains unclear. OBJECTIVES: This study aimed to examine ethical issues raised from that case, analyze constraints to the problems, and recommend alternatives to protect vulnerable populations from being exploited by local/international researchers. METHODS: A problem-solving approach was used in this study. It began with problem identification, evaluation of the action-oriented research goal, investigation of the constraints to the problem, and recommendation of some relevant alternatives to address the central issue. Ethical Consideration: The approval for conducting the action-oriented research that being investigated in this work was only obtained from the Head of local district. RESULTS: Some ethical issues were found in this case. No special protection for this population, no informed consent was obtained from the participants, exposure to social and economic risks, no future benefits for the subjects, and conflict of interests. Lack of control from the local research ethics committee and lack of competence of local researchers on human subject research were considered as the constraints to the problems. DISCUSSION: Creating an independent research ethics committee, providing research ethics training to the local researchers, obtaining written/video consents from underserved populations, and meeting local health needs were recommended alternatives to solve these problems. CONCLUSION: Indonesian government bodies should reform their international collaborative system on research involving human subjects. Exploitation may not occur if all participants as well as all local and national governing bodies understand the research ethics on human subjects and apply it into their practice.