Clinical Outcomes of Geriatric Care in Cipto Mangunkusumo Hospital, Before and After the Implementation of National Health Insurance Program
Abstract: the National Health
Insurance (NIH/JKN) has been enacted since January 2014. Various outcomes of
geriatric patient care, such as improved functional status and quality of life
have not been evaluated. Prolonged hospitalization and re-hospitalization are
potentially affecting the efficiency care of this vulnarable group. This study
aimed to identify the differences of functional status improvement, quality of
life improvement, length of stay, and hospitalization of geriatric patients
admitted to CMH between prior to and after NHI implementation.
Methods: a cohort study with historical control was conducted among
geriatric patients admitted to Acute Geriatric Ward CMH Hospital on two periods
of time: January-December 2013 (pre-NHI implementation) and June 2014-May 2015
(after NHI implementation). Patients who died within 24 hours of hospital
admission, those with APPACHE II score >24, advance stage cancer, transfer
to other wards before they were discharged or have incomplete record were
excluded from the study. Data on demographical and clinical characteristics,
functional status, quality of life, length of stay, and re-hospitalization were
taken from patient’s medical record. The differences of studied outcomes were
analyzed using t-test or Mann-Whitney test.
Results: there were 102 subjects in pre-NHI and 135 subjects in NHI
groups included in the study. Median lengths of stay were not different between
two groups (12.5 days in pre-NHI and 10 days in NHI groups, p=0.087), although
the proportion of patients with in-hospital stay less than 14 days was higher
in NHI group. The difference of functional status of discharged patients in
pre-NHI and NHI groups were 3 and 3 (p=0.149) respectively, whereas for
health-related quality of life, although NHI group in the beginning showed a
lower quality of life compared to the pre-NHI (0.163 [0.480] vs. 0.243 [0.550];
p=0.012). However, after incorporating comprehensive geriatric assessment (CGA)
the quality of life improved significantly by the end of in-hospital care in
both groups. Re-hospitalization incidence in NHI group was lower compared to
pre-NHI (7 [5.2%] vs. 13 [12.7%]; p=0.038).
Conclusion: our study shows that there was no
significant difference regarding length of stay, functional status, and
health-related quality of life between prior to and after national health
insurance implementation on admitted geriatric patients. Rehospitalization
incidence showed better results in NHI group and hence NHI implementation is
favored.
Keywords: national health
insurance (NHI); clinical service outcome; geriatrics
Author: Czeresna Heriawan
Soejono, Retna S Padmawati, Adi Utarini
Journal Code: jpkedokterangg170333
