Referral Procedures Research Articles

Physicians’ Behavior in Referring National Health Insurance Patients to Hospital

Physicians’ decision to refer patients in primary health care is vital in supporting the referral system. The increase of referral cases impacted the claims cost and hospital workload. This study aimed to analyze the physicians’ behavior in referring National Health Insurance (NHI) patients to hospitals. This study employed a qualitative method; 18 informants were selected using purposive sampling and analyzed using content analysis. The data were validated by triangulating method, source, and data. Physicians referred patients when the cases could not be handled; there were indications of severe disease and required further examination. The obstacles in the referral system were pressure from NHI patients that wanted to be referred and diagnosed differently from ICD 10. In referring NHI patients, physicians had followed referral procedures and criteria. High referrals were caused by patients being forced to be referred, coming with complaints of severe disease, having examined in a hospital, and some cases should not be referred to but still referred by entering a similar diagnosis into the ICD 10. It is expected that public health centers will educate NHI patients related to tiered referral procedures in health services.

Diagnostic Interval: Experiences among Women with Breast Cancer in Malaysia

BACKGROUND: The diagnostic pathway is critical for early breast cancer detection and prognosis improvement. Countries such as the United Kingdom, particularly England, have implemented faster diagnosis standards to ensure that patients receive a definitive diagnosis of cancer or are ruled out within 28 days of referral. However, there is a severe shortage of data on the experiences of breast cancer patients in Malaysia during the diagnostic interval. AIM: This study aimed to explore what happened to the women during the diagnostic phase prior to confirmation of breast cancer. METHODOLOGY: Purposive sampling was applied, and 14 participants were recruited from two government hospitals. The participants took part in in-depth, face-to-face, one-time, and audio-recorded interviews. All the interviews were subsequently transcribed verbatim and analyzed using narrative analysis. RESULTS: The diagnostic interval for the women in this study was 1–3 months from first medical contact till diagnosis. Four themes were identified during the analysis for the diagnostic interval: 1) Women who are suspected of having breast cancer; 2) Women who experience false reassurance; 3) Woman who experience delayed referral; and 4) Women who experience inconclusive investigation results. CONCLUSIONS: This study indicates that early warning signs of breast cancer may prompt doctors to take immediate action. However, unexpected delays may occur as a result of staffing and system issues in the healthcare system. Healthcare professionals should aggressively refer patients with typical symptoms and actively follow-up with patients who present with atypical symptoms in the community. Continuing education for healthcare professionals is necessary to improve diagnostic and referral procedures.

Patient satisfaction with referral service and associated factors among public hospitals in and around Addis Ababa, Central Ethiopia.

Objective:Studies in sub-Saharan Africa have shown that patient satisfaction with referral procedures and systems is low due to multiple factors. Despite the challenges on patient satisfaction with referral service in Ethiopia, there are only limited studies on overall satisfaction and associated factors with referral services of the hospitals. The purpose of this study was to determine patient satisfaction with referral services and related characteristics among patients referred to referral hospitals in Central Ethiopia, in the year 2021.Methods:A facility-based multi-center cross-sectional study was conducted at public hospitals in and around Addis Ababa using both quantitative and qualitative data collection methods. The hospitals were selected using a simple random sampling method from the list. Data were collected from 317 referral forms and chart reviews, 310 patient interviews, 27 focused group discussions, and 16 insider observations. The collected data were coded and entered into EPI INFO version 7 and transferred to SPSS version 25 for further analysis. Both binary and multivariable logistic regression models were computed to see the association between independent versus outcome variables. The findings were taken as significant with a p value of <0.05 at 95% confidence interval and results were presented with text, graphs, figures, and tables.Result:Overall level of patients’ satisfaction of referral services in Central Ethiopia was 73.5%, confidence interval (67.9%–81.1 %,) and near 85% of the participants had got an examination by the respective health care worker on arrival. This study identified that factors that increase odds of patient satisfaction toward referral services were status of communication (adjusted odd ratio 44.09 (95% confidence interval, 5.47, 355.68), perceived level of experience of health providers who handle the referral process (adjusted odd ratio 6.42 (95% confidence interval, 1.20, 34.42) and coordination status of the hospitals during referral acceptance (adjusted odd ratio 35.50 (95% confidence interval, 4.87, 258.60) and these were significantly associated with patient’s satisfaction toward referral services. Referral without communication among hospitals was stated as the leading challenge by focused group discussants and very limited practice on referral feedback was reported by insider observers.Conclusion:This study determined that the overall level of patient satisfaction toward referral services in Central Ethiopia was moderate with identified factors that increase odds of patient satisfaction toward referral system being the way of communication, health provider’s experience, and coordination status of the hospitals on referral acceptance. Hence, policymakers and the ministry of health would better consider the aforementioned factors during referral program development and training for improvement of patients’ satisfaction with referral services.

Outcome of Women Referred with Postcaesarean Complication in a Tertiary Care Centre in North India: A Retrospective Study

Introduction: Rate of Caesarean Sections (CS) has increased over the last few decades. There is an increased referral of women with postcaesarean complications. Aim: To evaluate the outcome of women with postcaesarean complications. Materials and Methods: This retrospective study was conducted at the Department of Obstetrics and Gynaecology, King George’s Medical University Lucknow, India over six months from August 2018 to January 2019. All the women referred with postcaesarean complications were included in the study. Women who had complications following CS performed at the centre were excluded. Demographic variables including age, socio-economic status, literacy, number of antenatal visits, indication for CS. The type of complication, number of places visited before admission, the interval between complication and admission, availability of referral documents, interventions required and outcome was noted. Chisquared tests were used to test for statistical significance. Thep-value was considered to be significant if &lt;0.05. Analysis was done using Statistical Package for the Social Sciences (SPSS) software 20.0. Results: Total women enrolled were 146, with mean age of women was 27.69±4.7 years. The youngest woman was 19 years, while the oldest was 36 years. Total 60.2% (88/146) women were referred from government centres, and the majority of women (82.18%) reached tertiary centres directly and had a referral document. The interval between complication and admission was within 24 hours in only 55 (37.66%) women. The most common reason for referral was septicaemia (39,26.71%), followed by Postpartum Hemorrhage (PPH) (27,18.49%). Mortality was seen in 35,24.6 % of women. Conclusion: Most women referred with postcaesarean complications were from the public health system with appropriate referral procedures. Timely referral after detection of complications will improve maternal outcome.

Turkish Version of Structured Interview of Psychosis-Risk Syndromes (SIPS) and Proposal of a Brief Version of SIPS as a Pretest Risk Enrichment.

The Structured Interview of Psychosis Risk Syndromes (SIPS) was created to identify patients with Clinical High Risk for psychosis (CHR). This study aimed i) to translate and validate the Scale of Prodromal Syndromes (SOPS) in Turkish adolescents, ii) to explore the factor structure of the SIPS/SOPS in the adolescent population, especially focusing on those under the age of 15, iii) to generate a brief version of SIPS (SIPS-B). A total of 150 adolescents aged between 12 and 18 years, were consecutively interviewed using SIPS/SOPS. Patients with psychotic syndrome (n=20), psychosis risk syndrome (PRS) (n=59), and clinical controls (CC) (n=71) were included in the study. Principal component analysis (PCA) yielded three latent factors, explaining 62.7% of the total variance in the whole clinical sample, including positive symptom factor, disorganized symptom factor, and negative symptom factor. The area under curve calculated in ROC analyses involving PRS and CC supported the four-item form of the SIPS-B (optimal cut-off=12.5, sensitivity=87%, specificity=80%). Our study results support the notion that the Turkish translation of SIPS/SOPS meets the reliability and validity criteria in Turkish adolescents. The SIPS-B could aid clinicians in their routine clinical practice to expedite referral procedures.

Analysis Of Procedures References Implementatiom National Health at Ujoh Bilang Public Health Center Mahakam Ulu District

Background:&#x0D; The number of referrals at Ujoh Bilang Health Center in 2016 wa 31 referrals in 2017 there were 37 referrals in 2018 there were 41 referrals and untiil april 2019 there were 114 referrals.&#x0D; Objectives:&#x0D; The research objective was to analyze procedures for implementing the referral system at Ujoh Bilang Public Health Center.&#x0D; Research Metodes: &#x0D; This Type of research is qualitative with a case study approach through interviews, observation and documentation of 4 informants namely doctors, nurses, the Head of Administration and the Head of Community Health Center. Data analysis techniques are data collection, reduction, data presentation and conclusion drawing&#x0D; Findings: &#x0D; The results of the study was to procedures for implementing the referral system based on National Referral System Guidelines but the public health center can’t reach refferal health facilities beacuse online network facilities were not available. The referral procedure at Ujoh Bilang Helath Center is in accordance with the National Referral System Guidlines but the puskesmas does not contact the referral destination health facility before the patient is referred because there is ni inline referral&#x0D; Conclusion: &#x0D; It was concluded that the provision of an internet network was inadequate, the puskesmas did not contact health facilities before seeing patients. Suggestionsfor the Ujoh Bilang Public Health Center Are to Provide an internet network in the form of wifi

An Analysis of Service Provision Standards in Primary Health Care Facilities of Khyber Pakhtunkhwa, Pakistan

This study explores the on-ground facilities available at primary healthcare facilities (PHCFs) against the service quality standards set by the provincial government of Khyber Pakhtunkhwa (KP), Pakistan. Primary data through a structured questionnaire was collected from 109 PHCFs. Two hundred seven responses from patients, 109 responses from PHCFs doctors and medical staff, and 109 researcher’s observations were recorded. Most service provision standards were met in rural health centres (RHCs) and basic health units (BHUs). However, the situation at civil dispensaries (CDs) was very alarming. Patients preferred RHCs on BHUs and CDs because of relatively better quality services provided in RHCs. However, in general, patients prefer to go to secondary or tertiary health care facilities due to the number of reasons identified by this study. Among the areas which demand quality improvement include cultural constraints, lack of following standard operating procedures (SOPs) for referral, no transport facility to referred patients, higher waiting time for patients, and no or fewer health education sessions, and unavailability of cold chain and waste disposal system. By addressing problem areas identified by this study, the KP government can reduce the patient burden on secondary and tertiary health facilities. As a result, service quality at PHCFs will improve access to primary health care, a world health organization’s millennium development goal, and the united nations’ sustainable development goal.

Abstract 14264: National Comparison of Hospital Market Share for Out-of-Hospital Cardiac Arrest and Elective Cardiac Surgery

Introduction: Competition in the healthcare market is a theoretical driver of innovation, cost-savings, and improved quality. When patients are treated for certain emergent conditions, such as out-of-hospital cardiac arrest (OHCA), individuals have less choice in their treating hospital. For patients undergoing elective cardiac valve replacement surgery (EVRS), hospital choice may reflect distinct referral patterns and preferences. Our objective was to compare hospital market share for different cardiac services, thus allowing for better understanding of the care landscape and target interventions to improve outcomes. Methods: Using age-eligible Medicare fee-for-service institutional claims, an emergency department (ED) treated OHCA cohort was identified via ICD-9/10 diagnosis codes and ED charges. EVRS, an inpatient referral procedure, were identified from in-patient summary claims using procedure codes. Market shares were built for each hospital by sequential addition of ZIP-code areas and calculating the hospital’s cumulative market share. Geographic market share areas were defined for each hospital at 90%, 25% and 10% cut-offs if present. Correlation between corresponding market shares and patient counts were assessed using Pearson’s r. Results: Between 1/2013 and 12/2015, we identified 206,162 EVRS claims and 222,018 OHCA claims. Median age was similar (77 vs 78 yrs), as was percent of female patient (43% vs 44%). Very few beneficiaries (0.38%) appeared in both cohorts. Many more hospitals cared for OHCA than EVRS (4482 vs 1170). More OHCA treating hospitals achieved a 25% market share (68% vs 57%) however, EVRS hospital with a 25% market share covered more population (420,294 vs 66,394) and had a greater client radius (21 vs 15 miles). Among the hospitals providing care to both cohorts, the cumulative market share and patient counts were positively correlated (r = 0.49 and 0.46 respectively, p&lt;0.001 for both). Conclusion: Despite many more hospitals providing care for OHCA, the market share for EVRS and OHCA trend together. This market trend, combined with the association of better outcomes with higher OHCA volume suggests that OHCA should be regionalized within markets to facilities that provide elective cardiac surgical procedures.

Contributing factors to perinatal mortality among women who gave birth at the Jimma University Medical Centre, southwest Ethiopia

Background Perinatal mortality remains a challenge worldwide, particularly in developing countries. Although significant achievements have been made to reduce neonatal mortality worldwide, in the last two decades there was a total of 5.3 million neonatal deaths and stillbirths each year. This study aims to assess the magnitude of perinatal mortality and its contributing factors among births at the Jimma University Medical Centre in Ethiopia. Method A facility-based cross-sectional study was conducted between January and April 2017. Convenience sampling was used to select study participants and data were collected using interviewer-administered pretested structured questionnaires. Descriptive statistics were used to analyse the data, with the chi-square test used to assess the relationship between each factor and outcome. Statistical significance was set at P&lt;0.05. Results The rate of perinatal death was 107 per 1000 births, of which 39.2%, 25.9% and 34.9% were fresh stillbirths, macerated stillbirths and early neonatal deaths respectively. The majority (77.8%) of stillbirths occurred before the study participant reached the hospital and 64.3% of stillbirths had low birth weight. Hyaline membrane disease (27.6%) and meconium aspiration syndrome (20.7%) were the two most common causes of early perinatal death. Obstetric complications contributed to 89.6% of perinatal deaths. Stillbirth was significantly associated with a lack of education (P=0.036). The rate of perinatal mortality was high among women with their first pregnancy (53.0%) and those who had no previous pregnancy-related problems (79.5%), and was significantly associated with mechanical causes and antepartum haemorrhage (P=0.015). Conclusions The findings indicated that the rate of perinatal mortality was high at the Himma University Medical Centre. Improving maternal education and health services in rural areas are important steps to prevent poor perinatal outcomes. Facilitating transport and improving referral procedures may help to prevent mechanical complications, which are the most common cause of perinatal death, particularly fresh stillbirths which, in the present study, often occurred before a participant arrived at the hospital.

Are We Facing a New Colposcopic Practice in the HPV Vaccination Era? Opportunities, Challenges, and New Perspectives.

The combination of primary and secondary prevention has already influenced the colposcopic practice by reduction in HPV (human papillomavirus) vaccine-type HSIL (HIGH-GRADE SIL), colposcopy referral numbers, colposcopic positive predictive value (PPV) for CIN2+, and by modification of referral pattern, colposcopic performance, and procedures. Different strategies, both isolated and combined, have been proposed in order to maintain the diagnostic accuracy of colposcopy: patient risk stratification based on immediate or future risk of CIN3+ or on HPV genotyping after a positive screening test. Data are needed to support alternative colposcopic strategies based on vaccination status and on the application of artificial intelligence where the patient’s risk stratification is implicit in precision medicine which involves the transition from an operator-dependent morphology-based to a less-operator dependent, more biomolecular management. The patient’s risk stratification based on any combination of “history” and “test results” to decrease colposcopy workload further reduce colposcopic and histologic morphological approaches, while adding genotyping to the risk stratification paradigm means less cytologic morphologic diagnosis. In Italy, there is a strong colposcopic tradition and there is currently no immediate need to reduce the number of colposcopies. Instead, there is a need for more accredited colposcopists to maintain the diagnostic accuracy of colposcopy in the vaccination era.

Reflections on Direct Access to the African Court on Human and Peoples’ Rights: A Cul De Sac?

Individuals and NGOs can directly access the African Court on Human and Peoples’ Rights if the state against which a case has been filed has made an optional declaration granting this access. Alternatively, they can access the Court if the African Commission on Human and Peoples’ Rights refers communications to it. However, two main barriers have riddled this structure. One, the few states that had made the optional declaration have begun to rapidly withdraw from it. Two, the African Commission, which was expected to mitigate such a situation where few states are making the optional declaration, is hardly referring cases to the Court. This paper examines these two barriers in tandem. It argues that if this status quo is sustained, then, sooner rather than later, this path treaded may lead the African human rights system to a cul-de-sac – back to a one tier system, composed of an accessible Commission and a Court inaccessible to both individuals and NGOs. Drawing lessons from the European and Inter-American Human Rights system, it recommends preventing this eventuality by amending the African Commission’s 2020 Rules of Procedure to provide for a default procedure of referral of cases from the Commission to the Court.

Understanding barriers to implementing referral procedures in the rural and semi-urban district hospitals in Tanzania: Experiences of healthcare providers working in maternity units.

Maternal and perinatal deaths occurring in low and middle income countries could be prevented with timely access to maternal and new-born care. In order to increase access to maternal and child health services, a well-functioning referral system that allows for continuity of care across different tiers of healthcare is required. A reliable healthcare system, with adequate numbers of skilled staff, resources and mechanisms, is critical to ensuring that access to care is available when the need arises. This descriptive, qualitative study design was used to explore barriers to implementing a reliable referral system. Twelve individual qualitative interviews were conducted with health care providers working in rural and semi-urban district hospitals in the Northern, Western, Eastern and Southern zones of Tanzania. Thematic analysis guided analysis of data. Three (3) main and interconnected themes were abstracted from the data relating to participants' experiences of referring women with obstetric complications to adequate obstetric care. These were: 1. Adhering to a rigid referral protocol; 2. Completing the referral of women to an adequate health facility and 3. Communicating the condition of the woman with obstetric complications between the referring and receiving facilities. Because of referral regulations, assistant medical officers were unable to make referral decisions even when they felt that a referral was needed. The lack of availability of hospital transport as well as the lack of a reliable feedback mechanism, prohibited effective referrals of patients. The Ministry of Health should revise the referral protocol to allow all clinicians to provide referrals, including assistant medical officers- who make up the majority of clinical staff in rural health care facilities. A mechanism to ensure effective communication between the referral facility and the tertiary care hospital should be instituted for quality and continuity of care. Furthermore, health care facilities should put aside budget for fuelling the ambulance for effective referrals.

Diagnostic and Cost Implications of the 2020 AUA Microhematuria Guidelines: Modeling Impact in a Large Public Health Care System.

We sought to model the diagnostic recommendations and associated costs of new hematuria guidelines regarding referral patterns, procedure utilization and urothelial cell carcinoma (UCC) detection. Patients with microhematuria were identified retrospectively. Initial encounter data were collected from January 2017 to May 2018 from a large public health care system; followup was continued to December 2020. Risk stratification was performed based on the American Urological Association 2020 microhematuria guidelines, and disease outcomes were analyzed within this framework. The guideline-recommended workups and costs were modeled; cost data were sourced from the Centers for Medicare & Medicaid Services Medicare Physician Fee Schedule and Clinical Laboratory Fee Schedule for 2020. Modeled diagnostic volumes and costs were assessed for 2020 and 2012 microhematuria guidelines, respectively. Of the 3,789 patients included for analysis, 1,382 (36.5%), 1,026 (27.1%) and 1,381 (36.4%) were retroactively stratified as low risk, intermediate risk (InR) and high risk (HiR), respectively. A total of 19 cases of UCC (17 bladder, 2 upper tract) were diagnosed, of which 84% were HiR. For high-grade UCC, 92% of cases were HiR. The 2020 guidelines recommended renal ultrasound for 1,117 InR cases, computerized tomography urogram (CTU) for 1,476 HiR cases, and cystoscopy for 2,593 InR and HiR cases combined. Total costs were $1,905,236 (2012) versus $1,260,677 (2020), driven mainly by CTU costs. Per-cancer detected costs were $100,276 (2012) versus $61,760 (2020). In retrospect, the 2020 guidelines would have effectively risk-stratified microhematuria cases for detection of malignancies. As compared to the 2012 guidelines, application of the 2020 guidelines would result in significant changes to diagnostic and procedural volumes, while substantially reducing total and per-patient costs.

Post-Identification Approaches to Addressing Health-Related Social Needs in Primary Care: A Qualitative Study.

Social determinants of health play a fundamental role in a patient's health status. In recent years, health systems across the nation have implemented numerous strategies aimed at identifying and addressing the health-related social needs of the patients they serve. Despite the influx of peer-reviewed research highlighting outcomes of specific health-related social needs interventions, the spectrum of practices utilized by primary care clinics has not been established. To determine the range of ways primary care clinics address health-related social needs after identification and initial contact with a frontline staff person is completed. We conducted 12 semi-structured, in-person interviews with staff from purposively sampled clinics. If the interview included more than one staff person, all participants were interviewed together. Twenty-one administrative staff and frontline clinic personnel with experience in 24 separate primary care clinics in the Minneapolis-St. Paul, Minnesota metropolitan area. Interviews focused on the range of health-related social needs processes utilized by clinics, including staff titles, referral procedures, and barriers to addressing needs. Interview recordings were transcribed and coded using thematic analysis. Thematic analysis identified variation in four key areas involving how clinics address patients' health-related social needs after identification and initial contact by frontline staff: clinic personnel involved in addressing needs, clinic referral processes, "resource" and "success" definitions, and barriers to accessing community-based supports. This study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies.

Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol

BackgroundFollowing a finding of alcohol use among children aged 5–8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6–13 years...

EDUKASI TENTANG PROSEDUR PERMINTAAN RUJUKAN BPJS DI PUSKESMAS TALUN KENAS

Talun Kenas Health Center is one of the Technical Implementation Units of the Deli Serdang District Health Office. In the current BPJS era, the Talun Kenas Health Center provides first-level health services related to the National Health Insurance, where referrals for BPJS patient services are still said to be high from 2017. This is caused by officers who do not understand the referral policy for outpatient health centers properly, the availability of medicines is limited and the supporting facilities for medical equipment are minimal. Education is carried out with the aim that officers who are responsible for and involved with BPJS referral procedures can carry out their duties better due to increased knowledge and understanding of the BPJS referral system. The number of participants in the educational activity was 18 health workers at the Talun Kenas Health Center. After the implementation of the activity, there was a significant increase in knowledge related to the referral system and referral for BPJS patients.

Perspectives of health care providers referring patients to a newly implemented sexual health program in a Canadian cancer center.

Screening and discussion about sexual health concerns within cancer care are frequently impeded by lack of access to sexual health resources and lack of fluency with sexual health topics. To address this, a multi-disciplinary sexual health program was developed and piloted in a Canadian tertiary cancer center. The aim of this study was to assess referring health care providers' perspectives on the newly implemented oncology sexual health program. A brief online survey was administered system-wide to cancer care providers to query their perceptions of the pilot multidisciplinary sexual health program, the Oncology and Sexuality, Intimacy and Survivorship (OASIS) program. According to survey results, the OASIS program was perceived by health care providers as valuable, helpful for patients, and important for addressing gaps in clinical care. Additional comments indicated an ongoing need for increased access to information about the program and referral procedures. Survey results highlight the need for consistent program dissemination efforts to equip health care providers with accessiblepatient education materials and easily implemented referral procedures. Importantly,providers indicated that they were more likely to raise the topic of sexuality with patients because they had somewhere to refer patients who had sexual concerns. Overall, findings inform efforts to implement sexual health programming within cancer care institutions.

Awareness of genetic counseling services among allied healthcare professionals in South Africa.

Genetic counseling has been shown to increase patient empowerment leading to positive outcomes. However, in the Johannesburg state healthcare system, the genetic counseling service is underutilized. Individuals with genetic disorders present with a variety of symptoms and are frequently referred to allied healthcare professionals for management; therefore, these professionals are in a unique position to identify appropriate patients and refer them for genetic counseling. This study aimed to determine whether allied health professionals, including physiotherapists, occupational therapists, and speech and language therapists, were aware of genetic counseling services in Johannesburg, South Africa, and whether they had previously referred patients to these services. The study also aimed to identify barriers and facilitators to referral. An adapted paper-copy questionnaire was administered to allied health professionals working at one of three state hospitals in Johannesburg. A total of 57 participants were included in this study. Results indicated that 29/57 (50.9%) of allied health professionals knew that genetic counseling services were available but only 15/29 (51.7%) of those who knew of the service had referred patients to these services in the last year. Barriers to referral included misconceptions about the role of genetic counselors, insufficient knowledge of which patients would benefit from genetic counseling, and being unable to obtain appropriate information from the Genetics Clinic for patient referral. However, allied health professionals recognized the benefit of genetic counseling and 53/57 (93%) wanted to increase their genetics knowledge. Therefore, genetics education of allied health professionals, and improved information regarding the referral procedure for genetic counseling, may improve the number of patients referred.

Studi Implementasi Sistem Rujukan Berjenjang Antar Fasilitas Kesehatan Tingkat Lanjut di Era JKN di Provinsi Sulawesi Selatan

One of the determinants of achieving quality control and cost control is the implementation of tiered referral health. This research was motivated by the absence of research on the implementation of referrals from FKTP to FKTL. Data from RSUP Dr. Wahidin Sudirohusodo’s annual report showed in 2015 and first half of 2016, &gt;60% cases in class A hospital were level 1 severity case which should still be handle in class D and C hospitals. This affects the accumulation of patiens in tertiary hospitals and inefficient use of resources. It is a qualitative research with phenomenology approach to determine the implementation of a tiered referral system between advanced health facilities in JKN era in South Sulawesi. The results shows most of referral were made due to facilities limitation and inavailability of specialist. There were referrals which made based on patients requests not based on clinical reasons. It is also found hospital staff who did not know about the existing of standard operational procedure of referral in the hospital. Some hospital staff has no knowledge on the referral regulation nor about hospital classification. This research is expected to be able to contribute to the development of science and can be used as input for hospitals and BPJS in an effort to improve the optimization of tiered referral services. Based on the results of the study it is recommended to improve facilities and infrastructure that can support the provision of referral services in hospitals.

STUDY ABOUT THE HEALTH REFERENCE INFORMATION SYSTEM IN THE CASE OF NON SPECIALISTICS IN KENDARI CITY PRIMARY HEALTH CARE

Background: I Implementation of a reference information system will not work well when its implementation is not in accordance with the policy or guidelines. One of the problems in implementing the referral system is the health information system, in this case the referral guidelines and referral templates. Methods: This research uses qualitative method and it conducted the Kendari City Inpatient Primary health care form April 2020 to August 2020. The informants in the study were the Kendari branch of the health insurance officers, consisting of the Head of the Inpatient Community Health Center, the doctors of Inpatient Primary health care, the Head of Primary Benefit Guarantee and 4 referral patients in the Inpatient Primary health care. Data analysis of interview data used a NVIVO QSR application 12. Results: There is a conceptual linkage between the Reference Guidelines, Referral Procedures, and Reference Patterns with the concept of implementing the referral system Conclusion: There is a conceptual linkage between the Reference Guidelines, Referral Procedures, and Reference Patterns with the concept of implementing the referral system.