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"Rumah Sakit Kanker Dharmais (RSKD) sebagai pusat rujukan penanganan penyakit kanker nasional di Indonesia, mulai menerapkan Lean Management dalam rencana strategi 5 tahun periode 2015-2019. RSKD menyusun agenda perubahan proses bisnis internal, salah satunya dengan proyek mengatasi waktu tunggu pelayanan kemoterapi peserta Badan Penyelenggaran Jaminan Sosial (BPJS) khususnya di ruang rawat singkat Anyelir (One Day Care). Value Stream Mapping digunakan untuk memperlihatkan situasi serta mengidentifikasi kegiatan yang Value Added dan yang Non-Value Added berdasarkan perspektif pasien. Dengan usulan perbaikan, Projected Value Perfomance memperlihatkan peningkatan efisiensi aktifitas pasien hingga 43,1%, memangkas waktu hingga 48%, dan jarak tempuh hingga 71,8% dalam sehari.

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Rumah Sakit Kanker Dharmais (RSKD) as a cancer referral centers nationwide in Indonesia, trying to implement a culture of continuous improvement. Lean methods provide analytical approach to the problem of organizing the queue chemotherapy participant of Badan Penyelenggaran Jaminan Sosial (BPJS), particularly in Anyelir ward (One Day Care). Cross-functional Flowchart, Value Stream Mapping, Fishbone diagram, and 5 Why's were used to show the situation and identify activities that Value Added and Non-Value Added based on the patient's perspective. With the proposed improvements, Projected Value Perfomance showed increased activity efficiency up to 43,1%, save the time up to" "48%, and cut the mileage up to 71.8% of one patient in a day."

"Pelayanan di Instalasi Gawat Darurat (IGD) memegang peran penting dalam menentukan kualitas pelayanan dan keselamatan pasien di rumah sakit. Indikator kinerja IGD, seperti Length of Stay (LOS), yang mengukur lama pasien d IGD dari kedatangan hingga pemulangan atau pemindahan, dapat memengaruhi tingkat kepadatan di IGD. Penelitian ini bertujuan untuk mengidentifikasi alur pelayanan, hambatan, dan akar penyebab masalah terkait LOS di IGD. Pengumpulan data dilakukan pada bulan April-Mei 2024 dengan pendekatan kualitatif studi kasus, berupa observasi pada 30 pasien, wawancara, dan telaah dokumen. Analisis data menggunakan flowchart untuk mengidentifikasi alur pelayanan, Value Stream Mapping untuk mengenali kegiatan bernilai dan menemukan waste, serta The Five Whys untuk menganalisis akar penyebab hambatan. Metode Lean Thinking digunakan untuk menghasilkan alur dan Model BAS (Baseline, Assess, Suggest Solution) dari Model BASICS. Hasil penelitian menunjukkan bahwa alur pelayanan pasien IGD melibatkan lima tahapan; dengan 65,5% waktu pelayanan adalah kegiatan non-value added, 23,4% kegiatan necessary but non-value added, dan 11,1% kegiatan value added, dengan total Lead Time 7 jam 55 menit 29 detik. Dari sisi pasien, waste yang terjadi meliputi waste of waiting (94,9%) dan transportation (5,1%). Bottleneck terjadi pada aktivitas menunggu terdaftar di rawat inap (25,2%), menunggu advis DPJP (22,9%), menunggu hasil pemeriksaan penunjang (22,3%), dan menunggu kesiapan rawat inap (18,2%), dengan total 88,6%. Perbaikan LOS di IGD dapat menggunakan lean tools seperti standardized work, visual management, heijunka, kaizen, dan just in time agar waste dapat dikurangi.

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Emergency Department (ED) services play a crucial role in determining the quality of care and patient safety in hospitals. Performance indicators in the ED, such as Length of Stay (LOS) which measures the duration from a patient's arrival to their discharge or transfer can significantly impact the congestion levels in the ED. This study aims to identify the service flow, obstacles, and root causes of issues related to LOS in the ED. Data collection was conducted from April to May 2024 using a qualitative case study approach, including observations of 30 patients, interviews, and document reviews. Data analysis involved using flowcharts to identify the service flow, Value Stream Mapping to recognize value-added activities and identify waste, and The Five Whys to analyze the root causes of obstacles. Lean Thinking methodology was applied to develop a service flow and the BAS (Baseline, Assess, Suggest Solution) model from the BASICS model. The study results show that the patient service flow in the ED involves five stages, with 65.5% of service time consisting of non-value-added activities, 23.4% of necessary but non-value-added activities, and 11.1% of value-added activities, resulting in a total lead time of 7 hours, 55 minutes, and 29 seconds. From the patient's perspective, the waste observed includes waiting (94.9%) and transportation (5.1%). Bottlenecks were identified in activities such as waiting to be registered for inpatient care (25.2%), waiting for specialist advice (22.9%), waiting for the results of supporting examinations (22.3%), and waiting for inpatient readiness (18.2%), totaling 88.6%. Improving LOS in the ED can utilize lean tools such as standardized work, visual management, heijunka, kaizen, and just-in-time to reduce waste."

"Latar Belakang : Waktu tunggu menjadi suatu permasalahan yang mendesak di rumah sakit karena semua rumah sakit saling berkompetisi untuk memberikan pelayanan yang tepat, cepat dan profesional. Di ruang rawat inap lantai 5 gedung baru RS Permata Cibubur kerap masih didapatkan keluhan pasien atau keluarga pasien terkait waktu tunggu pasien pulang dari rawat inap. Tujuan : Tercapainya perbaikan pelayanan pasien pulang dari rawat inap dengan menggunakan metode Lean Six Sigma. Metode : Penelitian ini menggunakan desain penelitian quasi experimental dengan memberikan perlakuan perbaikan menggunakan metode Lean Six Sigma dan menghitung waktu tunggu pada proses pelayanan pasien pulang pada 2 kelompok pasien dengan jaminan pribadi dan pasien jaminan asuransi swasta, sebelum dan sesudah perlakuan. Hasil : Setelah dilakukan observasi dan wawancara maka dilakukan identifikasi waste pada proses pelayanan pasien pulang dari rawat inap dan didapatkan 4 waste, yaitu waiting, defect, motion, dan overprocessing. Core problem dari proses pelayanan pasien pulang didapatkan bahwa DPJP tidak input sendiri resep pasien pulang, hal ini menyebabkan beberapa kegiatan yang tidak bernilai tambah dan membuat waktu tunggu proses pelayanan pasien pulang menjadi memanjang. Fokus perbaikan yaitu dengan menjadikan DPJP input sendiri resep pasien pulang dan didapatkan total waktu tunggu yang mengalami penurunan dan prosentase kegiatan bernilai tambah yang meningkat. Rata-rata waktu tunggu pasien pulang sebelum perlakuan dengan jaminan pribadi sebesar 61 menit dan dengan jaminan asuransi swasta sebesar 125,8 menit. Setelah dilakukan perlakuan upaya perbaikan dengan metode Lean Six Sigma didapatkan rata-rata waktu tunggu pasien pulang dengan jaminan pribadi sebesar 43,2 menit dan pasien dengan jaminan asuransi swasta sebesar 101,7 menit. Sedangkan prosentase kegiatan bernilai tambah sebelum perlakuan pada pasien dengan jaminan pribadi sebesar 57,4 % dan pasien dengan asuransi swasta sebesar 29,7%. Sesudah perlakuan upaya perbaikan didapatkan prosentase kegiatan bernilai tambah pada pasien pribadi sebesar 59,7 % dan pasien dengan asuransi swasta sebesar 30,4%. Kesimpulan : Metode Lean Six Sigma secara umum dapat dikatakan efektif untuk digunakan dalam melakukan evaluasi terhadap alur pelayanan di unit pelayanan kesehatan, karena terbukti khususnya pada penelitian ini terjadi pengurangan waktu tunggu pada proses pelayanan pasien pulang dari rawat inap.

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Background: Waiting time is an urgent problem in hospitals because all hospitals compete with each other to provide precise, fast and professional services. In the inpatient room on the 5th floor of the new building of Permata Cibubur Hospital, there are often still complaints from patients or patients' families related to the waiting time for patients to return home from hospitalization. Objective: To achieve the improvement of patient services discharged from hospitalization by using the Lean Six Sigma method. Method: This study uses a quasi-experimental research design by providing improvement treatment using the Lean Six Sigma method and calculating the waiting time in the process of returning patients to 2 groups of patients with personal insurance and private insurance patients, before and after the treatment. Results: After observation and interviews, waste identification was carried out in the service process of patients returning from hospitalization and 4 wastes were obtained, namely waiting, defect, motion, and overprocessing. The core problem of the service process for discharged patients is found that the DPJP does not input the prescriptions of discharged patients themselves, this causes several activities that are not value-added and makes the waiting time for the process of serving discharged patients prolonged. The focus of improvement is to make the DPJP input its own prescription for patients to go home and get a decrease in the total waiting time and an increase in the percentage of value-added activities. The average waiting time for patients to go home before treatment with personal insurance is 61 minutes and with private insurance guarantee is 125.8 minutes. After the treatment of improvement efforts with the Lean Six Sigma method, the average waiting time for patients to go home with personal insurance was 43.2 minutes, and for patients with private insurance, guarantees were 101.7 minutes. Meanwhile, the percentage of value-added activities before treatment for patients with personal insurance was 57.4% and for patients with private insurance was 29.7%. After the treatment of improvement efforts, the percentage of value-added activities in private patients was 59.7% and for patients with private insurance was 30.4%. Conclusion: The Lean Six Sigma method in general can be said to be effective to be used in evaluating the service flow in health service units because it is proven that especially in this study there is a reduction in waiting time in the service process of patients returning from hospitalization."

"Salah satu cara untuk melakukan efisiensi, meningkatkan mutu pelayanan dan meningkatkan keselamatan pasien di Amerika dengan menggunakan konsep Lean Thinking yang diterapkan di rumah sakit menjadi Lean Hospital. Di Rumah Sakit Atma Jaya yang merupakan Rumah Sakit Swata Kelas B Pendidikan, penelitian ini menganalisis alur pelayanan resep di Instalasi Farmasi Rawat Jalan sebagai data untuk perbaikan. Dengan menggunakan Root Cause Analysis RCA, metodologi penelitian operational research, dilakukan observasi dan wawancara mendalam memperlihatkan bahwa kegiatan non value added bisa sampai 85% dan kegiatan value added hanya 15% pada penyiapan obat non racikan. Sedangkan untuk obat racikan kegiatan non value added sekitar 68% dan value added sebesar 32% nilainya. Data tersebut menunjukan bahwa telah terjadi pemborosan waste. Usulan perbaikan untuk mengurangi pemborosan antara lain penggantian SIM RS yang baru dan menggiatkan fungsi Tim Kendali Mutu di Instalasi Farmasi. Bila perbaikan ini telah di implementasi, diharapakan terjadi peningkatan efisiensi di Instalasi Farmasi Rawat Jalan dan meningkatkan kepuasan pasien.

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One option to increase efficiency, service quality and patient safety in the United States of America is by using the Lean Thinking concept, which are implemented in Hospitals to become a Lean Hospital. In Atma Jaya Hospital, a class B study private hospital, the research analyses the workflow of prescription sevice in outpatient pharmacy departement to act as data for improvement analysis. Also, by utilizing Root Cause Analysis RCA, operational research methology, in depth observation and interviews are conducted at compounding and non compounding medicine storage of Outpatient Patient Departement, the result shows non value added activities reaches 85%, while value added activities are only 15% on non compounding medicine storage. While, on compounding medicine storage, non value added and value added activities are at 68% and 32% respectively. These data clearly shows that great inefficiencies has occurred. Solution is suggested to increase the efficiency in the department, changing Hospital Information System and activate the Quality Control Team function. If these steps are implemented, we can expect the overall efficiency in the Outpatient Pharmacy Departement to improve significantly and resulted in higher patient satisfaction. "

"Fenomena tingginya angka rujukan pasien yang diterima oleh rumah sakit di era Jaminan Kesehatan Nasional mengakibatkan penumpukan pasien yang berobat ke rumah sakit. Salah satu konsep yang dapat digunakan di era JKN untuk dapat memberikan kualitas pelayanan bagi pasien rujukan agar lebih efektif dan optimal, melakukan efisiensi biaya dan juga berorientasi kepada nilai walaupun dengan keterbatasan anggaran dan sumber daya yang dihadapi rumah sakit adalah dengan mengaplikasikan konsep Lean dalam pelayanan kesehatan. Penelitian ini menunjukkan bahwa faktor penentu belum optimalnya pelayanan pasien rujukan JKN di poliklinik disebabkan oleh waktu tunggu berkas rekam medik lama, waktu tunggu dokter spesialis lama, serta pasien yang menumpuk dan berkerumun menunggu antrian. Berdasarkan Karakteristik Sistem Rujukan WHO, kurangnya SDM rekam medik, profesionalitas dokter, kurangnya kerjasama dan komunikasi pra rujukan, kelengkapan fasilitas sarana prasarana dan sumber daya pendukung yang kurang memadai, serta belum sempurnanya aplikasi SIMRS juga menyebabkan belum optimalnya pelayanan pasien rujukan JKN di poliklinik. Berdasarkan Current State Value Stream Mapping didapatkan aktivitas value added pada proses pelayanan hanya 7,32 % sampai 17,75 %, sedangkan aktivitas non value added mencapai 82,25 % sampai 92,6 %. Dengan memotong alur pelayanan, mengeliminasi waste yang ditemukan, dan implementasi tools Lean 5S, Visual Management, Eror Proofing, dan Heijunka diharapkan pada Estimate Future State Value Stream Mapping akan menghasilkan penurunan waktu pelayanan sampai 87 menit, dan meningkatkan aktivitas value added sampai 34,95%.

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The phenomenon of high rates of referral of patients received by the hospital in the era of National Health Insurance resulted in a buildup of patients treated at the hospital. One concept that can be used in the era JKN to be able to provide quality care for the patients referral to be more effective and optimal, cost efficiency and also oriented to value although with limited budgets and resources faced by hospitals is to apply the concept of Lean in healthcare.

This study shows that the decisive factor is not optimal patient care referral JKN in polyclinic are caused by long waiting time for medical record file, long waiting time specialist doctors, and patients who accumulate and clump waiting queue. Based Referral System Characteristics WHO, lack of human resources in medical records, physician professionalism, lack of cooperation and communication pre references, complete infrastructure facilities and supporting resources are inadequate, and incomplete application SIMRS also lead to non-optimal patient care referral JKN in polyclinic.

Based on the Current State Value Stream Mapping, value added activities in the service only 7.32 % to 17.75 %, while the non-value added activity reached 82.25 % to 92.6 %. By cutting the service flow, eliminate waste were found, and implementation tools of Lean 5S, Visual Management, Error Proofing , and Heijunka expected at Estimate Future State Value Stream Mapping will result in reduced service time to 87 minutes , and increase value added activities until 34.95 %."

"ABSTRAKNama : Annisa Dea SariProgram Studi : Ilmu Kesehatan MasyarakatJudul : Analisis Kualitas Asuhan Keperawatan di Rawat Inap RS.Jantung danPembuluh Darah Harapan KitaPembimbing : dr. Agustin Kusumayati, M.Sc., PhdKualitas pelayanan di rumah sakit menjadi penting karena bila memiliki kualitas rendahmaka dapat membahayakan pasien. Perawat sebagai profesi yang 24 jam berhubungandengan pasien, turut menentukan mutu pelayanan. Depkes RI 2005 menyatakanpenerapan standar asuhan keperawatan untuk mengukur, memantau dan menyimpulkanapakah pelayanan sudah mengikuti persyaratan. Tujuan penelitian untuk melihatgambaran kualitas asuhan keperawatan melalui kinerja perawat. Pengukuran kualitasasuhan keperawatan dinilai melalui pelaksanaan asuhan dan pendokumentasi asuhan Muller-Staub, 2008 . Penelitian menggunakan desain deskriptf dengan cross sectionalstudy. Sampel penelitian menggunakan simple random sampling pada seluruh perawatdi rawat inap RSJPDHK sebanyak 159 orang. Pengumpulan data dilakukan melaluikuesioner dan observasi. Hasil penelitian yaitu sebanyak 56 perawat usia muda,57,2 pendidikan sarjana, 86,2 perawat perempuan, 57,2 pengetahuan baik tentangasuhan keperawatan, 64 perawat memiliki motivasi tinggi, 54,7 perawat memilikipersepsi positif, 66 perawat merasa beban kerja berat, 40,9 pelaksanaan asuhankeperawatan sesuai standard dan 63,5 pendokumentasian sesuai standar, hal inidipengaruhi oleh motivasi, pengetahuan dan beban kerja. Rekomendasi untukmanajemen keperawatan yaitu memberikan pelatihan tentang asuhan keperawatan,resosialisasi SPO pendokumentasian, bimbingan dan monitoring evaluasi penerapanstandar asuhan keperawatan.Kata Kunci : Kinerja perawat, pelaksanaan asuhan keperawatan, pendokumentasianasuhan keperawatan

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ABSTRACTABSTRACTName Annisa Dea SariStudy Program Public HealthTitle Analysis Quality Of Nursing Care On Inpatient Ward AtNational Cardiovascular Center Hospital Harapan Kita 2018Counsellor dr. Agustin Kusumayati, M.Sc., Ph.DQuality of health services in hospitals has become important considering that patientscould be endangered by poor quality services. As a profession which requires 24 hourscontact with the patient, nurses contribute to the quality of health services. The Ministryof Health of Indonesia 2005 stated that the purpose of applying the nursing carestandard is to measure, monitor, and conclude whether or not a service has been doneaccording to the requirements. The purpose of this study is to see and understand thequality of nursing care through the nurses rsquo performance. Nursing care qualitymeasurement is assessed through the implementation and documentation of care Muller Staub, 2008 . This study is a descriptive study using cross sectional studydesign. Samples are chosen through simple random sampling on all nurses of theinpatient care at RSJPDHK, which are 159 nurses. Data collection was done throughquestionnaire and observation. Results show 56 respondents are young adult, 57,2 are bachelor graduates, 86,2 female, 57,2 have good knowledge on nursing care,64 have high motivation, 54,7 have positive perception, 66 feel to have highworkload, 40,9 implemented nursing care according to standard and 63,5 documented according to standard. These results were affected by motivation,knowledge and workload. Recommendations for the nursing management are tofacilitate training on nursing care, resocialization of the documentation SPO, guidance,and monitoring and evaluation of the standard nursing care application.Keywords Nurse performance, nursing care implementation, nursing caredocumentation"

"Salah satu permasalahan penting dalam pembangunan Kesehatan Nasional adalahterbatasnya aksesibilitas terhadap pelayanan kesehatan. Hal ini terjadi juga diKabupaten Lingga Provinsi Kepulauan Riau. Untuk mengatasi hal tersebutPemerintah Kabupaten Lingga mengupayakan berbagai upaya diantaranya denganupaya meningkatkan Puskesmas Perawatan Dabo menjadi RSUD Dabo Kelas D.Penampilan suatu rumah sakit sangat ditentukan oleh sumber daya manusiakesehatan yang dimiliki oleh rumah sakit akan mempengaruhi diferensiasi dankualitas pelayanan kesehatan sehingga pengelolaan organisasi tidak bisa kitalepaskan dari pengelolaan sumber daya manusia di dalamnya. Namun sering kitatemui pengelolaan sumber daya manusia di rumah sakit tersebut terjebak pada sistemdan prosedur yang rumit dan kadang tidak efisien dan tidak efektif. Tujuan daripenelitian ini adalah ingin mengetahui bagaimana proses perubahan fungsioperasional manajemen sumber daya manusia di RSUD Dabo.Hasil penelitianmendapatkan bahwa sudah ada badan hukum dalam perubahan bentuk organisasi dariPuskesmas Perawatan menjadi RSUD Kelas D yang dibuktikan dengan adanya visidan misi, SK Bupati Lingga SK Menteri Kesehatan RI, Peraturan Daerah, SOTKbaru dan Pola PPK-BLUD. Fungsi operasional manajemen SDM telah diupayakanoleh Direktur RS dengan mengajukan formasi yang dibutuhkan ke BKD Lingga gunamerekrut paraPNS yang berkualitas. Disarankan agar perekrutan SDM lebihditingkatkan menginggat sangat pentingnya SDM kesehatan khusunya denganadanya perubahan bentuk status. Kemudian pihak RS lebih memperhatikandokumen-dokumen terkait yang berhubungan dengan RS guna bilamana diperlukantidak akan kesulitan dalam pencarian dokumen.

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One of the critical issues in the National Health development is the lack ofaccessibility of health services. It`s happened also in Lingga Regency, RiauArchipelago Province. To overcome this problem, the Lingga regency governmentseek various ways such as changing Dabo Primary health Center into DaboPublicgoberntment hospital in D class. The performance of hospital is determined by healthhuman resources owned which will affect differentiation and quality of healthservices. Therefore the management of the organization can not besparated fromthe management of human resources in it. But in commom human resourcesmanagement in hospital trapped in system and procedures that sometimes inefficientand ineffective. The purpose of thia study was to determine how the process ofchanging operational functions of human resource management in Dabo PublicHospital.

The results of the study found that existing legal entities in the form ofchanges in organization primary health center into Dabo public hospital evidencedby vision and mission, Lingga Regent decree,decree of Indonesia health ministry andother local regulations. Human resource management operational functions hasbeen attempted by hospital director with proposing the formation needed to Linggagoverntment employee depatrtment for recriut qualified of governtment employee.It rsquo s recommended that further enhanced the recruitmentof human resourceespeciallywith the changeof status. The hospital more attention to the relevan document,related to necessary in order to have no trouble in finding document."

"ABSTRAKUntuk dapat meningkatkan daya saing, rumah sakit umum harus dapat mengetahui bagaimana menjaga hubungan dengan pasien. Tujuan penelitian ini adalah merancang perbaikan loyalitas pasien rawat jalan rumah sakit umum yang menggunakan BPJS. Metode Structural Equation Modeling SEM digunakan untuk menganalisis faktor-faktor yang mempengaruhi loyalitas pasien dan metode analisis diskriminan untuk mengetahui prioritas perbaikan. Penilaian 5 orang ahli dilakukan untuk mendapatkan variabel laten dan indikator. Kusioner diberikan kepada 400 pasien. Dari model SEM, variabel yang mempengaruhi secara langsung dan positif terhadap loyalitas adalah kepuasan dan kepercayaan pasien.

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ABSTRACTTo improve competitiveness, public hospitals should be able to know how to maintain and retain their patients. The purpose of this research is to improve outpatient loyalty in public hospital that using National Health Insurance. Structural Equation Modeling SEM method is used to analyze the factors that influence patient loyalty and discriminant analysis method is used to know the priority of improvement. Assessment of 5 experts was performed to obtain latent variables and indicators. Questionnaire was given to 400 patients. From the SEM model, the variables that directly and positively affect loyalty are patient satisfaction and trust."

"Sistem pembayaran INA-CBG dalam JKN diduga meningkatkan kejadian readmisi, didefenisikan sebagai kasus rawat-inap kembali pasien dalam waktu kurang 30 hari dengan kondisi Sama (diteliti dalam 4 model readmisi yaitu CMG/Adjacent-DRG/Severity-Level/Diagnosis-Primer Sama), cara pulang rawatan sebelumnya sembuh, pada rumah sakit yang Sama. Hanya satu kasus readmisi dihitung dalam 30 hari dari tanggal pemulangan pasien pada rawatan pertama per-periode-kasus-readmisi. Desain penelitian potong-lintang dengan data sekunder klaim rawat-inap Rumah Sakit wilayah BPJS-Kesehatan Cabang Sukabumi terverifikasi, data tahun 2015.Kejadian readmisi didapatkan pada 11 dari 13 Rumah Sakit untuk keempat model readmisi diteliti, terbanyak pada Readmisi-CMG-Sama, dan paling sedikit pada Readmisi-Severity-Sevel-Sama. Variabel independen adalah kepemilikan RS, Kelas/Tipe RS, diagnosis klinis (CMG, jenis-rawat-inap, Severity-Level, Diagnosis-Primer), selisih biaya, dan LOS (Length of Stay). Analisis multivariat menunjukkan variabel diagnosis-primer (kategori-kronis) dan severit-level (kategori-akut) paling berpengaruh. Selisih biaya negatif dan LOS yang lebih rendah tidak terbukti memiliki risiko readmisi lebih tinggi.Diagnosis Congestive Heart Failure dan Typhoid Fever memiliki kekerapan readmisi tinggi sekaligus diagnosis dengan selisih biaya positif tertinggi. Diagnosis Chemoterapy Session for Neoplasm, Aplastic Anaemia (unspecified), dan End-stage Renal Disease perlu mendapat perhatian karena kekerapan readmisi tinggi dan selisih biaya minus tertinggi. Risiko biaya total lebih 2 kali dari biaya kasus original (initial-admission).

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The INA-CBG payment system in JKN is suspected to increase the incidence of readmission, defined as a case of patient re-hospitalization in less-than-30-days under the same conditions (studied in 4 readmission models of same- CMG/Adjacent-DRG/Severity-Level/Diagnosis-Primer), previous case recovered, at the same hospital. Only one case of readmission was calculated within-30-days from the date of discharge in the initial-admission per- readmission-case-periode. This is a cross-sectional study design with secondary data of verified-inpatient-claims of the Hospital of BPJS-Kesehatan-Sukabumi- Branch in 2015.

The incidence of readmission was found in 11 of the 13 Hospitals of all four models, mostly in the same-CMG-readmission, and at least at the same-severity- level-readmission. The independent variables are hospital-ownership, hospital- types, clinical-diagnosis (CMG, inpatient-type, Severity-Level, Primary- Diagnosis), cost-difference, and LOS (Length of Stay). Multivariate analysis shows the primary diagnosis-type (chronic-category) and severity-level (acute- category) most influential. A lower-negative-cost and lower-LOS are not shown to have a higher risk of readmission.

Diagnosis Congestive-Heart-Failure and Typhoid-Fever have high readmission frequency as well as diagnosis with the highest positive-cost-difference. Diagnosis of Chemotherapy Session for Neoplasm, Aplastic Anaemia (unspecified), and End-stage Renal Disease need attention because of high read-list-frequency and highest-minus-cost-difference. The total cost risk is more than 2 times the original-admissions cost."