WHO DAS BDG

8/13/2019 WHO DAS BDG

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Pembiayaan Kasus subakut

dan kronik INA CBGsTim NCC Kemkes RI


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Unbundled Components: Compilations

Core

CBG +

Special

Procedures+

Special

Investigations+

Special

Prosthesis+Special

Drugs

Sub-Acute

Group

+

Chronic

Group

/


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Tarif INACBGs kasus kronis

Jamkesmas

Selama ini merupakan tarif paket ditambah tarif

costperday untuk fase subakut dan kronis

Tarif costperday fase subakut( hari ke 35- 103) :

Rp 90.000

Tarif costperday fase kronik( hari ke 104-180) :

Rp 45.000


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Tarif INA CBGs kasus kronis BPJS

Merupakan tarif paket sesuai kode kasusnya,

ditambah tarif costperday utk fase subakut

dan kronis

Fase subakut : hari ke 43-103

Fase kronis : hari ke 104-180


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Tarif INA CBGs kasus kronis BPJS

Besaran tarif subakut : 0,375 x RIW x UC x LOS

Besaran tarif kronis : 0,25 x RIW x UC x LOS

RIW ( Resource Intensity Weight ) merupakanbobot dari intensitas sumber daya yg

digunakan utk merawat pasien kronis,

merupakan perbandingan skor WHO DAS

pasien dibanding total skor WHO DAS

UC ( Unit Cost )


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WHO DAS 2.0 dlm INA CBGs

Merupakan instrumen yg digunakan utk

mengukur skor disabilitas pasien kronis

Skor tsb merupakan dasar perhitungan dari RIW

Assesment bisa dilakukan oleh petugas terlatih :

dr spesialis DPJP, dr umum dan perawat

Tanda tangan /tanggung jawab oleh DPJP

Bukan sbg dasar untuk pemulangan pasien


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Why measure Disability?

For Prediction of

patients needs

level of care

outcome of care Prognosis health conditions

Length of hospitalization

receipt of disability benefits work performance

social integration

Copyright of United Nations University-IIGH


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Why Measure Disability?

For healthcare and policy decision

Identify health needs of community

Design treatment and intervention

Evaluate outcome and effectiveness

Sett health priorities

Allocate health resources



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WHO- DAS 2.0

Six Domains

Cognitive: Understanding and Communicating

Mobility: Moving and getting around Self-Care: Hygine, dressing, eating, staying alone

Getting Along: Interacting with other people

Life Activities: Domestic responsibilities, leisure,

work and school

Participation: Joining in community cctivities


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Modes of Administer WHO-DAS

Interview Interviews to be done by doctors or nurses

Face-to-Face preferred in INA-CBG

Can use telephone interview as well Proxy

Third party answer the questions

Views from Family Members, Carers or other observers such asnurses or other health workers

May be use in INA-CBG if patient cannot response

Self-Administered Filled-up by individual

Use pencil-paper-version



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Development of WHO-DAS

First developed by WHO in 1988

To assess functioning mainly for psychiatric patients

Developed further by WHO Collaborating Centre inGroningen, Netherlands

Developed to reflect ICF

Refinement done by WHO and US Institues

NIH- National Institute of Health NIMH- National Institute of Mental Health

NIAAA National Institute of Alcohol Abuse and Alcoholism

NIDA National Institute of Drug Abuse



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Process of Development

Collaborative approach at international level

Ensure applicability in all health settings

Extensive review of existing instruments

More than 300 tools reviewed

Cross Cultural Applicability Studies

Explore nature and practive of health statusassessement in different cultures

Use Qualitative Methods (FGD, Key-Informants, etc)



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Process of Development

Reliability and Validity field studies

Cover 4 different groups

General Population

Population with Physical Problem

Population with Mental or Emotional Problem

Population with problems of Drug Abuse and Addiction



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Final Structure of WHO-DAS

Three Versions

36 Items

12 Items

12+24 Items



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36-Item Version

Most detailed version

Each item when positively endorsed will be

followed by questions on number of days with

the disability

Three format: interviewer-administered, self-

administered and proxy-administered

Average Interview time:20 minute



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12-Item Version

brief assessments of overall functioning

Use when time constraints

explains 81% of the variance of the 36-itemversion

five minutes

interviewer-administered, self administeredand proxy-administered



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12+24-item version

hybrid of the 12-item and 36-item versions

Respondents screen for problems in specific domains

Based on positive responses to the initial 12 items,

respondents may be given up to 24 additionalquestions

administered by interview or computer-adaptive

testing (CAT). 20 minutes.



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Why use WHO-DAS?

Based on strong theoretical concepts

Good psychometric properties

Numerous applications Direct link to the ICF

Cross-cultural comparability

Ease of use and availability Public domain



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WHO- DAS 2.0

Six Domains

D1-Cognitive: Understanding and Communicating

D2-Mobility: Moving and getting around D3-Self-Care: Hygiene, dressing, eating, staying

alone

D4-Getting Along: Interacting with other people

D5-Life Activities: Domestic responsibilities,

leisure, work and school

D6-Participation: Joining in community cctivities


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Components of WHO-DAS Tool

Three Components

Questionnaire

Flashcard 1

Flashcard 2



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Questionnaire

Four parts

Introduction

Section 1: Face sheet

Section 2: Demographic and Background Info

Section 3: Preamble

Section 4: Core Questions



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WHO-DAS: Introduction

Brief information on WHO-DAS

Reminder that users has to be trained to use

WHO-DAS

List of different versions of WHO-DAS

Contact address of responsible person in WHO



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WHO-DAS: Section One

Instruction not to read the sentences (bold and italic) to

the respondents

Read the sentences in blue

Face sheet

Respondents ID No.

Interviewers ID No.

Assessment time point (1,2, 3,.)

Interview Date

Living situation:

Independent living in community (1)

Assisted living (2)

Hospitalised (3)



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WHO-DAS: Section Two

Demographic and Background Information (5

Items)

Gender (as observed)

Age

Years of education

Current Marital Status

Work Status



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WHO-DAS: Section Three

Preamble

What to say to respondents on the interview

Hand Flashcard #1 to respondents

Point to Flashcard #1

Hand Flashcard #2 to respondents

Read aloud the scale



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WHO-DAS: Section Four

Core questions

S1-S12

Show Flashcard #2

H1-H3

Number of days of disability



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WHO- DAS 2.0- 12 Items

(Score 1-5): Interview

In the past 30 days, how much difficulty did you have in:

S1 Standing for long periods such

as 30

minutes? (D2)

None Mild Moderate Severe Extreme or

cannot do

S2 Taking care of your household

responsibilities? (D5)


cannot doS3 Learning a new task, for

example, learning how to get to

a new place?(D1)


cannot do

S4 How much of a problem did your

have joining in community

activities (for example,

festivities, religious or otheractivities) in the same way as

anyone else can?(D6)


cannot do

S5 How much has you have been

emotionally affected by your

health condition?(D6)


cannot do


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WHO- DAS 2.0- 12 Items

(Score 1- 5): Interview

In the past 30 days, how much difficulty did you have in:

S6 Concentrating on doingsomething for ten minutes?

(D1)


cannot do

S7 Walking a long distance suchas a kilometer [or equivalent]?

(D2)

None Mild Moderate Severe Extreme orcannot do

S8 Washing your whole body?(D3)


cannot do

S9 Getting dressed? (D3) None Mild Moderate Severe Extreme orcannot do

S10 Dealing with people you donot know? (D4)


cannot do

S11 Maintaining a friendship? (D4) None Mild Moderate Severe Extreme orcannot do

S12 Your day-to-day work? (D5) None Mild Moderate Severe Extreme orcannot do


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Core Question H1-H3

H 1 : Overall, in the past 30 days, how many dayswere these difficulties present?

H2 : In the past 30 days, for how many days were

you totally unable to carry out your usualactivities or work because of any healthcondition?

H3 : In the past 30 days, not counting the days

that you were totally unable, for how many daysdid you cut back or reduce your usual activities orwork because of any health condition?


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Scoring Scheme-WHO-DAS

1 to 5;

None = 1 (Not disable)

Extreme/Cannot Do = 5 (Totally Disable)

Minimum Total Score = 12 (No Disability)

Maximum Total Score = 60 (12 x 5) (Total

Disability)


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Flashcard #1



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Flashcard #2



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Conclusion

Measuring disability is important exercise in

health system to support policy decision

WHO-DAS 2.0 is a robust, valid and reliable

generic disability assessment tool supported

by strong research and development

WHO-DAS 12-Item version is used in INA-CBG

for resource allocation



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TERIMA KASIH

WHO DAS BDG

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