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

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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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    Development of WHO-DAS

    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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    Development of WHO-DAS

    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)

    None Mild Moderate Severe Extreme or

    cannot doS3 Learn

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