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. 2024 May 30:16:461-469.
doi: 10.2147/CEOR.S447249. eCollection 2024.

Development of an Efficient and Effective Clinical Pathway for Cesarean Section in West Sumatra (Indonesia)

Aladin Aladin  1 , Werry Darta Taifur  2 , Syed Mohamed Aljunid  3 , Dwiana Ocviyanti  4
Affiliations

Development of an Efficient and Effective Clinical Pathway for Cesarean Section in West Sumatra (Indonesia)

Aladin Aladin et al. Clinicoecon Outcomes Res. .

Abstract

Introduction: As with several countries around the world, cesarean section rates are increasing also in Indonesia, raising issues of quality and cost-effectiveness of health care, especially with the shift from a fee-for-service to a prospective payment system. For hospital services to be effective (quality control) and efficient (cost control), clinical pathways are essential. However, no studies have been done to develop a clinical pathway for cesarean sections (CS) in the INA-CBG system that is both effective and efficient.

Objective: To develop clinical pathways for CS that are both effective and efficient by determining unit costs and tariffs for CS services, reviewing procedures and outcomes, and assessing performance efficiency and effectiveness.

Methods: Using a sample of 110 patients undergoing cesarean sections consecutively recruited in 11 hospitals of West Sumatra (6 public hospitals and 5 private institutions), this mixed (qualitative and quantitative) study aimed at developing clinical guidelines for childbirth delivery modes responding both to criteria of efficacy and efficiency.

Results: Of 110 patients, 50 patients (45%) had efficient CS, 85 patients (77%) had effective CS, and 40 patients (36.4%) had both effective and efficient CS. A comprehensive clinical pathway for CS procedure was created by investigating 40 patients who underwent effective and efficient CS using interviews, a Delphi study, and professional advice.

Discussion: Hospitals can adopt the effective and efficient clinical pathway for CS protocol to prevent cost-related losses (efficient) while retaining the quality of the service (effective).

Keywords: cesarean section; cost analysis; effectiveness; efficiency.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Quality Care Framework of Cesarean Section Services.
Figure 2
Figure 2
Integrated Clinical Pathway Cesarean Section in The INA-CBG’s System.
See this image and copyright information in PMC

References

    1. Indonesian Ministry of Health. Indonesia district health survey 2017: national population and family planning board statistics Indonesia; 2018.
    1. Santoso BI, Trisnantoro L, Hendra Y. Cesarean section tariff analysis based on Indonesian case base groups in cipto mangunkusumo hospital. Adv Sci Lett. 2017;23(4):3590–3593. doi:10.1166/asl.2017.9188 - DOI
    1. Wang W. Costs-Effectiveness Analysis of Elective Cesarean Section Compared with Vaginal Delivery: A Prospective Cohort Study in a Hospital in León, Nicaragua. Uppsala University; 2016.
    1. Molina G, Weiser TG, Lipsitz SR, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA. 2015;314(21):2263. doi:10.1001/jama.2015.15553 - DOI - PubMed
    1. Indonesian Ministry of Health. Indonesian basic health research. Science. 2013;127:2013.