Using hospital claim data to develop referral decision support systems: improving patient flow from the primary care
Penulis/Author
dr. Guardian Yoki Sanjaya, M.Health.Info (1); dr. M. Lutfan Lazuardi, M.Kes., Ph.D. (2); dr. Mubasysyir Hasan Basri, MA. (3); Prof. dr. Hari Kusnanto Josef SU., Dr.PH. (4)
Tanggal/Date
2019
Kata Kunci/Keyword
Abstrak/Abstract
The decision to make a referral for a primary physician is influenced by several factors such as the need for specialist consultation and requesting support for diagnosis or disease management using advanced equipment. Unfortunately primary care physicians are
faced with a number of hospitals that have different resources. This study aims to improve the quality of referral services by facilitating primary care physicians in determining the right referral hospital or specialty care. Rapid prototyping was used to extend rule-reasoning decision support systems based on history of hospital claim data in an electronic referral system. The research was conducted in DI Yogyakarta province, Indonesia. Appropriate referral hospital was inferred based on the presence of deferential
diagnosis and or required procedure. Distance estimation and availability of beds were used to narrow down hospital options. Hospital competence was seen from history of diagnosis and procedures code recorded in the hospital claim data. The hospital claim history was used as knowledge-based that connect hospital master data, medical diagnosis and procedures. IF ... AND (OR)... THEN rule-reasoning was used to recommend referral hospitals based on a differential diagnosis and or required medical procedure determined by a primary care physician. To narrow down the referral hospitals, the Google Maps API was used to estimate the distance from primary health facilities to several available hospital options. Information on the availability of beds was also visualized for preference in determining the choice of a referral hospital. A decision support system can help primary care physicians to find the right referral hospital or specialty care for a desired patient before making a referral to a higher level of health facility.
Rumpun Ilmu
Kesehatan Masyarakat
Bahasa Asli/Original Language
English
Level
Internasional
Status
Dokumen Karya
No
Judul
Tipe Dokumen
Aksi
1
Fulldok_Using Hospital Claim Data to Develop Referral Decision Support Systems Improving Patient Flow from The Primary Care.pdf
