Clinical Pathway Implementation and Hospital Outcomes Among Bronchopneumonia Patients Under the JKN System in Indonesia

Abstract

Introduction: Under Indonesia’s National Health Insurance (JKN) system, hospitals are expected to improve efficiency while maintaining quality of care. Clinical pathways (CPs) are widely implemented to standardize patient management, but evidence regarding their association with hospital outcomes among bronchopneumonia patients remains limited. This study examined the association between CP implementation and hospital outcomes under the JKN system. Methods: A retrospective analytic study with a cross-sectional design was conducted using secondary data obtained from medical records of 113 JKN inpatients diagnosed with bronchopneumonia at Pertamina Brain and Heart Hospital Biringkanaya Makassar, Indonesia. CP implementation was classified as compliant or non-compliant based on documented adherence to the established clinical pathway. Hospital outcomes included length of stay (LOS), hospital cost efficiency, quality of care, and patient recovery. Data were analyzed using chi-square tests, Mann–Whitney U test, and multivariable binary logistic regression adjusted for age group and sex. Results: After adjustment for age group and sex, clinical pathway compliance remained independently associated with shorter length of stay (AOR = 15.23; 95% CI: 5.74-40.41; p < 0.001) and greater hospital cost efficiency (AOR = 18.36; 95% CI: 6.77-49.83; p < 0.001). Clinical pathway compliance was also significantly associated with compliance with documented clinical service standards (OR = 140.800; 95% CI: 17.814–1112.876; p < 0.001). Median hospital treatment costs differed significantly between the compliant and non-compliant groups (Mann–Whitney U test, p < 0.001). No significant association was observed between clinical pathway compliance and patient recovery outcomes (p = 0.250). Conclusion: Clinical pathway compliance was independently associated with shorter LOS, greater hospital cost efficiency, and better adherence to documented clinical service standards. These findings support the role of clinical pathways in promoting standardized and efficient hospital care under Indonesia’s JKN system.

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