Risk factors of death among children hospitalized with social insurance (BPJS): a cross sectional study using hospital claim data

Latar belakang: Angka kematian di rumah sakit merupakan salah satu indikator yang digunakan untuk mengukur kinerja dan kualitas pelayanan. Tujuan penelitian ini untuk menganalisis  faktor risiko kematian pada anak yang dirawat dengan BPJS kesehatan di satu rumah sakit di Jakarta. Metode: Penelitian potong lintang pada satu rumah sakit pemerintah di Jakarta. Sampel menggunakan semua data klaim pasien BPJS selama periode Januari - Desember 2017. Semua pasien BPJS  berusia di bawah 18 tahun yang dirawat dimasukkan dalam analisis. Regresi logistik digunakan untuk menganalisis faktor risiko kematian anak. Hasil: Dari total 18,941 jumlah pasien BPJS yang dirawat, sebanyak 3689 data anak yang dianalisis. Proporsi angka kematian anak selama satu tahun sebesar 7,3%. Kasus dengan tingkat keparahan derajat II memiliki risiko kematian 11,51 kali lipat [rasio odds suaian (ORa) = 11,51; IK=7,45-17,78; P = 0,000] dibandingkan tingkat keparahan penyakit derajat I, sedangkan kasus dengan tingkat keparahan derajat III beresiko terhadap kematian 33,97 kali lipat (ORa = 33,97;IK=19,93-57,91; P = 0,000). Selain itu, anak yang memiliki indikasi dirawat di ICU meningkatkan risiko kematian  14,21 kali lipat (ORa = 14,21; IK=9,15-22,08; P= 0,000) dibandingkan yang tidak ada indikasi ICU. Kondisi tertentu yang timbul pada  periode perinatal meningkatkan risiko kematian anak 7,65  kali lipat (ORa = 7,65  ; IK=1,81-32,35;P = 0,006) dibandingkan penyakit pada sistem muskuloskeletal dan jaringan ikat. Kesimpulan: Tingkat keparahan penyakit, indikasi ICU dan kondisi tertentu yang timbul pada  periode perinatal adalah faktor risiko kematian anak yang paling sering di rumah sakit Kata kunci: Faktor risiko, kematian, anak, BPJS   Abstract Background: Hospital death rate is one of the indicators used to measure hospital performance and quality of care, especially the overall hospital death rate. This study aims to analyze the risk factors of death among children hospitalized with social insurance (BPJS) in one hospital in Jakarta. Methods: This was a cross-sectional study conducted in one government hospital in Jakarta. The sample was all individual claim data of BPJS patients who were hospitalized during the period of January to December 2017. All BPJS patients aged below 18 years admitted into the pediatric wards were included in the analysis. The logistic regression was used to analyze the risks of children death Results: A total of 18.941 BPJS inpatients in the hospital was identified, out of them 3689 met the inclusion criteria. The proportion of death in children during one year was 7.3%. Illness severity level II had 11.51-fold [adjusted odds ratio (ORa)=11.51;CI=7.45-17.78; P=0.000]] meanwhile severity level III had 33.97-fold higher risk of children death (ORa=33.97; CI=19.93-57.91;P=0.000) compared to children with severity level I. Children who had ICU indicator increase risk of children death at 14.21 -fold (ORa=14.21;IK=9.15-22.08;P= 0.000) compared to those who did not have. Furthermore the risk of children death in certain conditions originating in the perinatal period increases by 7.65–fold (ORa=7.65 ;IK=1.81-32.35;P=0.006) compared to diseases of the musculoskeletal system and connective tissue. Conclusion: Illness severity level, ICU indicator and diseases in certain conditions originating in the perinatal period are the most common risk factors for children death in the hospital Keywords: Risk factors, death, children, BPJS