curriculum vitae nama : prof. dr. iwan dwiprahasto, mmedsc ... · pdf file nama : prof. dr....

Nama : Prof. dr. Iwan Dwiprahasto, MMedSc, PhD

Riwayat pendidikan

Dokter, FK UGM tahun 1987

S-2: MMedSc (Farmakoepidemiologi), Newcastle University Australia, 1993

S-3: PhD, London School of Hygiene & Tropical Medicine, England, 2000

Jabatan:

1. Ketua Umum PB IKAFI (Ikatan Farmakologi Indonesia)

2. Ketua, Komite Pendidikan, Pelatihan, dan Pengembangan RS. Dr. Sardjito

3. Board of Governor, International Clinical Epidemiology Network (INCLEN)

4. Ketua, Komite Sistem Informasi, Universitas Gadjah Mada

5. Dewan Pakar Perhimpunan Rumah Sakit Indonesia (PERSI)

6. Tim Ahli Menteri Kesehatan untuk Evaluasi Harga Obat

7. Tim Ahli untuk DPHO, PT Askes Indonesia

8. Komite Uji Kompetensi Dokter Indonesia

9. Komite Nasional (KOMNAS) DOEN (Daftar Obat Esensial Nasional)

10. Komite Nasional (KOMNAS) Penilaian Obat Jadi Badan POM

11. Komite Nasional (KOMNAS) Informatorium Obat Nasional Indonesia (IONI)

12. Editor, Berkala Ilmu Kedokteran

13. Editor, Indonesian Journal of Clinical Epidemiology and Biostatistics

Curriculum vitae

Mutu outcome klinik pada

sistem pelayanan kesehatan

Iwan Dwiprahasto

Bag. Farmakologi/CE&BU FK UGM

Jocelyn Wildenstein

Jackie Stallone

From the perspective of a GoC Program

Untuk kepentingan pasien

Melakukan penyesuaian, perbaikan, better implementation

Memantau input, proses, output/outcome

Outcome Management is the set of activities designed to monitor, and adjust as required, the way in which the Program, and its associated Services, Processes and

Activities, contribute to meeting the needs of Patients/population.

7

how each output of an activity

contributes to an immediate outcome,

how these immediate outcomes

contribute to an intermediate

outcome,

and how these intermediate

outcomes contribute to a final outcome.

8

Perspektif pasien

Apakah semua pasien

Mengerti penyakitnya

Mengerti dampak dari penyakitnya

Diberitahu berbagai opsi

terapi

Mendapat informasi tentang

probabilitas

Memiliki komitmen

Puas/sangat puas

Mengapa harus peduli terhadap

outcome?

Providing high-quality care is the RIGHT THING TO DO

Patients need, expect, and deserve quality care

The National Committee for Quality Assurance (NCQA)

estimates that 80,000 Americans die each year because

they do not receive evidence-based care.

Need for Quality: Americans Receive Only Half of

Recommended Care

RAND Corporation. The First National Report Card on Quality of Health Care in America. 2006.

Available at: www.rand.org.

• Patients fail to receive needed services 46% of the time

• Patients receive services they do not need 11% of the time

0 10 20 30 40 50 60 70 80 90 100

Percentage of Recommended Care Received

N=6,700

Hypertension

Stroke

Depression

Coronary artery disease

Asthma

High cholesterol

Headache

Diabetes

Pneumonia

Alcohol dependence

Pengukuran Outcome secara Proaktif

Diperlukan assessment terhadap

Patient survival Hospitalization

rates Costs Adherence to quality benchmarks

Pay for performance (P4P) sebagai titik masuk

Esensial untuk menyediakan “quality care “

measure – intervene – measure – adjust

Putting systems in place now will improve quality today and help to

demonstrate it (if needed) tomorrow.

70

75

80

85

90

130

135

140

145

150

ALLHAT Mean Systolic and Diastolic Blood

Pressure During Follow-up

S y s to

lic B

P (

m m

H g )

Follow-up, yrs 0 1 2 3 4 5 6 0 1 2 3 4 5 6

D ia

s to

lic B

P (

m m

H g )

Chlorthalidone

Amlodipine

Lisinopril

Chlorthalidone

Amlodipine

Lisinopril

ALLHAT Research Group. JAMA. 2002;288:2981-2997.

Copyright ©2002, American Medical Association. www.hypertensiononline.org

SBP=systolic blood pressure DBP=diastolic blood pressure

Dibanding chlorthalidone:

DBP significantly lower in

amlodipine group (~1 mmHg).

Dibanding chlorthalidone:

SBP significantly higher in

amlodipine (~1 mmHg) and

lisinopril (~2 mmHg) groups.

0

4

8

12

16

20

ALLHAT Primary Outcome

by Treatment Group C

u m

u la

ti v e F

a ta

l C

H D

a n

d N

o n

fa ta

l

M I e v e

n t

ra te

( %

)

Time to event, yrs

0 1 2 3 4 5 6

15255

9048

9054

7

No. at Risk

Chlorthalidone

Amlodipine

Lisinopril

14477

8576

8535

13820

8218

8123

13102

7843

7711

11362

6824

6662

6340

3870

3832

2956

1878

1770

209

215

195

Chlorthalidone

Amlodipine

Lisinopril

www.hypertensiononline.org ALLHAT Research Group. JAMA. 2002;288:2981-2997.

Copyright ©2002, American Medical Association.

Sorafenib (US$ 1800/vial)

% Pasien yang mendapat tindakan

• Transplantasi

• Hemodialisis

• Peritoneal Dialysis (CAPD atau APD)

Structured training/retraining program?

Patient survival

Infection rates

Hospitalization rates

Mortality rates

Continuous Ambulatory Peritoneal Dialysis (CAPD),

Ambulatory Peritoneal Dialysis (APD)

Clinic-Specific

Which Outcomes?

Which Outcomes?

Patient- Specific

Hemoglobi n achieved

Infections

Phosphate achieved

Albumin sustained

Survival and SMR

Hospitaliza tion rates

Access

Patient satisfaction

Clinical Performance Measures (CPMs)

Menyediakan “tools” untuk mengukur quality of care kepada praktisi

Didasarkan pada Evidence-based Clinical Practice Guidelines

Menetapkan seberapa sering outcome terjadi

Menetapkan apakah SOP dilaksanakan

American Heart Association. Available at:

http://www.americanheart.org/presenter.jhtml?identifier=3012906.

Clinic-specific CPMs

Patient-specific CPMs

Clinical practice guidelines for

HD/PD

Clinical Practice Guidelines for Peritoneal

Adequacy, Update 2006

National Kidney Foundation. KDOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy: 2006

Update. Am J Kidney Dis. 2006;48(suppl):S91-S97.

Initiation of Dialysis

Peritoneal Dialysis Solute Clearance Targets and Measurements

Preservation of Residual Kidney Function

Maintenance of Euvolemia

Quality Improvement Programs

Pediatric Peritoneal Dialysis

Highlights of 2006 Update of

HD Adequacy Guidelines

National Kidney Foundation. KDOQI Clinical Practice Guidelines for Hemodialysis Dialysis Adequacy:

2006 Update. Am J Kidney Dis. 2006;48(suppl):S2-S90.

Perlu edukasi bagi pasien dan petugas

tentang pilihan renal- replacement jika tercapai

CKD stage 4

Dosis dialisis dipertahankan sama

dengan yang direkomendasikan

sebelumnya

Hindari bahan-2 nefrotoksik untuk

mempertahankan fungsi ginjal yang tersisa

Frekuensi dan lamanya dialisis berdasarkan

fungsi ginjal yang tersisa

Ilustrasi hasil evaluasi

11% pasien hemodialysis dan

30% pasien dengan peritoneal dialysis di AS menerima dosis dialisis yang inadekuat

Bass EB et al. Am J Kidney Dis. 2004;44:695-705. Goodkin DA et al. Am J Kidney Dis. 2004;44(suppl 2):S16-S21.

The crude RR untuk mortalitas di

AS 2 kali lebih besar daripada

Eropa dan 5 kali lebih besar

daripada di Jepang

S u

rv iv

a l

(% )

100

90

80

70

60

50

40

30 0.0 0.5 1.0 1.5 2.0 2.5 3.0

Years

Europe

US

Japan

Low Use of Recommended Drugs

in CKD Post-MI

Use of recommended drugs after mi by level of kidney function

(serum creatinine concentration in mg/dL, unadjusted).

MI = myocardial infarction, ACE = angiotensin converting enzyme, ARB = angiotensin-II receptor blocker

Winkelmayer WC et al. Clin J Am Soc Nephrol. 2006;1:796-801.

Kurang dari separuh pasien CKD menerima obat yang

direkomendasikan untuk post MI

P=0.02

P=0.006