The Effect Of Clinical Pathway Compliance In Stroke Management On Patient Health Outcomes And Its Implications For Hospital Costs (A Study At Rspal Dr. Ramelan Surabaya)

Abstract

This study aims to analyze the impact of compliance with Clinical Pathway (CP) in stroke care on patient health outcomes and its implications for hospital costs. Stroke is a high-volume, high-risk disease with substantial financial burden. A mixed-method design was employed using secondary data from 50 medical records and interviews with four key informants. Analysis was conducted using Structural Equation Modeling–Partial Least Square (SEM-PLS). Results showed that CP compliance had no direct effect on hospital cost efficiency (coefficient = 0.332; p = 0.202), but significantly improved patient health outcomes (coefficient = 0.825; p = 0.000). Patient health outcomes, however, had no direct impact on cost efficiency (coefficient = -0.123; p = 0.636). The findings suggest that while CP improves clinical outcomes, it has not yet translated into cost efficiency within the hospital setting. Qualitative insights revealed systemic challenges such as misalignment between CP and the INA-CBGs claim system and diagnostic variability, particularly in a Type A hospital like RSPAL Dr. Ramelan.