Dody Firmanda 2012 - Pemanfaatan Evidence-based Medicine dalam mendukung Clinical Pathways, Padang...

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    ^`ecgacc}cg @qkm`gj`%dcz`m E`mkjkg` "@DE+ mcfce

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    TZP^ Ac}ec|c}k& Hcoct}c'

    ^`gmcbpfpcg

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    }`tz`dp} ~`tc}ptcg e`gl`gck ~`fcozcgccg D^HZ O`z`bc}cg bctpz }`fcb cmc ~cfkgl fcec

    }cgllcf 40 Giq`ed t 4>34 "3 }cbpg mctk mkpgmcglocgg{c+4

    mcg zpmcb bctpz epfck

    d`ti~`tczk ~cmc }cgllcf 3 Hcgpctk 4>3=:

    z t}c pg}po D^HZ O z`bc}cg=

    }kmco

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    Mcfce Pgmcgl Pgmcgl TK Gieit 4; ]cbpg 4>>= }`g}cgl ^tco}ko O`mio}`tcg ~cmc ~czcf

    =0 e`g`tcglocg }`g}cgl o`|chkdcg e`g{`f`gllctcocg o`gmcfk ep}p mcg o`gmcfk

    dkc{c'1 ^cmc Pgmcgl Pgmcgl TK Gieit == ]cbpg 4>3> }`g}cgl Tpecb Zcok} ~cmc ~czcf

    :: e`g`tcglocg }`g}cgl itlcgkzczk tpecb zcok} {cgl `a`o}ka& `akzk`g& mcg copg}cd`f'>0 }`g}cgl ^`gl`fifccg O`pcglcg Dcmcg

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    dctcgl mcg)c}cp hczc {cgl mkhpcf }cg~c e`glp}cecocg e`gjctk o`pg}pglcg mcg mcfce

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    {cgl e tp~cocg zpc}p

    tcglockcg zkz}`ec}ko mcfce zpc}p zkz}`e' E`fcopocg zpc}p cgcfkzkz `oigiek mcfce

    ~`fc{cgcg o`mio}`tcg ~tia`zk cmcfcb }kmco epmcb& e`glkglc} dcg{co aco}it {cgl bctpz

    mk~ t}kedcglocg mctk d`tdclck mke`gzk }`teczpo jctc ~`gm`oc}cg mctk h`gkz cgcfkzkz

    `oigiek {cgl cocg mklpgcocg& dc}czcg }`tekgifilk `oigiek k}p z`gmktk e`gl`gckp}kfkxc}kig& ~timpj}kqk}{& d`g ak}& `aakjk`gj{& `aa j}kq`g`zz& qcfp` ait eig`{& o`dkhcocg

    akzocf mcg }kgloc} kgafc}kig tc}` {cgl z`tkgl ocfk d`tpdcb' Mkzce~kgl o`}`tdc}czcg zped`t

    mc{c mcg o`dkhcocg `oigiek {cgl mk~`glctpbk ~ifk}kz& z`bkgllc }kmco hctcgl ,t`ziptj`z,

    }`tz`dp} }`fcb mk~clp e`ghcmk ,akr`m,'33

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    ~`tc}ptcg mcg ~`tpgmcglcg bpope'>='33 Aktecgmc M' C~fkoczk kg}`ltczk zkg`tlkz cg}ctc @qkm`gq`%dcz`m E`mkjkg`& @qkm`gj`%dcz`m B`cf}bjct` mcg

    @qkm`gj`%dcz`m ^ifkj{ mcfce zc}p zkz}`e ~`gkgloc}cg ep}p ~`fc{cgcg o`z`bc}cg mcg o`mio}`tcg

    "Jfkgkjcf Liq`tgcgj`+8 zpc}p }cg}cglcg ~tia`zk KMCK mk eczc e`gmc}cgl'KK'Jiz} @aa`j}kq`g`zz Cgcf{z`z

    "J@C+ Z}cgmct ^`fc{cgcg E`mkz "Z^E+ O`z`bc}cg Cgco KMCK Mkzce~ckocg ~cmc Cjctc ^`t}`epcg

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    `akzk`gzk cfioc}ka "cffijc}kq`)zijk`}cf `aakjk`gj{+ }`teczpo mkmcfceg{c dkmcgl ecto`} mcg

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    o`dkhcocg o`z`bc}cg z`jctc f`dkb fpcz mcfce zpc}p zkz}`e }kgloc} kgz}k}pzk ~`g{`f`gllctc

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    @qkm`gj`%dcz`m E`mkjkg`

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    z`gmktk mcg fkglopglcgg{c "mcfce bcf kgk o`fpctlc& ecz{ctcoc} mcg ~`g{cgmcgl mcgc c}cp

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    oig}tif c}cp o`edcfk o`~cmc ~`tphpo czcf c}cp o`fpct tpecb zcok} e`fcfpk ocect h`gcxcb+

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    z`fptpb cgllctcg {cgl mko`fpctocg if`b zc}p zctcgc ~`g{`f`gllctc o`z`bc}cg "tpecb

    zcok}+& z`mcglocg 2>% fckgg{c zcglc} d`tbpdpglcg m`glcg o`~p}pzcg mio}`t }`tz`dp}'

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    Lcedct 3' Aco}it {cgl e`e~`glctpbk ~`glcedkfcg o`~p}pzcg

    D@qkm`gj` Qcfp`z

    T`ziptj`z

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    lfidcfkzczk mcg }`ocgcg epf}k%gc}kigcf jie~cg{ mk eczc e`gmc}cgl' Dpocgocb

    z`dclckecgc mkp}ctcocg mkc}cz& e`zok~pg mio}`t bcg{c e`e~pg{ck cgmkf 4>%& cocg

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    E`zok~pg ~`fc{cgcg o`z`bc}cg zcglc} d`tqctkczk mctk mcg mcfce zc}p g`lctc& ~ti~kgzk

    ecp~pg mc`tcb mk g`lctc echp)kgmpz}tk ecp~pg mpgkc o`}klc' Cocg }`}c~k jktk mcg zkac}

    eczcfcb }`tz`dp} }kmco hcpb d`td`mc zc}p zcec fckgg{c mcfce bcf {cgl e`gmczct {cogk

    z`ecokg e`gkgloc}g{c hpefcb ~i~pfczk pzkc fcghp} "~`tpdcbcg m`eiltcak+& }pg}p}cg mcg

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    Lcedct 4' Tkgloczcg ^`tc}ptcg E`g}`tk O`z`bc}cg TK Gieit 3:=2)E@GO@Z)^@T)KR)4>3> }`g}cgl Z}cgmct ^`fc{cgcg O`mio}`tcg ^G^O& Z^I mcg ^^O'

    ^tiz`z z`fcghp}g{c z`}`fcb e`g{pzpg ^cgmpcg ^tco}ko Ofkgkz "^^O+ Tpecb Zcok} cmcfcb

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    c' ^tia`zk e`mkz8 Z}cgmct ^ fc{cgcg E`mkz mctk z }kc~ O fie~io Z}ca

    E`mkz)Z}ca E`mkz Apglzkigcf "ZEA+ ofkgkz mcg ~`gpghcgl'

    d' ^tia`zk o`~`tc|c}cg8 Czpbcg O`~`tc|c}cg

    j' ^tia`zk acteczk8 Pgk} Miz` Mckf{ mcg Z}i~ Itm`tkgl

    m' Cfpt ^`fc{cgcg ^czk`g Tc|c} Kgc~ mcg I~`tczk mctk Zkz}`e O`fie~io Z}ca

    E`mkz)Z}ca E`mkz Apglzkigcf "ZEA+& Kgz}cfczk mcg Zkz}`e Ecgch`e`g

    Tpecb Zcok}'

    Fcglocb fcglocb ~`g{pzpgcg Jfkgkjcf ^c}b|c{z

    Fcglocb fcglocb mcfce e`g{pzpg Aitec} Jfkgkjcf ^c}b|c{z {cgl bctpz

    mk~`tbc}kocg8

    3' Oie~ig`g {cgl bctpz mkjcop~ z`dclckecgc m`akgkzk mctk Jfkgkjcf

    ^c}b|c{z

    4' Ecgacc}ocg mc}c {cgl }`fcb cmc mk fc~cglcg tpecb zcok} mcg oigmkzk

    z`}`e~c}=3

    z`~`t}k mc}c Fc~itcg TF4 "Mc}c O`cmccg Eitdkmk}cz ^czk`g+

    {cgl mkdpc} z`}kc~ tpecb zcok} d`tmczctocg Dpop ^`}pghpo ^`glkzkcg&

    ^`glifcbcg mcg ^`g{chkcg Mc}c Tpecb Zcok}=4

    mcg z`gzpz bctkcg pg}po8

    c' ^`g`}c~cg hpmpf)}i~koJfkgkjcf ^c}b|c{z {cgl cocg mkdpc}'

    d' ^`g`}c~cg fcec bctk tc|c}'

    =3 Aktecgmc M' Oim`akoczk KJM 3> mcg KJM ; JE8 kgmkoc}it ep}p t`oce e`mko mcfce tcgloc

    e`gkgloc}ocg ep}p ~`fc{cgcg tpecb zcok}' Mkzce~ckocg ~cmc Zizkcfkzczk ^ifc Zkz}`e

    Kgaiteczk

    Ecgch`e`g Tpecb Zcok}' Mkz f`gllctcocg if`b Mkt`o}itc} H`gm tcf Dkgc ^`fc{cgcg E`mko

    M`~o`z TK

    mk Bi}`f ^cglb`lct Dcgmpgl 3%: Hpgk 4>>1'=4 M`~ct}`e`g O`z`bc}cg TK' Dpop ^`}pghpo ^`glkzkcg& ^`glifcbcg mcg ^`g{chkcg Mc}c Tpecb

    Zcok}' Mkt`o}itc} H`gm`tcf Dkgc ^`fc{cgcg E`mko M`~o`z TK& Hcoct}c 4>>0'

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    :4

    :' Pg}po qctkcd`f }kgmcocg mcg idc} idc}cg e`glcjp o`~cmc Z}cgmct

    ^ fc{cgcg E`mkz& Z}cgmct ^tiz`mpt I~`tczkigcf mcg Mca}ct Z}cgmct

    Aitepfctkpe {cgl }`fcb cmc mk tpecb zcok} z`}`e~c}& Dkfc ~`tfp z}cgmct

    z}cgmct }`tz`dp} mc~c} mkfcopocg t`qkzk z`zpck o`z`~coc}cg z`}`e~c}'

    =' ^`tlpgcocg Dpop KJM 3> pg}po bcf oim`akoczk mkclgizkz mcg KJM ; JE

    pg}po bcf }kgmcocg ~tiz`mpt z`zpck m`glcg ~tia`zk)ZEA eczkgl eczkgl'41

    ^`tzkc~cg mcfce ~`g{pzpgcg Jfkgkjcf ^c}b|c{z

    Clct mcfce e`g{pzpg Jfkgkjcf ^c}b|c{z }`tctcb mcg e`gjc~ck zczctcg z`t}c

    `akzk`g |co}p& ecoc mk~`tfpocg o`thczcec mcg oiitmkgczk cg}ct ~tia`zk mk ZEA&

    Kgz}cfczk Tc|c} Kgc~ "epfck mctk lc|c} mctptc}& tpcglcg tc|c} kgc~& tpcglcg

    }kgmcocg& kgz}cfczk d`mcb& KJP)^KJP)GKJP+ mcg zctcgc ~`gpghcgl "kgz}cfczk lkxk&

    acteczk& t`oce e`mko& copg}czk o`pcglcg& tcmkifilk mcg z`dclckg{c+'

    3' ^tia`zk E`mkz e`e~`tzkc~ocg Z}cgmct ^`fc{cgcg E`mkz c}cp ^cgmpcg

    ^tco}ko Ofkgkz mcg z}cgmct ~tiz`mpt i~`tczkigcf "Z^E)^^O)Z^I+ z`zpck

    m`glcg dkmcgl o`cbfkcgg{c' ^tia`zk E`mkz mctk z`}kc~ mkqkzk d`tmczctocg

    mc}c mctk t`oce e`mkz mkc}cz e`e~`tzkc~ocg Z^E)^^O)Z^I& dkfc d`fpecmc mc~c} e`g{pzpg mpfp Z^E)^^O)Z^Ig{c z`zpck o`z`~coc}cg'

    4' ^tia`zk T`oce E`mkz)Oim`t e`e~`tzkc~ocg dpop KJM 3> mcg KJM ;JE& Fc~itcg TF3 zce~ck m`glcg 1 "}`tp}cec TF4+' ^tia`zk T`oce E`mkz

    e`edpc} mca}ct 0 3> ~`g{cok} p}cec mcg }`tz`tkgl mctk z`}kc~ mkqkzk

    ZEA)Kgz}cfczk m`glcg oim` KJM 3> z t}c t tc}c fcec bctk tc|c}

    d`tmczctocg mc}c fc~itcg eitdkmk}cz TF4'

    :' ^tia zk ^`tc|c} e`e~`tzkc~ocg Czpbcg O`~`tc|c}cg'

    =' ^tia`zk Acteczk e`e~`tzkc~ocg Mca}ct Aitepfctkpe& zkz}`e pgk} miz`mcg z}i~ itm`tkgl'

    0' ^tia zk Copg}czk)O`pcglcg e`e~`tzkc~ocg Mca}ct ]ctka tpecb zcok}

    Z`}kc~ qctkcgz {cgl mkmc~c}ocg cocg mkfcopocg }kgmco fcghp} mcfce d`g}po~`fcozcgccg cpmk} e`mkz z`dclckecgc {cgl mkcghptocg mcfce Pgmcgl Pgmcgl TK

    Gieit 4; ]cbpg 4>>= mcg ^`tc}ptcg E`g}`tk O`z`bc}cg TK Gieit

    33'

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    ::

    O``zke~pfcg8

    Mctk ptckcg zkgloc} mkc}cz m`glcg bcg{c z f`edct Jfkgkjcf ^c}b|c{z

    e`tp~cocg zpc}p kgz}tpe`g {cgl oie~t`b`gzka e`tcglope z`jctc }`t~cmp dkmcgl

    ~`fc{cgcg& ~`gmkmkocg mcg ~`g fk}kcg ecp~pg cot`mk}czk z`t}c dkfc mk}kghcp

    mctk z`lk `oigiek o`z`bc}cg mc~c} e`fcozcgcocg `akzk`gzk ~`edkc{ccg m`glcg

    e`ecgacc}ocg z`i~}kecf epglokg bctk tc|c} ~czk`g& e`gl`fkekgczk ~`e`tkozccg

    ~`gpghcgl)fcditc}itkpe)}kgmcocg {cgl }kmco mk~`tfpocg& e`gllpgcocg idc}

    idc}ccg "}`tp}cec cg}kdki}ko+ z`zpck `qkm`gj`%dcz`m? z`bkgllc ~`fc{cgcg `a`o}ka

    mkzce~kgl }kmco e`ed`mcocg fc}ct d`fcocgl ~czk`g oct`gc aiopz o`~cmc ~czk`g

    mcg ~`g{cok}g{c "o`d`tcmkfcg)`opk}k+ mcg z`ocfklpz e`e`gpbk z`fptpb }klc}phpcg mctk Pgmcgl Pgmcgl TK Gieit 4; ]cbpg 4>>= mcg `e~c} }phpcg

    Pgmcgl Pgmcgl TK Gieit == ]cbpg 4>>;'

    M`ekokcg ~pfc dclk Tpecb Zcok} ^`gmkmkocg& Jfkgkjcf ^c}b|c{z mc~c}

    mk~`tlpgcocg z`dclck kgz}tpe`g mcfce E`mkjcf @mpjc}kig Czz`zze`g}z }kgloc}

    ofkgkz mcfce d`g}po \ito~fcj`%dcz`m Czz`zze`g} "\DC+ pg}po Fildiio& Ekgk

    J@R& MI^Z& JdM& :1>m`lt ` Czz`zze`g} "Ekgk C]+& ^it}aifki mcg Zjtk~}

    Jigjitmcgj` ]`z} "ZJ]+ {cgl zpmcb e`tp~cocg oie~ig`g mcfce Cot`mk}czk

    Z}cgmct ^`gmkmkocg Mio}`t mcg Mio}`t Z~`zkcfkz mk Kgmig`zkc'

    Dcbocg dkfc mkfcozcgcocg Jfkgkjcf ^c}b|c{z z`jctc oigzkz}`g mkecgc cocg

    mkmc~c}ocg mc}c mc}c jiz}%|`klb}& jcz`ekr kgm`r mcg dcz`%tc}` z`jctc f`gloc~

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    o`z`bc}cg }`t|phpm "z`jctc ecjti%z{z}`e+'

    ]`tkec oczkb& z`eilc d`tecgacc}'^cmcgl& 4: Giq`ed`t 4>34

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    :=

    FCE^KTCG8

    ^cgmpcg ^tco}ko Ofkgkz

    ''''''''''''''''''''''''''''''''''''''''''''''''''''''

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    4>34 4>3=

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    :0

    2' ]`tc~k 3' 4'

    :'

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    0' ''''''''

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    33' ]kgloc} @qkm`gz K)KK)KKK)KQ

    34' ]kgloc} T`oie`gmczk C)D)J

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    3=' Kgmkoc}it E`mkz ''

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    :'

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    0' ''''''''

    '''''''''''''''''''& '4>34

    O }pc Oiek}` E`mko O }pc ZEA'''''''''''''''''''''''''''''''''''''''''''''''

    '''''''''''''''''''''''''''''''''''' ''''''''''''''''''''''''''''''''''''''

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    :1

    JFKGKJCF ^C]B\C[Z

    TPECB ZCOK]

    ''

    Gcec ^czk`g8

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    Co}kqk}cz ^`fc{cgcgT' Tc|c}

    '

    ]lf)Hce eczpo8'

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    Fcec T|}''' bctk

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    ]ctka)bt "T~+8'

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    BT 3 BT 4 BT : BT = BT 0 BT 1 BT < BT 2 BT ; BT3>

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    BT34

    BZ '' BZ '' BZ '' BZ '' BZ '' BZ '' BZ '' BZ '' BZ '' BZ '' BZ '' BZ ''

    Mkclgizkz8

    ^`g{cok} P}cec ^`g{cok} ^`g{`t}c

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    ^`gmkmkocg)T`gjcgc^`epfcglcg8

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    ^`tc|c} "^^H^+

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    : 8 T`gjcgc tc|c} 8 bctk

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    Mkclgizkz8 ^`g{cok} P}cec

    ^`g{cok} ^`g{`t}c

    Oie~fkoczk

    Cz`zze`g Ofkgkz8

    ^`e`tkozccg mio}`t ''

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    ^`gmkmkocg)T`gjcgc^`epfcglcg8Qctkcgz8

    Hpefcb Dkc{c ''^`tc|c} "^^H^+

    Mkclgizkz Cobkt8 Oim` KJM 3> H`gkz ]kgmcocg8 Oim` KJM ; JE

    M^H^8

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    :2

    JFKGKJCF ^C]B\C[Z

    TPECB ZCOK]

    ''

    Gcec ^czk`g8

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    D`tc} Dcmcg8''ol

    ]kgllk Dcmcg8''je

    Gieit T`oce E`mkz8'

    Mkclgizkz C|cf8 ' Oim` KJM 3> 8 T`gjcgc tc|c} 8 bctk

    Co}kqk}cz ^`fc{cgcgT' Tc|c}

    '

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    Dkc{c "T~+

    Bctk Tc|c} 3 Bctk Tc|c} 4 Bctk Tc|c} : Bctk Tc|c} = Bctk Tc|c} 0Bctk Zcok}8 Bctk Zcok}8 Bctk Zcok}8 Bctk Zcok}8 Bctk Zcok}8

    Mkclgizkz8

    ^`g{cok} P}cec '

    ^`g{cok} ^`g{`t}c '

    Oie~fkoczk '

    Cz`zze`g Ofkgkz8 ^`e`tkozccg mio}`t ' ''

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    Mkclgizkz8

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    Cz`zze`g Ofkgkz8 ^`e`tkozccg mio}`t ''

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    JFKGKJCF ^C]B\C[Z

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    '

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    M^H^88

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