Effectiveness of the Chronic Disease Management Program (Prolanis) on the Incidence of Vertical Referral at Klinik Sabilillah, Malang City: A Retrospective Study Based on Electronic Health Records

Abstract

Introduction: The Chronic Disease Management Program (Prolanis) is a BPJS Kesehatan strategy to control chronic disease at primary care facilities  and reduce unnecessary referrals to advanced-level facilities, yet its real-world effectiveness requires further evidence. Objective: To analyze Prolanis effectiveness on vertical referral using electronic visit-record data. Methods: A retrospective cross-sectional study used secondary data from Klinik Sabilillah, Malang City, for March 2025–March 2026. Because Prolanis participants tend to be older with chronic diagnoses, analysis was restricted to visits diagnosed with hypertension/diabetes or Prolanis status for comparability, analyzed with chi-square, odds ratio, and logistic regression adjusted for age and gender. Results and Discussion: Overall vertical referral was 15.01%. Without adjustment, no significant difference was found between Prolanis and non-Prolanis participants (OR=1.046; 95% CI 0.858–1.275; p=0.692), due to a large age difference (55.0 vs 31.7 years; p<0.001). Vertical referral was lower among Prolanis participants in the comparable group (15.49% vs 24.86%; OR=0.554; 95% CI 0.376–0.818; p=0.004), consistent after adjusting for age and sex (Adjusted OR=0.540; 95% CI 0.371–0.809). Conclusion: Prolanis reduced vertical referral risk by 45–46% among comparable chronic disease patients. Unadjusted comparisons risk misleading conclusions. These findings support strengthening Prolanis coverage as a referral-control strategy in Primary Health Care Facility