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Factors Affecting Hospital Network Management in the Social Security Organization of Iran 影响伊朗社会保障机构医院网络化管理的因素
Pub Date : 2021-09-29 DOI: 10.18502/jebhpme.v5i3.7290
F. Mohammadi, I. Asl, S. Mahfoozpour, S. Hessam
Background: Hospitals are considered the most important consumer units in the health system. Based on the effect of the hospital network in optimal and efficient hospital management, this study aimed to identify and explain the role of factors influencing hospital network management in the Iranian Social Security Organization (ISSO). Methods: This study was conducted by a mixed method in 2018. First, variables and factors affecting the management of hospital networks were extracted from the literature review and through interviews with 15 experts, and a questionnaire with 40 questions was developed. Then, it was distributed among 448 experts in the healthcare section of the ISSO all over the country, and 405 questionnaires were completed and collected. Data were analyzed via exploratory and confirmatory factor analysis and structural equations using SPSS23 software and AMOS24 software. The validity of the questionnaire was determined via expert judgment (CVRs = 0.40) and reliability was estimated by Cronbach's alpha coefficient (α = 0.87). Results: Based on the confirmatory factor analysis, financing, monitoring and evaluation, accountability, strategic planning, and decision rights were identified as key factors affecting hospital network management. Financing with standard coefficients of 0.83 had the highest and decision rights with standard coefficients of 0.44 had the lowest effect on hospital network management of the ISSO. Conclusion: To efficient hospital network management of the ISSO, while emphasizing all identified factors, special attention should be paid to financing and modifying the method of budgeting and using suitable monitoring and evaluation mechanisms.
背景:医院被认为是卫生系统中最重要的消费单位。基于医院网络在优化和高效医院管理中的作用,本研究旨在识别和解释影响伊朗社会保障组织(ISSO)医院网络管理的因素的作用。方法:本研究于2018年采用混合方法进行。首先,从文献综述中提取影响医院网络管理的变量和因素,并通过对15位专家的访谈,编制了一份包含40个问题的问卷。然后,将其分发给全国卫生保健科的448名专家,完成并收集了405份问卷。采用SPSS23软件和AMOS24软件对数据进行探索性和验证性因子分析和结构方程分析。问卷的效度采用专家判断(CVRs = 0.40),信度采用Cronbach’s alpha系数(α = 0.87)。结果:通过验证性因素分析,确定资金、监测与评价、问责制、战略规划和决策权是影响医院网络化管理的关键因素。筹资标准系数为0.83时对医院网络化管理的影响最大,决策权标准系数为0.44时对医院网络化管理的影响最小。结论:在强调所有确定因素的同时,应特别注意资金筹措和修改预算编制方法,并采用适当的监测和评价机制,以实现ISSO高效的医院网络管理。
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引用次数: 0
Identifying and Prioritizing of Factors Influencing the Entry of Medical Centers on the Medical Tourism Market in Iran 确定和优先考虑影响医疗中心进入伊朗医疗旅游市场的因素
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6553
M. Dehghani, N. Baghian, M. Dehghani
Introduction: Medical tourism is a fast-growing industry that has provided special opportunities for international organizations to achieve a competitive advantage. This research has been conducted to recognize and prioritize the factors affecting the admission of medical centers into the medical tourism market in Iran. Methods: The combined study was conducted in two qualitative stages and hierarchical analysis in governmental and non-governmental centers related to medical tourism on 15 experts and specialists in the qualitative stage and 25 people in a quantitative stage. The interview guide was used to collect data in the qualitative stage and the pairwise comparison questionnaire was used in the hierarchical analysis stage. Qualitative phase results were analyzed by conceptual framework method and quantitative phase results were analyzed by AHP method applying 11 Expert Choice software. Results: 41 sub-themes were identified in the qualitative stage, which were categorized into six groups: service quality, infrastructure, human, information, economic and political. The highest weight or priority was related to the diversity and quality of services and the lowest weight or priority was associated with the field of information and marketing among the six factors based on the Analytical Hierarchy process (AHP) method. Conclusion: The most significant factor for medical centers to join the health tourism market is to focus on the quality of provided services based on the results. It is recommended that medical centers provide all services from the time of admission to follow-up after discharge in the context of intelligent and web-based systems in order to strengthen the quality of services, in addition to standardize departments and treatment processes according to international standards.
医疗旅游是一个快速发展的产业,为国际组织获得竞争优势提供了特殊的机会。本研究旨在识别并优先考虑影响医疗中心进入伊朗医疗旅游市场的因素。方法:采用定性研究和分层分析相结合的方法,在政府和民间医疗旅游相关中心对15名专家和专家进行定性研究,对25人进行定量研究。定性阶段采用访谈指南收集数据,层次分析阶段采用两两比较问卷。采用概念框架法对定性相结果进行分析,采用AHP法对定量相结果进行分析。结果:在定性阶段确定了41个子主题,分为6组:服务质量、基础设施、人力、信息、经济和政治。基于层次分析法(AHP)的六个因素中,权重最高或优先级与服务的多样性和质量有关,权重最低或优先级与信息和营销领域有关。结论:医疗中心加入健康旅游市场最重要的因素是在结果的基础上关注所提供的服务质量。建议医疗中心从入院到出院后随访的所有服务都在智能化和基于网络的系统背景下提供,以加强服务质量,并根据国际标准规范科室和治疗流程。
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引用次数: 0
Scoping Review of Computerized Physician Order Entry Systems in Reducing Medical Errors 计算机化医嘱输入系统在减少医疗差错方面的范围审查
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6559
Gisoo Alizadeh, A. Jafarzadeh, Mohammad Farough Khosravi
Background: Medical errors have dramatic clinical and economic consequences. Using various information technology can reduce medical errors and improve services’ quality via preventing medical errors. In this study, the role of a computerized medical order entry system was investigated in reducing medical errors. Methods: This study was conducted as a scoping review. The research question was formulated; then, the inclusion and exclusion criteria, keywords (such as medical errors, adverse event, physician order entry system and control) and search strategy were determined. International databases(Scopus, ProQuest, and PubMed) and manual searches were used. The studies that had the inclusion criteria were entered into the study and were evaluated qualitatively, then information of studies was extracted and summarized. Results: In total, 16 studies were included. Most studies were about medication errors and adverse medication events. So, it is possible to claim more confidently about reducing medication errors to adverse medication events, since in studies, the impact of this system on medication errors had been further discussed. Some studies have pointed to an increase in error reports due to better checking and error entry with this system, and in general, the positive impact of this action has been mentioned in minimizing errors, especially medication errors and adverse medication events. Positive and significant effects have also been reported on prescribing errors, especially medication prescriptions. Conclusion: Computerization of medical orders through its positive effects, can be considered a useful and appropriate intervention in increasing patient safety if implemented completely and correctly.
背景:医疗差错具有显著的临床和经济后果。利用各种信息技术可以通过预防医疗差错来减少医疗差错,提高服务质量。在这项研究中,一个计算机化的医疗订单输入系统在减少医疗差错的作用进行了调查。方法:本研究为范围综述。拟定了研究问题;然后确定纳入和排除标准、关键词(如医疗差错、不良事件、医嘱录入系统和控制)和搜索策略。使用国际数据库(Scopus、ProQuest和PubMed)和人工检索。将符合纳入标准的研究纳入研究,进行定性评价,提取总结研究信息。结果:共纳入16项研究。大多数研究是关于用药错误和不良用药事件。因此,有可能更自信地声称将药物错误减少为药物不良事件,因为在研究中,该系统对药物错误的影响已经得到了进一步的讨论。一些研究指出,由于该系统更好的检查和错误输入,错误报告有所增加,总的来说,这一行动在尽量减少错误,特别是用药错误和不良用药事件方面的积极影响已经被提到。在处方错误,特别是药物处方方面也有积极和显著的影响。结论:医嘱电脑化通过其积极的作用,如果全面正确地实施,可以被认为是一种有效的、适当的提高患者安全的干预措施。
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引用次数: 0
Designing and Evaluating the Establishment of Admission Criteria for Patients in an Intensive Care Unit: A Descriptive Study in Iran 设计和评估重症监护病房患者入院标准的建立:伊朗的一项描述性研究
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6554
Fariba Hosseinpour, M. Sedighi, F. Hashemi, S. Rafiei
Background: A few studies have reviewed and revised ICU admission criteria based on specific circumstances and local conditions. The aim was to develop ICU admission criteria and compare the cost, mortality, and length of stay among identified admission priorities. Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patients' clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used. Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patient's stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patients' age, total cost, and insurance share of the total cost (P-value < 0.05). Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.
背景:一些研究根据具体情况和当地情况对ICU住院标准进行了审查和修订。目的是制定ICU入院标准,并在确定的入院优先事项中比较费用、死亡率和住院时间。方法:这是一项横断面研究,在伊朗加兹温一家培训医院的重症监护病房进行。研究对象为2019年7月至9月ICU收治的127例患者。数据收集工具是一份自行设计的检查表,包括患者的临床数据及其账单、诊断类型、住院时的意识水平(基于GCS量表或格拉斯哥昏迷量表)、住院时间和出院时的患者状态。采用描述性统计检验来描述研究变量,为了确定研究变量之间的关系,采用方差分析和卡方检验。结果:设计了一套标准来确定ICU患者入院的优先顺序。根据确定的标准,根据患者的稳定性、血流动力学和呼吸将患者分为四组。研究结果显示,相当大比例的患者入院时处于住院的第二和第三优先级(分别为26.8%和32.3%)。四组患者年龄、总费用、保险占总费用的比例差异均有统计学意义(p值< 0.05)。结论:研究结果强调了根据明确的标准对患者进行分类以有效利用现有资源的必要性。
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引用次数: 0
Developing Strategies and Designing its Map for Advancement of Medical Tourism Industry: Case Study of Shiraz 医疗旅游产业发展策略与地图设计——以设拉子为例
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6557
T. Shafaghat, A. Jabbari, N. Hatam, P. Bastani, H. Rahimi, Omid Fazelzadeh, Mohammad Kazem Rahimi Zarchi
Background: The medical tourism industry is a rapidly growing global market that has capabilities such as earning income and improving the quality of services. The purpose of this study was to utilize the capabilities of Shiraz city by developing a strategic plan. Methods: This mixed-methods (qualitative and quantitative) research was conducted in 2019. The study population included all entities and key stakeholders involved in the medical tourism industry in Shiraz. A strategic plan was developed through focus groups and conventional content analysis and then the Decision Making Trial and Evaluation Laboratory (DEMATEL) technique was utilized to map it. Results: The strategic plan of the medical tourism industry of Shiraz city was explained in the form of 63 strategies, 5 goals, and 18 objectives. Also, the medical tourism industry strategic map was illustrated. Conclusion: Achieving common agreement of all policy-making and implementing institutions, empowering managers on various medical tourism industry dimensions, and developing operational plans required by each organization in charge of the medical tourism industry can be effective in better use of the capabilities of Shiraz in attracting medical tourists.
背景:医疗旅游行业是一个快速增长的全球市场,具有赚取收入和提高服务质量等能力。本研究的目的是通过制定战略规划来利用设拉子城市的能力。方法:于2019年采用定性和定量混合方法进行研究。研究人群包括设拉子医疗旅游业的所有实体和主要利益相关者。通过焦点小组和常规内容分析制定战略计划,然后利用决策试验和评估实验室(DEMATEL)技术绘制战略计划。结果:以63个战略、5个目标、18个目标的形式对设拉子市医疗旅游产业战略规划进行了阐述。并绘制了医疗旅游产业战略地图。结论:达成所有决策和执行机构的共识,授权管理人员在医疗旅游行业的各个维度,并制定每个医疗旅游行业负责组织所需的操作计划,可以有效地更好地利用设拉子吸引医疗游客的能力。
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引用次数: 0
Letter to the Editor Regarding “Factors Affecting Outpatient Consultation Length among Specialists in Tabriz, Iran” 致编辑关于“影响伊朗大不里士专家门诊会诊时间的因素”的信
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6552
Elaheh Haghgoshayie, E. Hasanpoor
The article's abstract is not available.
这篇文章的摘要没有。
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引用次数: 0
Calculation of the Visit Costs of Various Services Provider Groups: Improvement of Payment Mechanisms 不同服务提供者群体访问费用的计算:支付机制的完善
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6555
A. Sabermahani, Mohammad Jafari Siriz, M. Barouni
Background: Initiatives to improve the quality of health services and reduce costs currently have centered around payment mechanisms. In Iran, like many other countries, the outpatient visit costs are paid via fee for service, while real-time visits and other details of provided services are not considered in the tariff setting process. This study attempted to calculate the visit costs of various service provider groups and compared them with tariffs. Methods: In this cross-sectional research, the essential data about different costs were collected from providers' offices, standard time of each visit was achieved from Iran's Ministry of Health and Medical Education, current visit time of service providers was calculated based on health insurance companies' data across the country. After calculating the standard and current visit costs through the activity-based costing technique, main determinants of costs (major cost centers) were specified for use in probably future weighted tariffs in fee for service payment mechanism. Results: The greatest difference between standard and the current number of visits was found in the Sub-specialist physician group (6784 in a year), and the greatest difference was between standard and current cost of visits in sub-specialist psychiatrists (126703 IRR). Staffing and rental cost centers account for the highest share of total visit cost (87 %). Conclusion: This study demonstrated a significant difference between the current and standard visit costs with tariffs. Therefore, it is essential that policymakers improve the payment mechanism by modifying the visit tariffs for medical service providers. One suggestion in this way is using domestic relative value units according to costing research results.
背景:目前,提高保健服务质量和降低费用的举措主要围绕支付机制展开。在伊朗,与许多其他国家一样,门诊费用通过服务费支付,而在定价过程中不考虑实时就诊和提供服务的其他细节。本研究试图计算不同服务提供商群体的访问成本,并将其与资费进行比较。方法:采用横断面研究方法,从服务提供者办公室收集不同费用的基本数据,从伊朗卫生和医学教育部获得每次就诊的标准时间,根据全国健康保险公司的数据计算服务提供者的当前就诊时间。通过基于作业的成本计算技术计算了标准和当前的访问成本后,确定了成本的主要决定因素(主要成本中心),以便将来可能在服务收费支付机制中使用加权关税。结果:亚专科医师组的标准就诊次数与当前就诊次数差异最大(每年6784次),亚专科精神病医师组的标准就诊次数与当前就诊费用差异最大(126703 IRR)。人员和租金成本中心占总访问成本的最高份额(87%)。结论:本研究表明,当前和标准的访问成本与关税之间存在显著差异。因此,政策制定者必须通过修改医疗服务提供者的就诊费用来完善支付机制。建议根据成本核算的研究成果,采用国内相对价值单位。
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引用次数: 0
Relationship Between General Health and Health-Related Quality of Life in Educational Hospitals' Nurses in Ahvaz 阿瓦士教育医院护士一般健康状况与健康相关生活质量的关系
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6556
Mehdi Rezaei Far, F. Faraji-Khiavi
Background: Nurses face a lot of stress in their jobs, and the quality of life has a significant impact on the quality of their services. Therefore, the purpose of this study was to determine the relationship between general health and the quality of life conditions in nurses working in hospitals affiliated with Jundishapur University of Medical Sciences in Ahvaz. Methods: This cross-sectional descriptive-analytic study was conducted in 2017 on nurses working in educational hospitals in Ahvaz. The sample size was 265. A categorized random sampling was used for the research The collected data were analyzed using mean, standard deviation, independent t-test, ANOVA, regresson and Pearson correlation tests. Data collection tools included the general health questionnaire (GHQ) and the questionnaire on health-related quality of life (HRQOL). Results: Nurses had fairly good general health (23.9 ± 12.4) and their health-related quality of life was moderate (60.29 ± 16.07). Their physical health (63.4 ± 22.5) was found better than their mental health (61.7 ± 20.3) as a factor in the health-related quality of life states. General health had a strong and negative correlation with the quality of life associated with physical health (P-value < 0.001 and r = - 0.61) and the quality of life associated with mental health (P-value < 0.001 and r = - 0.68). Conclusion: Many aspects of health-related quality of life are influenced by general health factors. Therefore, it is recommended that prevention, identification, and treatment of physical and psychological problems and factors affecting the quality of life be considered as a priority, leading to an improvement in nurses’ quality of life.
背景:护士在工作中面临着很大的压力,生活质量对其服务质量有很大的影响。因此,本研究的目的是确定在阿瓦士Jundishapur医科大学附属医院工作的护士的一般健康状况与生活质量之间的关系。方法:对2017年在阿瓦士教育医院工作的护士进行横断面描述性分析研究。样本量为265。研究采用分类随机抽样,收集的资料采用均值、标准差、独立t检验、方差分析、回归分析和Pearson相关检验进行分析。数据收集工具包括一般健康问卷(GHQ)和健康相关生活质量问卷(HRQOL)。结果:护士总体健康状况较好(23.9±12.4),健康相关生活质量为中等(60.29±16.07)。身体健康(63.4±22.5)优于心理健康(61.7±20.3)。总体健康与与身体健康相关的生活质量(p值< 0.001,r = - 0.61)和与心理健康相关的生活质量(p值< 0.001,r = - 0.68)呈强烈负相关。结论:与健康相关的生活质量的许多方面受到一般健康因素的影响。因此,建议将预防、识别和治疗影响生活质量的身心问题和因素作为重点,从而提高护士的生活质量。
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引用次数: 0
Factors Influencing Nurses' Intention to Leave Profession in Iran 伊朗护士离职意向的影响因素
Pub Date : 2021-06-10 DOI: 10.18502/jebhpme.v5i2.6558
Zohreh Hosseini Marznaki, S. Barzegari, W. J. Salisu, Maryam Azarnivand, Khatere Khanjankhani
Background: Several reasons account for nurses' intention to leave the nursing profession. Understanding these factors is a step towards reducing such incidents which pose a threat to the nursing profession. This study aimed to identify and rank the circumstances that influence the intention to leave the nursing profession in Iran. Methods: The present study is a cross-sectional analytical study, which employed four other methods to reach a sound conclusion in 2019.The electronic databases, including the Scientific Information Database, PubMed, Scopus, Science Direct, OVID, Cochrane Library, CINAHL,, were searched for studies published from the year 1998 to December 2018 for scientific studies conducted among factor associated intention to leave in Iran. The Exploratory Factor Analysis (EFA) method was then used to extract hidden factors and determine the hierarchical structure of the review's findings. Using the combination of Analytical Hierarchy Process and Fuzzy Logic, the weight of each one of the factors that affect the intention to leave the nursing profession was then calculated. Finally, the accuracy of the results of the Consistency Ratio and Fuzzy analytic hierarchical process (FAHP), was calculated and evaluated. Results: The electronic search delivered 100 studies, from which we identified and extracted 26 most occurring reasons for the desire to leave the nursing profession. Based on the EFA results, we identified four criteria (personal, managerial, organizational, and side issues) with eigenvalues ​​higher than 1. The first criteria (personal issues) scored the highest (53.39 %), while side issues scored the lowest (13.40 %) as reasons accounting for the intention to leave the nursing profession. Conclusion: Job stress, the lack of freedom and independence in the clinical environment, discrimination, and the probability of catching an illness have higher prominence in influencing nurses' tendency to leave work. These factors can be mitigated by altering managerial techniques within organizations.
背景:有几个原因可以解释护士离开护理行业的意图。了解这些因素是减少对护理职业构成威胁的此类事件的一步。本研究旨在确定和排名的情况下,影响意向离开护理专业在伊朗。方法:本研究为横断面分析研究,采用其他四种方法在2019年得出合理的结论。电子数据库,包括科学信息数据库、PubMed、Scopus、Science Direct、OVID、Cochrane图书馆、CINAHL,检索了1998年至2018年12月期间发表的与离境意愿相关的科学研究。然后使用探索性因素分析(EFA)方法提取隐藏因素并确定综述结果的层次结构。运用层次分析法和模糊逻辑相结合的方法,计算出影响护士职业离职意向的各因素的权重。最后,对一致性比和模糊层次分析法(FAHP)结果的准确性进行了计算和评价。结果:电子检索提供了100项研究,从中我们确定并提取了26个最常见的离开护理行业的原因。基于EFA结果,我们确定了特征值大于1的四个标准(个人、管理、组织和附带问题)。第一个标准(个人问题)得分最高(53.39%),而次要问题得分最低(13.40%)是导致离开护理专业的原因。结论:工作压力、临床环境缺乏自由和独立性、歧视、患病概率对护士离职倾向的影响更为显著。这些因素可以通过改变组织内部的管理技术来减轻。
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引用次数: 2
Unsuccessful Weight-Loss in Adults Admitted to Health Centers, Ahvaz, Khuzestan: A Phenomenological Study 在胡齐斯坦阿瓦士健康中心住院的成人减肥失败:现象学研究
Pub Date : 2020-12-15 DOI: 10.18502/jebhpme.v4i4.4890
F. F. Khiavi, K. Djafarian, Mahbubeh Afrashtabar
Background: Nowadays, obesity is one of the most important public health problems worldwide. There are so many various factors interfering with obesity that it is necessary to be studied separately in each population. Although many people can lose weight by observing low-energy diets, they often return to the former weight and even higher. The present study aimed to identify the causes of unsuccessful weight-loss in adults admitted to health centers in Ahvaz. Methods: This was a qualitative phenomenological study carried out in one of the health centers in western Ahvaz, 2017. The data collection tool for this study was semi-structured in-depth interview conducted face-to-face and individually. The interviews were recorded and transferred word-by-word on paper immediately. Then interviews were analyzed using the content analysis method. Results: Seven themes and 11 key concepts were extracted from the contents of the interviews.The following items led to a failure of keeping the diet and achieving the proper weight: Underlying diseases, the effects of drugs on overweightness and obesity, physical characteristics, lifestyle, affecting overweight and obesity behaviors, food habits, and psychological factors. Conclusion: Lifestyle and some diseases and medications can lead to a failure of overweight and obesity confronting programs. Provision of the educational and informational programs to the society with emphasis on the side effects of weight loss medications and lifestyle changes, especially the dietary habits, together with a consideration of the mental health dimension may affect the success of people in controlling obesity.
背景:肥胖是当今世界最重要的公共卫生问题之一。影响肥胖的因素太多了,有必要对每个人群分别进行研究。虽然许多人可以通过低能量饮食减肥,但他们往往会回到原来的体重,甚至更高。本研究旨在确定在阿瓦士健康中心住院的成年人减肥失败的原因。方法:这是一项定性现象学研究,于2017年在阿瓦士西部的一个卫生中心进行。本研究的数据收集工具是半结构化的深度访谈,面对面和单独进行。采访被记录下来,并立即逐字转印在纸上。然后采用内容分析法对访谈进行分析。结果:从访谈内容中提取出7个主题和11个关键概念。以下项目导致无法保持饮食和达到适当的体重:基础疾病,药物对超重和肥胖的影响,身体特征,生活方式,影响超重和肥胖的行为,饮食习惯和心理因素。结论:生活方式、某些疾病和药物可导致超重和肥胖对抗计划的失败。向社会提供教育和信息方案,强调减肥药的副作用和生活方式的改变,特别是饮食习惯,同时考虑到心理健康方面可能会影响人们控制肥胖的成功。
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引用次数: 0
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Evidence Based Health Policy, Management and Economics
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