مجله بیمارستان
سال دهم شماره 4 (زمستان 1390)

Since normal vaginal delivery is concerned in the mother’s health and their child,different levels of the healthcare system are engaged in this process, and due to the high rates of studies related to normal vaginal delivery is one of the priority areas in medical research worldwide. Function of normal vaginal delivery process- like many other clinical processes- is far from optimal in Emma Reza hospital, and needs improvement. This study was carried out with the aim of development of a clinical pathway for normal vaginal delivery to improve this process. In this paper we report the process of clinical pathway development. We will report the results of its implementation later. This is a quality improvement study which is one of the effectiveness or online studies. In this study we used Dr. Lameei's model for clinical pathway development. The following activities were done for the pathway development: 1) the quality improvement steering committee of the hospital took the responsibility of the overseeing the clinical pathway development process and policy issues in the hospital. 2) The steering committee created the criteria for selection of the first clinical process for pathway development. 3) Based on the criteria, the normal vaginal delivery process was selected for clinical pathway development. 4) Flow chart of the process was depicted and a multidisciplinary team was formed. 5) The multidisciplinary team assessed the current function of the process. 6) Using methods of evidence-based medicine, the team found out the best practice regarding normal vaginal delivery. 7) The team determined the format and content of the pathway. 8) It created alist of possible variances from the pathway. 9) Finally, the team developed the standing orders and necessary evidence based protocols. The outputs of the pathway development stage of this study were: 1) normal vaginal delivery clinical pathway. 2) Inclusion criteria into the pathway. 3) List of the variances. 4) Evidence based actions regarding each variance, standing orders, and necessary protocols. Clinical pathway was an effective tool for designing and standardization of clinical processes based on evidence based medicine. Nine steps model (FOCUS-PDCA) which used in this study was performable. The pathway development took more about one and half years, which was longer than the time western countries have used to develop clinical pathways. Two outstanding constraints in affecting the time devoted for clinical pathway development were: 1) Non familiarity of the multidisciplinary team with the concepts and principals of the clinical processes quality improvement in general, and the clinical pathway development in particular. 2) It took a very long time for the team to go through the team development stages and becoming a mature performing team.

Medical tariff is one of the most important tools for health policy making in a country that influences equity, efficiency, quality and accountability of service deliveries. If relative values for different services are not determined correctly, it may have negative consequences on availability and sustainability of care. This study was designed to assess the challenges and respective solutions of the tariff system in Iranian health sectors. This is a qualitative study, involving nine face to face interviews with health managers, policy makers and researchers at the Ministry of Health and Medical Education and relevant organizations, as well as public and private institutions and service providers who had experiences in medical tariff. We used the thematic framework method for analyzing qualitative data. The problems and respective solutions were classified into stewardship power, policy making and surveillance for tariff setting, structural organization of medical tariff system, methods and principles of setting the tariffs, medical costs recording systems and other concepts related to the medical tariff system in the health sector. To improve medical tariffs system in the country, one need to have a deep understanding of the current challenges and potential solutions in different levels. It is advisable to follow a clear model based on focus on policy-making and stewardship of medical tariffs system as an important cornerstone of any effort to rectify the current situation.

Medical error is a global topic. Its costs high and causes injuries to people. This issue imperils patient security which it is one of the most important dimensions of health care. Medical errors in health care institutions and hospitals in United States is the third cause of mortality and morbidity of about 98000 people annually. The objective of this research was assessing the viewpoints of GPs in medical errors issues. This is a descriptive-analytical cross-sectional research with 80 GPs participated in Zabol city. Instrument of data collecting was a questionnaire made by the research team including 19 questions related to all kinds of medical errors and disclosure medical errors that were used to etermine the narrative abstract views of the experts& teachers corresponds which validity used were confirmed. The reliability of the questionnaires were ascertained by test-retest which used the Pearson correlation coefficient (r = 0/80). Data analyzed by SPSS 18 software in statistical tests as a Chi- square. The GPs expressed (72/5%) diagnostic error as the most common type of medical errors.32/5 percent participants represented that cause of medication error was the error of pharmacy personnel.36 percent individuals mentioned that changing behavior and motivating staff were as the first factor in decreasing medical errors. 67/5 percent participants agreed to the training of medical errors and 32/5 percent were against disclosure to medical errors. There was no significant association between age and rate of medical errors (P >0/05). The role of authorities to enacted rules for generating legal and ethical security increased regarding the magnitude of medical errors. There is high prevalence and direct relationship between alive of people within period of time, budget, and staff in the health systems.

Identifying learning styles among students are very important in order to orient in learning and teaching activities. The aim of this study was to determine the learning styles of students in the ground of health services management in Tehran University of medical sciences in 2010. In this descriptive cross-sectional study, total of health services anagement students’ in Tehran University of medical sciences applied in a census study. The tool which used in this research was VARK learning style questionnaire. Data was analyzed by VARK software that later on designed into Excel and SPSS soft wares. In total, 130 out of 150 students completed returned questionnaire (Response Rate=7%).Only 33.1% of the students preferred a Uni-modal learning style. Among those students; 10.8% referred kinesthetics style, 10% preferred read & writing style, 9.2% auditory, and 3.1% preferred visual style. In contrast, the most of students (66.9%) preferred multi-modal [Bi-modal (18.5%), Trimodal (13.1%), Quad-modal (35.4%)] learning styles. There was no significant association between grade point average, sex and education degree with learning styles. Awareness of existing different learning styles among health services management students’ will help to trainers and educators to develop the effective learning approaches and also tailored to students in learning styles. Based on results, it is suggested to apply active learning strategies such as discussion groups, role playing, and simulation and so on to students in this field.

Picture Archiving and Communication System (PACS) provides the possibility of electronic transfer and storage of medical images in different units of treatment and educational centers. The aim of this study was to determine the problems and obstacles related to implementation of PACS in Urmia Imam Khomeini hospital. In this descriptive study, 88 physicians, nurses, radiographers, health information managers and executive managers in Urmia Imam Khomeini hospital were assessed. The sample size was accordance to the size of population; so, the census method was used for sampling.Data collection was performed by two questionnaires. The validity and reliability of the questionnaires were confirmed by content validity and test-retest method respectively. The four areas composed of human resources, management, organizational and technological factors which evaluated with those questionnaires. The data analysis was conducted based on the descriptive analysis. Results in four areas showed that the knowledge of employees and managers with the concept of PACS was 43.1% and 83.3% respectively. The findings also indicated that the interest of employees and managers to implementing such a system were 80% and 66.7% respectively. Based on the opinions of both managers and employees, it was found that the lack of awareness of hospital executive managers was the most important obstacle in the implementation of the PACS. Considering the progress in the medical informatics domain and applications of health information systems, it is necessary that the executive managers apply such systems in hospitals.

Diabetes control should be considered as a chronic illness in many fields. Perceived social support is one of the most important social factors in diabetes control. In this study, we aimed to determine the relation between perceived social support and relevant factors with HbA1C in type 1 diabetic patients. This study was a cross sectional which assessed relation between perceived social support and HbA1C of 113 diabetic patients affiliated to hospitals of Tehran University of Medical Sciences during 6 months in 2011. The instrument for data collection was a multidimensional scale including socio demographic and health status data, perceived social support scale by family members (20 items), perceived social support scale by friends (20 items). Collected data was analyzed by SPSS oftware version 11.5 with using nonparametric tests such as Mann-Witney and kruskal-Wallis tests. None of variables has statistical association with perceived social support by friends (p>0.05). Perceived social support by family members had significant relation with HbA1C among men (p=0.05) and patients with BMI in 26-29.9 ranges (p=0.01). It seems that perceived social support from family members is more important than perceived social support from friends. This finding is highlighted among men and patients with borderline BMI. Other variables such as disease duration, marital status, occupation, and education level had no statistical relation with HbA1C.

Each organization urgently needs a system evaluation for perception of desirability of the activities especially in complex & dynamic environments. In the other hand, Absence of an evaluation & controlling system in an organization is equal to lack of having communication with internal & external organizational environment which its outcome is organizational death. This is a descriptive study in the obstetric and genecology wards. Library studies, questionnaire, field studies and expert opinions used for data gathering. Indicators’ tree was designed by using analytical hierarchy process. The Delphi technique used for nominating the reliability of research. Several stages in process of designing a hierarchy are necessary which composed; determining performance indicators, regimentation of indicators and designing the tree, weighting and determining inconsistency rate. Performance evaluations of all wards in hospitals should been done by a systematic model in specific period of time. To identify this aim the specific performance indicators were necessary. Analytical hierarchy process could be an appropriate model for hospital wards performance in the evaluation.

Who has declared that protected of people against medical expenditures is as one of the three important objectives of the health system. The criticized of the economic situation urges the policy makers and academician area to pay more attention to this issue. This study was conducted to estimate the patient’s out of pocket for medical expenditure in Qazvin province in per income decentiles in 2009. This was a descriptive –analytic study performed on 384 urban ouseholds in Qazvin in 2009. The data were collected through interviews which used questionnaire consists of 25 stems. The data were analyzed by descriptive statistical index. The average of out of pocket money in patients was 59/7% of total medical enditures.The highest percent (67/5%) belongs to first income level and fifth income decentile has lowest percent (45/5%). Total average oop divided by total household income which was %7/3, that the highest percent belongs to the first income decentile (lowest income) 19%, and tenth income decentile has the lowest percent (3.6%). Despite coverage of general insurance, results of this study reveals that OOP ercentage of studied urban households is relatively was high (59/7%) and lower income decentiles (first decentile), OOP consists of substantial percent of household’s income (19%).