فهرست مطالب علی زارع عسکری

 Cost management of inpatient records can directly and indirectly affect the management and control of hospital costs. Therefore, the present study was conducted with the aim of designing and validating the cost management model of inpatient records in the global system.

 The present mixed method study was conducted in 2021. Senior and middle managers composed the statistical population in the qualitative section and the senior, middle managers and staff of Niknafas Hospital in Rafsanjan were the quantitative section statistical population. In the qualitative section, in-depth interviews were conducted with 33 experts using the purposive sampling accompanied with snowball method. A researcher-made questionnaire with a random sampling method was used to assess the model among 210 people in the quantitative section. Qualitative data were analyzed by Atlas.ti software and quantitative data were analyzed by exploratory and confirmatory factor analysis using SPSS and SmartPLS version 3 software.

 The results of the qualitative section indicated that the cost management model includes 15 sub-categories and 6 main categories. "Information and awareness", "sensitivity", "risk-taking and motivation", "control and supervision", "experience and skill", and "factors beyond the hospital's control" were the main categories. The SRMR fit indices (0.069), R2 (>0.67), GOF (>0.36) showed that the fit of the measurement, structural and general models were appropriate and approved.

 The present study showed that the designed model of cost management of inpatient records in the global system has a good fit and can be used in medical centers.

It is very important to calculate the costs of inpatient services covered by the global tariff and compare it with the approved tariff in hospitals in regard to the financial profit and loss. In this regard, this study was conducted with the aim of comparing the costs of global inpatient services bills with their approved tariffs in Niknafs Obstetrics and Gynecology Hospital in Rafsanjan.

In this descriptive study, the population included all the invoices of hospitalized cases subjected to the global tariff in 2019 in Niknafs Hospital in Rafsanjan. The required data were collected from the patients' accounts and analyzed using descriptive statistics and SPSS 20 software.

In 2019, out of the total inpatient services related to the obstetrics and gynecology group, 6 services subjected to the global tariffs were performed in Niknafs Obstetrics and Gynecology Hospital in Rafsanjan. A comparison of the average costs incurred in these services with their approved tariffs showed that in all of them, hospital costs were between 10.74% and 20.54% higher than the approved global tariffs. The highest difference (20.54%) was related to cesarean section, and the lowest (10.74%) was related to hysterectomy.

The results of this study showed that the global services of this hospital have no economic justification and global tariffs lead to losses of the hospital. Therefore, it is suggested that hospital officials focus more on managing the costs of global services, and approved tariffs be reviewed in a timely manner, commensurate with the growth of inflation and taking into account the different conditions of patients.

Parturition is one of the most important events in women's lives, and therefore, factors that lead to a reduction in pain and its consequences during childbirth with minimal intervention are important for researchers. Therefore, the aim of this study was to investigate the relationship between midwifery counseling along with type of delivery and the rate of anxiety, stress, and depression in primiparous women in Niknafs Hospital of Rafsanjan in2021.

This was a cross-sectional and descriptive study. The statistical population included all primiparous pregnant women who volunteered for natural childbirth in Niknafs Hospital of Rafsanjanfrom March to August 2021, numbering 199. In this study, a checklist and a questionnaire were used. The checklist included demographic information and clinical characteristics of the patient and a questionnaire (Stress, anxiety, depression questionnaire DASS) for stress, anxiety and depression were assessed. The confidence level was considered as 0.05. Thestatistical software used was SPSS version 20.

The results showed that there were significant relationships between age (p = 0.03) and economic status (p = 0.00) with the type of delivery. Based on statistical analyses, the mean, Chi-square, and Mann-Whitney tests, there was a significant correlation between midwife support with mean stress score and anxiety (p = 0.03) and also between midwife support and depression (p = 0.01). Nevertheless, there was no significant relationship between the mean stress score and type of delivery (p = 0.30), anxiety (p = 0.27) and depression (p = 0.51).

Supporting a trained midwife on a maternity bed reduces her stress, anxiety, and depression in pregnant women, which has a positive effect on mother-infant relationships in midwifery and medical care. Therefore, it should be used to support childbirth and increase positive childbirth experiences in pregnant mothers.