فهرست مطالب

  • Volume:1 Issue: 4, 2018
  • تاریخ انتشار: 1396/10/30
  • تعداد عناوین: 8
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  • Ali Jannati, Elham Dadgar, Jafar Sadegh Tabriz, Masoumeh Gholizadeh, Neda Kabiri Pages 198-204
    Background
    Performance assessment tries to find the best, valid and cost-effective way of measuring performance and work satisfaction. There are several indicators for health systems performance evaluation which ignore the managerial aspect. We aimed at evaluating the validity and reliability of managerial performance assessment tool for Iranian hospitals.
    Methods
    The current study is a part of larger study which aims at developing a reliable and valid tool for managerial performance assessment tool. The intended tool has seven dimensions of planning, organizing, leadership, information management, resource management, clinical governance, and performance indicators. We conducted a 2-round Delphi study with 18 experts whom were selected purposefully to evaluate the validity of the tool. Reliability was assessed through implementing the tool in three randomly chosen hospitals of Tabriz. Content Validity Index (CVI) and Content Validity Ratio (CVR) along with internal consistency and Cronbach's alpha were calculated for this reason.
    Results
    A checklist with 117 indicators was prepared. After determining the validity and reliability of checklist, scores for these indicators were calculated given the importance scores. The whole tool has the score of 1000. Cronbach's alpha coefficient was 0.76 for the whole checklist.
    Conclusion
    The validated tool in the current research can be used in performance assessment, evidence-based dismissal, installation, and upgrading of hospital managers in order to avoid non proper selection of these managers. Further researches are needed to apply this tool in managerial performance assessment of hospitals in order to measure probable bugs of this model.
    Keywords: Management, Performance Assessment, Checklist
  • Hedayat Salari, Mohammad Reza Ravanbod, Ali Akbari Sari, Gholamreza Farzanegan, Atefeh Esfandiari Pages 205-210
    Background
    Evidence Based Medicine can be define as the process of systematically finding, critically appraising, and using recently published researches as a basis for making decisions regarding individual patients.One of the most prevalent MRI procedures is Brian MRI. This study aimed to identifying and developing appropriate indications for prescriptions of Brain MRI in Iran.
    Methods
    This is a consensus based study using one of the practical methods, RAND Appropriateness Method. The study sample were among experts in the treatment and diagnostic field of brain disorders. The experts consisted of nine specialists: Four neurosurgeons and five neurologists, all of whom were faculty members and worked in educational hospitals. The list of indications and scenarios sent to 9 experts for scoring. They scored the scenarios according to RAM instruction.
    Results
    A total of 104 indications and scenarios were extracted. After that, Finally80scenarios fall in the category of appropriate scenarios, 20 in uncertain and4 in the category of inappropriate scenarios.
    Conclusion
    Currently a huge number of medical imaging prescriptions may be unnecessary in Iran and there is need for developing clinical practice guidelines. The findings of this study can be used for developing national guidelines, conducting research to assess whether the criteria are followed in practice and whether their application can curb the growing rate of unnecessary care in all countries. In Iran, a limited amount of resources are allocated to the health sector
    Keywords: Developing, Clinical Practice Guidelines, MRI, Brain
  • Hojjat Vahdati, Ali Hozni, Mehrnaz Tohidi Moghaddam Pages 211-221
    Background
    The quality of services is the most important determinants of successful hospital in competitive world. The aim of this study was to investigate the effect of human resource management based on hospital accreditation standards on the quality of hospital services using SERVQUAL model.
    Methods
    The method of this research In terms of purpose, was functional and applied, In terms of data collection, was descriptive, statistical community includes 310 family hospital clinical personnel in Rasht at fall of 2016, This sample was selected randomly, based Morgan table evaluated 175 persons. For data collection standard questionnaires Based on Iran's Ministry of Health and SERVQUAL used, for Information analysis, structural equation modeling with partial least square method was used with the Smart PLS2 software.
    Results
    Test hypotheses suggest that empowering human resources management based on the accreditation standards for hospitals affects the quality of hospital services significantly. The most important factors in the management and empowerment of human resources include: education and empowerment of employees (0.950), policies and methods (0.949), safety and occupational health and environmental health guideline book (0.938).
    Conclusion
    In order to improve the quality of hospital services as accreditation view, it is important notice to the management and empowerment of human resources items and it is suggested that hospital managers consider it to be the priority of their programs
    Keywords: Accreditation, Human Resource Management, Service Quality, SERVQUAL, Famili Hospital of Rasht
  • Naseh Lotfi, Soraya Nouraei Motlagh, Mohammad Hadian, Saman Ghasempour Pages 222-230
    Background
    Insurance industry is recognized as a major economic entity. Development of insurance, and particularly life insurance, is among the necessities of industrial societies as this plays a substantial role in reinforcement of the society’s economic power and, thus, establishes security and confidence. Aimed at analyzing the economic-social factors affecting insurance demand, the present study deals with estimation of life insurance demand function using panel data from 2006 up to 2014 in Iran.
    Methods
    The present research is a descriptive-analytical study of the retrospective cohort applied type. Information registered in Iran’s Statistics Center encompassing the interval from 2006 to 2014 was analyzed. Benefitting from economic evaluation mechanism and macro-scale economic and social variables affecting life insurance demand were investigated in 30 provinces of Iran. Finally, the country’s demand function of life insurance was estimated using Stata12 and Eviewes8 software packages with panel data method.
    Results
    Life expectancy rate has the largest impact on life insurance demand among the variables analyzed. In addition, urban settlement rate leaves the smallest effect on life insurance demand.
    Conclusion
    Results of the study indicate that increase and rise of variables such as life expectancy rate, dependency rate, urban settlement rate, literacy rate, likelihood of family head’s death, population, and average net annual expenditures of urban family lead to increased tendency of individuals to life insurance. Furthermore, increase of other parameters like inflation rate and interest rate result in reduction of people’s tendency toward life insurance.
    Keywords: Life Insurance, Demand, Inflation Rate, Interest Rate, Life Expectancy Rate
  • Mohammad Hossein Mehrolhassani, Vahid Yazdi-Feyzabadi, Hossein Saberi, Marzieh Lashkari Pages 231-242
    Background
    The main resources of health care are allocated to hospitals. However, resource bottlenecks are a challenge faced by health systems around the world, especially in developing countries such as Iran. Inefficiencies in resource allocation can increase the constraints in double fold. Therefore, the present study was conducted to determine the allocation of financial resources in one of the hospitals of the board of trustees, Afzalipour Medical Center, Kerman, Iran.
    Methods
    Review of documents, two deep interviews and five focus group discussions with eleven experts were used to collect data in the present qualitative study. Participants were members of the board of trustees and representatives of the financial department of the hospital. Data were then analyzed using content analysis method.
    Results
    Based on the present study, four main themes and ten sub-themes were identified, with main themes including decision-making reference, process, criteria and factors influencing decision-making. In this regard, there was no clear process and criteria for allocating resources at this center, and allocation of resources was done based on a reactive approach, response to critical situations, political currents and financial bottlenecks. Contrary to the potential capacity of the structure of board of trustees, in practice, headship and management played a key role in allocating financial resources.
    Conclusion
    The process of allocating financial resources in the investigated hospital follows a less rational approach and coincided with the chaos theory and the garbage can model of decision-making in the governmental bureaucratic structure. The governmental bureaucratic structure and the board of trustees structure (decentralization) in contrast to each other have led to a disorder, where the lack of transparency in determining goals, criteria and document performance have also exacerbated this disorder. In this regard, the oil-related budget has stabilized the inappropriate allocation of resources.
    Keywords: Resource Allocation, Board of Trustees, Chaos Theory, Garbage Can, Hospital
  • Manal Etemadi, Habibe Vaziri Nasab, Ali Ebraze, Elahe Khorasani Pages 243-252
    Background
    One approach to improve efficiency in health care is to identify patients with high risks of readmission so that resources should be distributed in a way they would benefit targeted care. A model named LACE (length of stay, acuity of admission, Charlson comorbidity index (CCI(, and number of emergency department visits in preceding 6 months) has been proposed to predict patient readmission which is widely used due to its simplicity to rank factors’ risks. The aim of this study is to determine if LACE Index could be used to predict Iranian hospital readmission.
    Methods
    This was a prospective cohort study in which the prediction of readmission for patients admitted to the cardiac intensive care of Shahid Beheshti Hospital of Qom during April to June 2012 within one month after the discharge was evaluated based on 4 items of LACE index. Following-up readmission states by making calls within a month after discharge. Purposive sampling was used to select the sample, patients having four most prevalent chronic heart diseases in the CCU of the hospital were selected and at last sample size was 109 patients. We used logistic regression, the phi and Spearman correlation coefficient to analyze data using SPSS18. the significance level was considered as 5% in all tests.
    Results
    Among the items of LACE model, 48.6% of patients stayed at the hospital for 4 to 6 days. Only 11 patients (10.09%) referred to the hospital after a month. None of the components of the LACE index could enter the stepwise logistic regression model.
    Conclusions
    Considering that LACE model with its four items is a weak in predicting readmission, in order to improve the model in predicting the readmission of cardiac patients, it is recommended that individual variables and factors associated with the service providers be added to it.
    Keywords: Readmission, LACE Index, CCU, Hospital, Iran
  • Mojtaba Nouhi, Mahdi Naderi, Alireza Olyaeemanesh Pages 253-260
    The revision of health benefits package is considered a potential policy for making reforms in the healthcare system. However, limited studies have been carried out on the concept of revising health benefits packages and finding applicable levers to effective revision and also determining the characteristics of a desirable model. This paper investigates the concept and the levers in revising the health benefits package and also suggests the characteristics of desirable model.
    Keywords: Revision, Health Benefits package, Concept Clarification, Universal Health Coverage (UHC)
  • Mohammad Mohseni, Ahmadreza Raeisi, Saber Azami-Aghdash, Ahmad Moosavi, Seyed Masood Mousavi Pages 261-269
    Background
    The identification of strengths and weaknesses of services provided is the first step for the improvement of the quality of services. In hospitals, patients are the most important groups for the evaluation of the quality of healthcare services. Thus, this systematic review and meta-analysis aims to evaluate hospital service quality from patients’ perspective in Iran using Servqual model.
    Methods
    A systematic review and meta-analysis of studies evaluating patients’ perspective about hospital services quality was conducted. Required data were collected through searching following key words: Servqual, services quality, gap, hospital, patients, Iran, using the database sources including PubMed, Scopus, Google Scholar, MagIran, SID and IranMedex. Comprehensive meta-analysis (CMA) software, Version 2 was used to estimate the total mean score of patients’ perception and expectation of services quality and the gap between them.
    Results
    Totally, 11 eligible studies were entered into the systematic review. Based on the random effect model, the total mean score of patients’ perception, patients’ expectation and the gap between them were estimated 3.66 (95% CI, lowest = 3.40, highest = 3.92), 4.62 (95% CI, lowest = 4.42, highest = 4.82) and 0.94 (95% CI, lowest = 0.78, highest = 1.10), respectively. The mean score of the gap between perception and expectation was 0.95 and the biggest gap was related to the responsiveness dimension.
    Conclusion
    Responsiveness is related to the areas, such as providing appropriate and timely services, the reliability of providers, good communication between staff or physicians and patients. The importance of these areas signifies the necessity of taking actions in order to provide more appropriate and higher quality services.
    Keywords: Hospital Service Quality, Systematic Review, Meta-Analysis