نشریه مدیریت سلامت
پیاپی 85 (پاییز 1400)

Palliative care plays an essential role in improving the quality of life of patients suffering from chronic and incurable diseases; therefore, it seems necessary to remove barriers in improving palliative care. The present systematic review aims to describe the current status of palliative care, and determine the challenges of palliative care services.

In this systematic review study, we searched Scopus, Magiran,SID,Cochran,Embase, PubMed, Web of Science, and Google Scholar databases. Also, we retrieved articles published in English and Persian during 2000 to 2021. The keywords include "hospice care," palliative care," "health care," "terminal care," "end of life care," and palliative medicine". All retrieved articles were screened in three stages, namely review of titles, abstracts, and full texts. Meanwhile, we analyzed data based on the WHO 2018 framework and deductive-inductive approach.

A total of 3497 articles were found. After reviewing these articles, we were able to selecte 48 articles. Data were extracted and categorized according to four functions, namely service delivery, stewardship, resources generation, and financing. Service delivery had four themes, and nine sub-themes; stewardship had two themes and five sub-themes; resource generation had three themes and nine sub-themes; and financing had one themes and three sub-themes.

Findings of the present study can help policymakers improve the infrastructure and resources, as well as processes of palliative care that can consequently lead to an improvement in the outcomes of palliative care. Also, solving the challenges of palliative care requires strengthening the health systems so that they will be able to design and implement appropriate policies

The MRI is one of the most expensive departments in hospitals due to high number of referrals and use of advanced equipment and diagnostic devices. The purpose of this study was to calculate the cost of services of this unit at Imam Reza Hospital and compare it with the tariffs for their  correct pricing.

In this descriptive and applied study, the cost price of selected MRI services was calculated using the step-down costing method for the radiology department of Imam Reza Hospital in Urmia in 2018. Data collection tools were standard forms related to the cost list of MRI services and related activity centers. Also, to estimate the share of costs of other departments in MRI services of the radiology department, appropriate sharing bases were determined and, then, using these bases and Excel software, the costs were calculated.

According to the research findings, the cost of selected services of this unit including MRI of the brain without injection was  calculated to be 1449224 Rials, brain with injection was 1793634 Rials, brain simultaneous with and without injection was 3121783 Rials, lumbar spine without injection was 1994881 Rials, and lumbar spine with and without injection was 3449832 Rials.

Based on the results, there was a difference between the actual price of MRI services and tariffs, and personnel costs had the highest share of MRI costs. Therefore, accurate calculation of the cost of MRI services can help reduce costs and increase efficiency by identifying and modifying, merging, or eliminating costly centers.

Patient engagement is a concept that has gained special importance in medical care today, and is considered as a valuable goal in patient care. With the evolution of modern health from a disease-centered model to a patient-centered model, patient interaction has played an important role in improving the health care processes. This study aims to identify the factors affecting the patient's interaction with the physician.

This is an applied study with a qualitative-descriptive method. First, the information of patients who underwent angioplasty in 2019 was extracted from the hospital information system. Then, in-depth interviews with patients were conducted using a semi-structured interview guide. In the next step, we analyzed the data using qualitative content analysis with MAXQDA.

After analyzing data, we were able to extract 1072 codes. Then, we categorized the codes into two sub-categories of supply side (physician) and demand side (patient). We identified 11 factors affecting supply-side interaction (information, physician behavior, education, access, cost, responsiveness, patient perception of physician expertise and skill, managerial weakness, facilities, trust, and satisfaction with physician), as well as seven factors on demand-side (personal problems, patient questioning spirit, response from other sources, financial problems, lack of knowledge and awareness, advice from others, and self-medication).

It is expected that the patient's interaction with his/her physician after angioplasty could accelerate the patient's recovery process, prevent possible complications, and reduce costs. Recognizing the effective factors and designing appropriate interventions on the supply and demand side that can lead to improving patient interactions with physicians, and pave the way for promoting community health.

Human resources are the most important asset of any organization; also, the payment system is the main motivating factor for hospital staff. The aim of this study is to evaluate the effect of implementing pay for performance (P4P) instruction on inequality in income distribution between medical and non-medical staff.

The present study is a applied research study conducted through a descriptive method. The statistical population of the study, hospitals, and P4P were selected from Mashhad University of Medical Sciences, Iran. Data on personnel characteristics and their income were also collected for three periods including a six-month pre-implementation period, as well as two six-month post-implementation P4P periods. Meanwhile, we used Lorenz curve and Gini coefficient to measure inequality in the distribution of income.

The Gini coefficient obtained for all employees has increased from 63% for the period before the implementation of the instruction to 62% in the second period and 65% in the third period after the implementation of the instruction. The Gini coefficient between the physicians group and the nurses group for the first period was 64 and 35%; for the second period 61 and 25%; and for the third period 62 and 26%.

Results of this study are expected to be applied to reform current P4P policies in hospital. However, schemes that cause the service compensation change need to be examined from different dimensions; one of which is the impact on income inequality that requires more comprehensive studies.

Poor performance of the resuscitation team can have negative consequences for the hospital and the community. Identifying and correcting problems related to the emergency department is one of the priorities to improve the quality of service delivery and increase satisfaction. The aim of this study was to determine the effect of the FOCUS PDCA method on improving the cardiopulmonary resuscitation (CPR) index in the emergency department.

The present study was a quasi-experimental study performed in the emergency department of Imam Ali Hospital in Andimeshk. The control group included 75 CPR events before the intervention, and the experimental group included 76 CPR events after the FOCUS-PDCA. A team of nurses working in the emergency department and resuscitation group were selected based on the inclusion criteria. Basic and advanced CPR training and FOCUS PDCA method workshops were held for them. Then, the nine steps of the FOCUS-PDCA were performed. The data collection tool was a researcher-made checklist. Data were analyzed using the SPSS-22 software: Chi-square, Fisher, and Mann-Whitney U tests were performed.

The result of successful resuscitation for patients after FOCUS PDCA increased by 3.64%.The  CPR results were successful in 6.7% before the intervention and 26.3% after the intervention. The rate of unsuccessful CPR in traumatic, internal, and non-traumatic patients decreased after the intervention. There was a statistically significant difference between the two groups in terms of the occurrence of cardiac arrest in presence of witnesses.

It is expected that the implementation of the FOCUS PDCA method can lead to the improvement of indices and successful resuscitation of patients in the emergency department.

Road traffic accidents are one of the leading causes of death worldwide, including Iran. There are several factors involved in the occurrence of them; using different models, these factors can be identified and the occurrence of road traffic accidents can be predicted. The purpose of this study was to predict road traffic accidents based on weather conditions using artificial neural network model.

In the present study, traffic data during the years 2014 to 2017, were examined using a multilayer perceptron network. Network input variables included minimum temperature, average temperature, average rainfall, maximum wind speed, glaciation, air pressure, fog concentration and output variable was the number of accidents.

The designed network with seven neurons in the input layer, four neurons in the middle layer, and one neuron in the output layer with Lunberg-Marquardt optimization function and sigmoid tangent transfer function in the middle layer and linear transmission function in the output layer was selected as the optimal network. The results showed that the designed network with the correlation coefficient of 0.90 and mean square error of 0.01 has a high ability to predict road traffic accidents.

The results showed that the artificial neural network has a good performance for predicting road traffic accidents. Given the importance of predicting road traffic accidents and its role in promoting the health of people in such accidents, the results of this study can be used to expand more effective preventive measures for policy makers and researchers.

The readiness of health centers, especially hospitals for management challenges ahead, has a significant impact on reducing mortality in addition to physical and psychological damage due to the prevalence of viral or infectious diseases with high pandemic potential, including the COVID-19. Given the importance of this issue, this study aimed to identify the challenges of managing health centers and prioritizing them during the COVID-19 pandemic.

In this research, first, by reviewing the literature, text mining and, using the opinions of experts, we identified the main challenges of managing health centers. Then, the Likert-scale questionnaire was used to determine the main challenges. The Best Worst Method was used to determine the importance of each challenge, and the Fuzzy Cognitive Map Approach was used to determine the impact of each challenge on other challenges.

The 20 identified challenges were classified into three categories: human resource challenges, organizational challenges, and external challenges. Nine main challenges were identified among them. According to the results, inadequate physical space, restrictive rules and regulations, and manpower shortages were the most important challenges, respectively, and inadequate physical space was the most effective of the challenges.

Due to the importance of managing health care centers and the need for immediate action during this period, more specialized personnel response, empowerment of medical personnel, and correction of laws which act as obstacles can be useful tools for improving the management of these centers in the short term.

Achieving sustainable economic growth requires investment in infrastructure to increase production capacity. Such investments include not only physical investments, but also human investments, education, and health. In this study, we aim to analyze the effect of labor force education in the health sector on Iran's economic growth.

This is an experimentally analytical-descriptive study conducted using the Autoregressive Distributed Lag Model (ARDL) and annual data for Iran from 1991to 2019. In addition to analyzing the effect of labor force education in the health sector on economic growth, the effect of public education, higher education in the Ministry of Science, physical investment, openness, and export were also examined. Data were extracted by documentary method from the database of the Statistics Center of Iran, and estimates were made using Eviews 10 software.

Findings of this study indicated the positive effect of independent variables on Iran's economic growth, in which the coefficients of public education, labor force education in the health sector, labor force education in the Ministry of Science, physical investment, openness, and exports were equal to 0.0125, 0.621, 0.8752, 0.449, 0.218, and 0.2429, respectively.

Results of the model estimation indicated the positive impact of public education, labor force education in the health sector, and labor force education in the Ministry of Science. Based on the results of the present study, the adoption of appropriate policies by policymakers in the field of educational investment at the public and higher levels, especially in the health sector, has an effective role in increasing Iran's economic growth.