نشریه مدیریت سلامت
پیاپی 96 (تابستان 1403)

Understanding the hospital costs associated with COVID-19 and their impact on different populations helps develop a comprehensive approach to hospital preparedness, decision-making, and risk management. This study aimed to analyze the costs and identify factors associated with the direct treatment costs of hospitalized COVID-19 patients in a military hospital in Tehran.

This cross-sectional, descriptive-analytical economic evaluation study was conducted from February 20, 2020, to November 19, 2021, using a census of 28,997 hospitalized COVID-19 patients in a military hospital. Data analysis was performed using SPSS 26 and STATA 17 software, employing ordinary least squares regression and logistic regression.

The total direct medical costs of treating the patients were 3,510,832,085,964 IRR (Iranian Rial), and the average treatment cost per patient was 121,049,964 IRR. Age, length of stay, place of residence, and comorbidities were significantly associated with treatment costs. The results showed that increasing age, length of stay, and the presence of other diseases had a significant positive correlation with treatment costs.

To reduce patient costs, healthcare policymakers should improve insurance coverage, hotel services, and pharmaceutical provision, and promote a culture of seeking medical care earlier. Other important measures include outpatient treatment instead of hospitalization, telehealth follow-up, reducing hospital length of stay, prioritizing the elderly in preventive programs such as screening and vaccination, and providing greater insurance support for COVID-19 patients with comorbidities and specific conditions

The lack of quality management in nurses services will cause significant harm to the healthcare systems. This study aimed to investigate the factors affecting the quality of nursing service management at the medical sciences universities in Iran.

This study employed an applied, descriptive survey research design. The sample consisted of 255 nurses from Tehran, Kermanshah and Guilan provinces in Iran. A total of 152 questionnaires were collected. To assess the validity of the questionnaire, confirmatory factor analysis and structural equation modeling (SEM) was counducted using SmartPLS 3 software.

Factors influencing the quality of nursing service management included individual, educational, motivational, international, social, environmental, intra-organizational, and technological factors. All items had factor loading greater than 0.4, also the t statistic values exceeded 1.96. Individual and social factors had the most significant impact, with coefficients of 0.830 and 0.820, respectively.

Evaluating training courses and fostering constructive interactions between university officials and healthcare network administrator can enhance the availability of facilities, and promote mutual cooperation, performance and respect for nurses. It is suggested that directors of the nursing departments and the vice-chancellor of the university maintain continuous supervision over clinical lecturers’ performance , regular briefing sessions for lecturers, and enhance training on management service quality to improve students’ interpersonal interactions with patients and staff.

The differences in mental models of decision-making among managers with different educational backgrounds have not been systematically extracted, compared, or analyzed. Mental models serve as cognitive frameworks for managers' decision-making as an intellectual resource. The mental model has three components: image, imagination, and assumption. This study aimed to compare the decision-making mental models among clinical (medical) managers and professional managers (non-clinical specialists: engineers and humanities graduates), focusing on clinical managers’ mental model.

This qualitative study employs phenomenological theory. The study participants comprised 39 managers from three fields: humanities and social sciences, medical sciences, and engineering sciences, selected through criterion-based purposive sampling. Data were collected through structured interviews containing 19 open-ended questions. Collected data were analyzed by thematic analysis and continuous comparison techniques.

Analysis of 1300 data propositions yielded 19 findings and revealed 14 mental models. We systematically compared and reported images, imagination and mental assumptions between clinical and non-clinical managers.

Our findings demonstrate that the decision-making mental model across all three groups of managers exhibit simplicity, imprecision, incorrect (unscientific) foundations, as well as unstructured and static characteristics. Clinical managers demonstrated simpler and more limited mental models than those of non-clinical managers. These findings underscore the necessity of transformative restructuring of managers' decision-making mental models, particularly regarding the dynamics of their mental models.

The demand for pre-hospital emergency services is increasing globally, with a significant number of cases being non-urgent. The aim of this study was to determine the amount of non-urgent demand and to investigate the relationship between demographic characteristics, medication use, underlying diseases, vital signs, and the day and time of non-urgent demand contacts.

This descriptive-analytical study utilized information from 300 individuals who had contacted the emergency medical services of Tehran province in the first six months of 2021. Proportional sampling was conducted for two groups of individuals that had made urgent and non-urgent demands to the emergency medical services. Multivariate logistic regression and Chi-square statistical tests were used to analyze the data.

More than one-third (33 percent) of all calls made to the emergency services of Tehran province were non-urgent demand. Place of residence, normal heart rate and oxygen level, underlying cardiovascular disease, and not taking medication were also statistically significantly associated with non-urgent demand at the 95% confidence level (P<0.05). The most common reason for contacting the emergency services was cardiac problems (23.5% for the urgent demand group and 28% for the non-urgent demand group).

Place of residence, heart rate, oxygen levels, underlying diseases, and medication are associated with non-urgent demand for emergency services. Addressing these factors by authorities during decision-making and planning will help direct valuable financial and human resources toward responding to truly urgent demands.

Quality improvement in education seems essential for the enhancement of educational productivity, learning quality, and learners' capabilities. This study aimed to identify the challenges and solutions for improving the implementation of the internship program for students of health services management.

The study was conducted using a qualitative approach. This study applied a stakeholder perspective along with a review of studies. A total of 35 interviews were conducted with students, university faculty members, hospital administrators, hospital quality improvement experts, instructors or internship administrators, and university staff managers. Finally, for validation purposes, an expert panel was held with the presence of faculty members in the field of health services management, hospital quality improvement experts, and hospital managers.

Students spend their internships in hospitals and headquarter units under the supervision of the head of the unit. The evaluation methods were also completely different through written reports, project completion, direct supervisor evaluation, evaluation by the course instructor, or a combination of the mentioned methods. The challenges for improving the provision of internship units included educational system challenges, professors and trainers-related challenges, challenges related to students, and challenges related to internship objectives. The solutions were also divided into four categories: teacher and course instructor, course syllabus, hospital liaison, and educational field centers.

Experienced internship unit supervisors, simultaneous presence of a faculty member and a supervisor from the organization, developing detailed framework for each course, updating the course outlines, especially the practical units, and requiring internship and apprenticeship students to attend committees can be recommended for better implementation of this course.

The Integrated Health System (locally called SIB system) is one of the most important electronic health record systems in Iran, developed with the aim of integrating the country’s health and medical information at the primary care level. This study aimed to comprehensively evaluate SIB from the perspective of health center users in West Azerbaijan province.

For this study, all 215 users were selected through a census method Data were collected using a standard questionnaire consisting of seven dimensions: system interface quality, task quality, quality of performance, quality of information and statistics, quality of support services, quality of general services, and overall quality of system services. Data were analyzed using SPSS version 28, and findings were presented as mean and standard deviation.

The average score of the seven dimensions were as follows: interface quality (3.35/5), task quality (3.13/5), performance quality (3.10/5), quality of information and statistics (3.32/5), quality of support services (3.04/5), quality of general services (3.24/5), and overall quality of system services (2.74/5).

this study found that the lowest score was associated with the overall quality of system services, which is mostly influenced by the satisfaction of human resources with managerial and financial supports. Ignoring user satisfaction may lead to long-term decline in the quality of SIB services.

The migration of nurses leads to a shortage of human resources in healthcare systems, a decrease in the quality of health services, an increased workload on the remaining staff, and reduced access to effective healthcare services for vulnerable populations. This study aimed to identify strategies for managing nurse migration.

In this a scoping review,relevant Persian and English studies on the management of nurse migration were searched in databases such as PubMed, Web of Science, Wiley Online Library, Springer, Science Direct, Scopus, Magiran, SID, and the Google Scholar search engine between January 2000 and October 2023 using appropriate keywords. Finally, 89 documents were selected and analyzed using MAXQDA software and thematic analysis.

A total of 42 strategies for managing nurse migration were identified, which were divided into two categories: strategies for countries of origin and destination. The most important strategies related to countries of origin included increasing salaries and benefits, improving working conditions, creating barriers to migration, establishing bilateral or multilateral agreements, implementing brain circulation processes, and improving the political and economic conditions of countries. On the other hand, strategies for destination countries included ethical recruitment of nurses from developing countries, compensating countries of origin, and efforts towards self-sufficiency in nursing workforce.

Despite the short-term benefits of nurse migration for the destination country, it poses serious challenges for the healthcare systems of developing countries. Identifying and implementing effective strategies, including increasing salaries and benefits, improving working and living conditions in countries of origin, and creating bilateral or multilateral agreements while ensuring ethical recruitment in destination countries are essential for managing this phenomenon. These actions require extensive international cooperation and the commitment of policymakers to prevent health crises and enhance global health systems.