نشریه مدیریت سلامت
پیاپی 27 (بهار 1386)

Abstract The patient who is referred to a medical center for the physical or mental injuries has legal and official rights. With due attention to the increasing knowledge of patients about their rights and also their needs and expectations from medical centers, it is necessary that all members involved in of caring of patient, including hospital managers, be aware of patient rights. This study was conducted to determine the level of knowledge of administrators in Tehran governmental hospitals about patient's rights (2004). This was a descriptive analytical study using cross-sectional method. Subjects were all administrators of governmental hospitals in Tehran (n=46). Data were collected by a 36 items questionnaire and analyzed by SPSS. Fisher and? 2 testes. Our findings showed that 34.5% the administrators had good knowledge, 48.5% had intermediate and 17% had poor knowledge about patient's rights. Also level of knowledge of hospital's administrators was considered in 5 fields of patient rights: access to medical services, informed consent, individual freedom, awareness, and privacy. Educational degree, major of study and trained in managerial courses was three effective factors on knowledge of Tehran governmental hospital administrator about patient rights. All in all 65.5% the administrators did not have good knowledge level about patients rights and due to knowledge is the base for functionality, therefore it could be predictable that performance of hospital administrators about patient rights rooted in confronting hospital administrators their knowledge level with the rise in the patient's awareness of their rights. This should cause major challenges there for a training courses about this subject must be held for hospitals administrators. For hospital administrators, therefore, the need to improve the administrator's knowledge concerning the issue would deem essential and the necessity of training the administrators to meet those challenges seems inevitable, therefore polices should geared towards those needs.

Abstract Because of importance of coded data in quality management activities, case-mix management, planning, marketing, research activities, fee-for-services initiatives, patient safety monitoring, the development of clinical decision support tools, and public health surveillance, observance of coding quality elements is necessary more than ever. Having thorough knowledge of the classification systems key component of data quality include validity, completeness, and timeliness are necessary. In this study, validity, completeness, and timeliness of coding were compared among medical universities located in Tehran namely Iran, Tehran, and Shaheed Beheshti. This descriptive-comparative study conducted between 22Marh and 22 Oct. 2007). Research population was included medical records of discharged inpatients of all medical universities located in Tehran, namely Iran (10 hospitals), Tehran (9 hospitals) and Shaheed Beheshti (10 hospitals) respectively. Data collection was done through direct observation by using 1 checklist to determine observance rate of validity, completeness, and timeliness. Data analysis was done using descriptive statistics and SPSS software. Observance rate of validity of coding, in Iran, Tehran and Shaheed Beheshti Medical Sciences Universities for main diagnosis were 83.3%, 79.23%, and 85.53% respectively; and 79.46%, 75.04%, 88.87% for other diagnosis. For main procedures 85.23%, 80.62%, and 85.41%; and 80.84%, 84.49%, 91.3% for other procedure. Observance rate of coding completeness, in above Universities for main diagnosis were 93.06%, 96.91%, 97.96% respectively, and for other diagnosis 88.08%, 90.76%, 95.02%, and 96.7%, 94%, 98.93% for main procedure, and 93.85%, 97.35%, 95.65% for other procedure. Only 20 percent (2 hospitals) of 33 hospitals were observed for timeliness of coding. Although, observance rate of completeness of coding to some extent have improved against to past, but not validity rate of coding; and still combined with some problems. Also majority of hospitals had excessive difference with World Health Organization standards for timeliness of coding. Thus, critical activities are necessary for improving coding quality in these areas.

Safdari R.1 / Meidani Z.2 / Hajavi A.3 / Ghazi Saeedi M.4 / Sharifian R.5 Abstract According the studies that revealed the absence of specific and applied appropriate standards related to medical records, incompatibility of medical record departments with standards are prevalent, and also according consensus opinions of Iranian experts -wide universities of medical sciences on medical records activities, conducting a research on determining, confirming, and approving medical records standards; and finding an evaluation mechanism and appropriate tools according to pioneer countries and through the national appears to be necessary. In this descriptive-analytic study, we collected performance standards, evaluation mechanisms, and evaluation checklist for health information (medical record) of USA, Australia, Canada, New Zealand, Lebanon, Zambia, and Southern Africa through the email, literature review, Fax and Internet. Also we asked views of faculty members of medical record departments in 17 Iranian universities and Health Deputy experts about evaluation of medical record departments through a questionnaire related to proposed model (2005- 2006). Our findings showed that maximum agreements were focused on staffing and directing standards (66/7%). Staff development and education standards accounted for the minimum agreements (52/67%). More than 50% of experts believed that the current evaluation system is not desired and 99% were agreed on developing special sub- committees. Nearly all of experts (96/9%) agreed on adopting self-assessment process before on-site survey. Consensus of some medical records experts and faculty members to proposed model for medical records evaluation standards -despite availability of medical record standards determined by Iran Ministry of Health- should be attributed to shortcoming in available standards, evaluation mechanisms, and evaluation checklist.

Abstract According to mortality rates in Iran, cardiovascular diseases, neoplasms, perinatal mortality, and respiratory tract diseases were top rate mortality in 2003(1382). To reduce mortality rate, Iranian medical community need to know more about recent therapeutic regimens. Two main medical databases are Pubmed and Embase. Researching Pubmed and Embase indexing methods and comparing MeSH with Emtree help users to do more successful search in these databases. Consequently, designers of national medical information database in Iran may construct a model for updating indexing methods and thesaurus. This study aimed at comparing indexing methods in Pubmed and Embase. This was an applied; descriptive - analytical research. Research population was all of the descriptors in MeSH and Emtree; and indexed articles from Pubmed and Embase about four selected fields. In the last 3 months in 2006, all of the descriptors of selected fields were extracted through a structured search strategy. Then needed data was extracted from 6381 descriptors and 3358 articles. For collecting data we used a checklist and a questionnaire. Nine factors (including phrased descriptors versus single word descriptors, number of words in phrased descriptor, descriptor on adjectives and substantives format versus prepositions and conjunctives format, transforming versus non-transforming descriptors, using different quotation sign in descriptor structure, using abbreviations and commencer as descriptor, using definitions in descriptors, descriptors with explanations, and providing comments) selected from standard and analyzed in thesauri. Data were analyzed by SPSS using t-test and z test. Emtree in six factors, and MeSH in four factors are more similar to standards. Pubmed articles are indexed with average number of 21-30 indexing terms. Embase uses average number 31-40 indexing terms for each article. Emtree structure is more suitable for modeling. Embase indexing method is assignmentive and derivative indexing and does it specific and more exhaustive. Pubmed indexing method is derivative and exhaustive indexing.

Abstract Iran's health system is encountered with a variety of challenges and problems due to the issues of quality, relevancy, and effectiveness. The main reason of inefficacy in health system is unnecessary centralization. In the latest decade, health sector decentralization polices have been implemented on a broad scale throughout world especially in developing countries. Decentralization is transfer of decision making authority from central ministry of health (MOH) to preferable units or alternate institutions to Improve productivity. The main objectives of this research were to review in decentralization at provision of services and presenting a model for Iran. In this comparative research, mechanisms of decentralization in England, Turkey, Zambia, Ghana, Mexico, Thailand, France, Chile, Sweden, and Philippines were reviewed in order to prepare an appropriate model for Iranian health system. The valid mechanisms in function of delivering services proposed in a model for Iran. The developed model in the form of a questionnaire using Delphi techniques was distributed among informant and experts such as health management professors, heads of medical universities; and authorities of MOH and vice chancellors. Analysis of 35 collected questionnaire indicated that all participated subject agreed with appropriate this new developed model. Also the model was statically confirmed the significant of results (P<0/05). Constituents of the model are: Decentralizing in provision of services to provincial level and delegating of social services for aged people, disabilities and un- attended children to ministry of welfare and social security or municipalities.

Abstract Generally, epidemiologic review began with death data. Long time is seen changes in causes of death. These changes indicate increasing causes of death from infective diseases to chronic diseases. Thus, death indicators are good instruments for determining of community health. And with it can suggest constructive and positive recommends reducing causes of death. This descriptive study carried out on 5837 death existing data in Kashan city-Iran 1998-2002. Data gathering carried out with checklist from death certificates. Then data has coding and classified with international classification of diseases (ICD10) and in accordance with general condense death list number one. Their frequencies are reported in tables. Common causes of deaths were circulatory system diseases (44%), symptoms, signs and abnormal clinical and laboratory findings (16.6%), external causes of mortality (11.38%) and neoplasm (9.94%). Most deaths was up 65 years (54.5%) and under 1 years (12%). 53.8% of death was men and 42. 4% of them was women. 50% of cause of death had incomplete register and only 14% had continuum of causes of deaths. Common causes of deaths had normal trend in last 5 years and current plan do not have any effect on reduce or control of that. Training people about effective factors on chronic diseases and training medical students in academic education are recommended.

Mohaqeqi Kamal H.1 / Sajadi H.2 / Zare H.3 / Beiglarian A.4 Abstract Quality of life is considered as a component of individual's subjective well- being. This means more emphasis on social policy and on reforms in social goals aimed to make productive life for the elders. One way for improving quality of life is using a variety of social and welfare supports. The purpose of the present study was to investigate and compare pensioner quality of life between pensioners of Social Security Organization and National Retirement Fund in Qom County, Iran. In this cross-sectional study 150 aged pensioners (75 people from Social Security Organization and 75 people from National Retirement Fund) who were randomly selected were enrolled to compare their quality of life each other. As tools for collecting data, demographic check list, and LEIPAD elderly quality of life questionnaire were used. Statistical analyses performed by SPSS. T-test, one way ANOVA, and Pearson correlation coefficient were used to data analysis. We found no statistically significant association between two groups in terms of total quality of life (P= 0.103). There were no significant differences between groups in all dimensions of quality of life except subjective and mental function (P = 0.005). There was significant statistical correlation between elderly quality of life and their age, marital status, educational status and sex (P < 0.05); but not between quality of life and their housing and income (P > 0.05). In this study, we found no any statistically significant difference between pensioner's quality of life in terms of organization type.

Abstract Patient safety is one of the most important aspects of health care. Medical errors and specifically medication errors, however, make health care environment dangerous. Computerized Physician Order Entry (CPOE) has potentials to reduce these errors. So this study aimed to analyze the patient's safety condition and to determine the CPOE capabilities to decrease medication errors and create a safe health care environment for Iranian patients. Literature review: Untimely access to information at time of decision making and weak communication among health care providers are the main causes of medical errors. In addition, unavailability and lack of attention to information related to patients and drugs are the most common reasons for medication errors. So data reporting systems can support patient's safety. Manual systems, however, are not adequate to this end. In addition, CPOE has a special role at time of drug prescription to decrease medication errors. Using CPOE is a suitable approach to have access to timely information and to improve the relationships among specialists, and therefore; to reduce errors. The results of our study show the necessary capabilities to design CPOE for Iranian hospitals. Patient's drug profiles and informing physicians about using drugs and patient's inactive drugs, obligatory documentation, warning ability and reminding important and effective points on treatment, creating facilities to support decisions, relationship between CPOE to other information systems, presenting educational information about prescribed and replaced drugs, using internet and treatment protocols, are some such capabilities that all affect physician's prescription behaviors and finally lead to improvement in drug prescription process and reduction of medication errors.