نشریه مدیریت اطلاعات سلامت
سال نهم شماره 4 (پیاپی 26، مهر و آبان 1391)

Patient/customer satisfaction and loyalty have gained increasing attention from executives across the healthcare industry. Discharge against medical advice (DAMA) can be considered as one of the indicators of patient dissatisfaction. It has negative effects on patient treatment and leads to increased hospital costs. Study of predictors of DAMA in a teaching hospital was the aim of this research.

In this retrospective, case-control study during the winter if 2009, a total of 9463 discharged patient medical records were reviewed. They were selected based on kind of discharge using systematic sampling. Data was analyzed using chi-square test and t-test and binary regression in SPSS.

Overall, 9% of discharges in this period were against medical advices. There were significant associations between DAMA and health insurance status, hospital wards, and kind of disease. Emergency ward patients and patients with no health insurance were more likely to DAMA.

High rate of DAMA should be considered by hospital managers. They should try to find out the causes of DAMA to prevent it and finally improve satisfaction and loyalty of patients.

In recent years, the concepts of artificial neural networks (ANN) have extensively undergone remarkable development in early detection and classification of diseases such as benign prostatic hyperplasia (BPH). The usage of ANN has become widely accepted in medical applications owing to its potential capabilities for detecting the complex interactions among variables, diagnosis and diseases’ modeling. The present study aimed to design and implement a decision support system (DSS) based on ANN for early detection of prostate cancer. This survey design was conducted through data collection among 360 males with prostate abnormalities in Urology Department of Imam Khomeini Hospital, Tehran, Iran, from January 2008 to March 2011. In order to assess the performance and accuracy of the designed system, sensitivity, specificity and receiver-operating characteristics (ROC) curve were used as the indicators of distinguishing prostate cancers from BPH. In order to implement DSS in this study, scaled conjugate gradient (SCG) algorithm was used as the main algorithm for early detection of prostate cancer from benign prostate. The proposed intelligent ANN-based system can be used as a strong diagnostic tool with 97.0% specificity and 92.1% sensitivity for detecting the prostate cancer and to differentiate it from BPH. The results indicated a high potential of artificial neural network as a strong tool in classification of prostatic neoplasia diseases. A medical decision support system was used aiming to help medical experts in their classification and early detection of prostatic neoplasia disorders in the present study. Such artificial intelligent-based medical intelligent systems, particularly for neural networks, can help physicians in accurate decision-making concerning prostate cancer and BPH. Using such systems, specialists would be able to eliminate or minimize unnecessary biopsy and reduce diagnostic costs. In addition, such systems can accelerate the diagnostic detection time.

World Health Organization (WHO) attempts to update ICD-10 (international classification diseases-10th version) according to the required information of the scientific community. In this study, changes of ICD-10 will be reviewed in updating process.

The data of the present descriptive study was extracted from the World Health Organization website. The data were interpreted based on descriptive statistics after classification of changes, type of instructions to make change, source of changes, and approved and implementation date of the changes.

Out of 1914 changes occurred in ICD-10 during 1995 and 2009, the greatest change happened in the third volume with 1249 cases (65.5%). Most of the major changes were in the first volume with 264 cases (50.1%) and most of the minor changes were in the second volume with 69 cases (49.6%). The majority of the instruction changes were adding an item to the system in every three volumes. Among the active groups for creating modification, mortality reference group (MRG) had the highest role in the first and second volumes with 107 (20.3%) and 116 cases (83.4%), respectively. Germany with 305 cases (24.4%) in the third volume had the highest role.

Maintaining the fluidity of a classification system in the field of health is an enormous and necessary task. This fluidity has occurred in ICD-10 with making significant changes due to new discoveries in the field of medicine, diagnostic and therapeutic equipments and health information subsequently. In Iran, due to the governmental policy to create the Iranian electronic health records, the updated health classification is further needed.

Since hospitals are the main healthcare providers, they are assumed as the main institutions for implementing information systems. Hospitals need efficient hospital information system (HIS) to manage their raising needs. This study reviewed the importance of HIS, implementation of prerequisites and selection factors from views of staff of medical record department in hospitals affiliated to Hormozgan University of Medical Sciences. This was a descriptive-cross sectional study in which study subjects included the staff of medical record department of hospitals affiliated to Hormozgan University of Medical Sciences. Views of staff were collected through a researcher-made questionnaire. Validity of the questionnaire was measured by content validity (by reviewing the relevant resources and faculty members’ perspectives). Reliability was assessed by Cronbach’s alpha test (0.94). The sample size was equal with the sample population (n = 71). The researchers collected the necessary data through direct observation method. According to the views of staff, importance of every three aspects i.e. “different criteria for selecting HIS”, “importance of prerequisites for HIS implementation” and “importance of using HIS” was at high to very high level (91.4%, 89.6% and 77.4%, respectively). Staff with higher educational level emphasized more on importance of HIS prerequisite implementation. Importance of different criteria for selection of HIS was more obvious among staff with educational level related to their organizational position. Staff of medical record department had very positive attitude towards HIS implementation. Managers have to pay higher attention to the views and experiences of these users and staff in order to develop and upgrad these systems.

One of the types of hospital management information systems is decision support information system (DSIS). This system uses decision-making models and databases for preparing specific information to support their semi-structured or unstructured decisions. The present study aimed to design a decision DSIS model for Board of Trustees of Ayatollah Kashani Hospital, Shahrekord, Iran. This exploratory and modeling study was performed in 2010 and conducted in Board of Trustees Ayatollah Kashani Hospital in Shahrekord. The study population consisted of 30 Board of Directors and hospital administrators. Data collection was performed through a researcher-made 42-item questionnaire with approved validity and reliability (85%) by the expert professors used for interviewing and observation. The data were analyzed using principles of systems analysis and management and, mathematical analysis and also operations research technique. Complete information about identifying the organizational environment, information architecture diagrams, the decision-making pattern of Board of Directors and the hospital authorities, the mathematical models and other decision-making models were achieved and the DSIS model was designed for Board of Trustees of Ayatollah Kashani Hospital, Shahrekord, Iran. Hospital information architecture diagram did not have much difference compared with the other conducted studies; however, using DSIS model and its output through the operations research techniques, mathematical patterns and other appropriate patterns would resulted in decisions that the hospital’s board might make and support them.

Hospital managers and healthcare providers should access to hospital information system (HIS) in order to enhance their efficiency and effectiveness in the organization. Accurate, appropriate, precise, timely and valid information as well as an appropriateness information system are required for their tasks and a basis for decision-making in various levels of the hospital management. The present study was conducted to assess selected HIS in hospitals affiliated to Isfahan University of Medical Science according to ISO 9241-10. This was an applied, descriptive cross-sectional study in which seven selected HIS medical records modules were assessed using ISO 9241-10 questionnaire consisting 74 ranked components and entities in hospitals of Isfahan University of Medical Science. The content validity and reliability were confirmed and the obtained data were analyzed through SPSS software, and descriptive statistics were used to examine measures of central tendencies. Data analysis suggested the following percentages concerning the software: 68% appropriateness for user’s tasks, 67% self-descriptiveness, 70% controllability by user, 74% compatibility with user’s expectations, 69% error tolerance, 53% possibility of individualization, and 68% possibility of desired learning for user. The total acceptability with the ISO 9241-10 Software was 67%. Information is the basis for policy and decision-making in various levels of the hospital management. Consequently, it seems that developers of HIS should reduce HIS errors and increase its appropriateness for the tasks, self-descriptiveness, controllability, conformity with user’s expectations, error tolerance, appropriateness for individualization and appropriateness for user’s learning.

Recently, the accreditation program has been used increasingly by an emphasis on patient safety. In Iran, efforts have been made to establish the accreditation program. In 2011, it replaced previous standards of traditional evaluation system. As the impact of accreditation plan need internal self assessment against minimal standards, this study aimed to survey the readiness of selected hospitals in Isfahan based on the functional model of Joint Commission on Accreditation. This cross-sectional descriptive study was conducted on four hospitals in Isfahan, Iran. Data was collected using 13 checklists based on the functional model of Joint Commission International Accreditation. The checklists were verified by the Iranian Ministry of Health. Data was collected via observations and interviews with hospital representatives in quality management. All statistical analyses were performed using SPSS. The readiness of the selected hospitals in Isfahan was 64% regarding patient-based standards and 66% for facility-based standards. In general, the studied hospitals had adequate readiness for implementation of accreditation standards. As the study population has ISO 9000 certification, it is possible to replace old methods of process, outcome, and structure evaluation with new standards. Accordingly, patient rights have to be considered by health care employers in Isfahan.

Traditional medicine is not only useful in health care and improvement of quality of life, but also is applied in diagnosis and treatment of diseases. Hence, paying more attention to this area is of high important. This study aimed to evaluate the scientific production and scientific mapping of Iranian researchers in traditional medicine during 1990-2011 in “Web of Science” database.

This was an applied study in which scientometric indicators have been used. Documents of Iranian researchers in traditional medicine in Web of Sciences during 1990-2011 were analyzed and then, the historiography of scientific productions was depicted.

Studies have shown that Iranian researchers in traditional medicine could be ranked as the 26th in the world in term of scientific productions with 288 document records. Furthermore, the growth rate of scientific publications of this area was 53.3%. In addition, Abdollahi with 13 records and Tehran University of Medical Sciences with 60 records had the highest rate of scientific production in this field. Moreover, most documents were presented as articles and were published in Journal of Ethnopharmacology. No cluster was established from the top 50 records.

In general, growth rate of scientific production in traditional medicine of Iranian researcher has an upward trend. Nevertheless, global and total citations of these publications are very poor which indicates that these publications are not effective enough.

Nowadays, organizations perform segmentation of their customers in order to maximize profits and minimize costs. However, in addition to segmentation, an optimal combination of the customers, i.e. the number of the customers or their percentage, is required to be specified in order to invest on development of products and services. In this study, by maximizing the customers’ satisfaction, we measured the optimal combination of the clients. Therefore, this study aimed to identify a method of deciding on the optimal combination of the customers based on the Kano Model and ideal programming. In terms of objectives, this study was developmental and applied; with regard to data collection time, it was a cross-sectional survey; and in terms of nature of the data, the study was a qualitative and descriptive investigation. Based on literature review concerning costumers’ satisfaction, logical frameworks for maximizing customers’ satisfaction in addition to the hierarchical dimensions of the quality of services were evaluated. In order to maximize the customers’ satisfaction, an ideal programming model has been used. The proposed model indicated the maximization of the customers’ satisfaction in which the hierarchical dimensions of the quality of services have been considered based on Kano model. Furthermore, the dimensions of the quality of services constitute the constraints of the model of which the decision-making variables coefficients have been calculated through the Kano standard questionnaire and customers’ satisfaction maximization. A standard questionnaire was designed and completed by the participants in the cardiology clinic of Al-Zahra Hospital, Isfahan, Iran. The study subjects (n = 196) were randomly selected among the patients who had referred to the above mentioned clinic during August and November 2010. Validity and reliability of the questionnaires were evaluated using content validity and Cronbach’s alpha coefficient. WinQSB (windows for qualitative system for business) software was used to analyze the data. The findings indicated that the proposed approach is able to specify the optimal combination of the patients. Thirty-four percent of the patients suffered from myocardial infarction (MI) and 66 percent were patients with valvular heart disease. In general, the findings of the present study were effectiveness in customers’ segmentation, planning to provide appropriate services compatible with different customers’ needs and increased positive outcomes by hospital.

In today’s world, organizations are attempting to achieve advantages and competitive results. Understanding mutual interactions between organizations and using modern management techniques as well as modern management tools might have an influential effect on obtaining optimal organizational results. Nowadays, one of the competitive advantages is applying the excellence models. The present study aimed to evaluate the improvable areas in Al-Zahra Hospital, (Isfahan, Iran) using EFQM (European foundation for quality management) model. This was an applied, cross-sectional descriptive study. Data collection was performed using EFQM questionnaire through census method. Thirty-nine managers were involved in all the levels (junior, senior and operational management) of this study. The results showed the Al-Zahra Hospital obtained total score of 502.78 (out of 1000 scores). The obtained score was 259.60 in enablers area and 243.08 in results area. Each of the nine EFQM-criteria score and percentages were as the following: Leadership 52 scores (52%) policy and strategy 43 (54%), human resources 42 (47%), resources and companies 50 (56%) and processes 70 (50.6%) for the enablers area. In the results area customer satisfaction score was 97 (48.8%), staff satisfaction 31.5 (35%), society results 30.7 (51%) and key performance results was 83.6 (55.7%). Implementation of the self-evaluation model in this hospital led to identification of strengths and areas in need of improvement. Out of enabler and results criteria, staff and costumer satisfaction were with lowest scores, respectively; which are considered as the areas with improvement prioritization. Therefore, further attention is required for improving these modification criteria in hospitals.

Equity in health means justice in the distribution of community health. The purpose of justice in health is to consider health needs of all people regardless of their geographical location or cultural, economic, and social status. The aim of this study was to assess distribution of specialists based on population (100,000 people) in public hospitals of Iranian provinces during 2010. In this descriptive study, distribution of each specialization in different provinces was shown as maximum, minimum, mean, standard deviation, and median. In order to display the relation between number of specialists and population, the correlation coefficient was employed. Data was analyzed using SPSS. The highest and lowest ratios of specialists to population of 100,000 people in specialty fields were observed in case of pediatricians (1.72) and neurosurgeons (0.31), respectively. The highest and lowest correlations between specialized fields and population were in pathology (0.96) and psychiatry (0.47), respectively. Meanwhile, the highest and lowest ratios of specialists to population were observed in Yazd Province (19.22) and Sistan and Baluchestan Province (8.8), respectively. This study showed a high correlation between the number of specialists and population in public hospitals of Iran. Moreover, distribution of specialists was more homogeneous during the last five years. Appropriate management can improve the current status.

Human skills, knowledge and efficiency are important factors in the success of organizations and community health centers which have a critical role in total quality management (TQM) as a management system. Knowledge is necessary as a source for the organizations survival. On the other hand, in order for implementation of knowledge management, there is a need for a relatively long period, providing intellectual and cultural contexts, educational skills and knowledge and technological centers. This study aimed to determine the relationship between TQM and knowledge management from the perspective of faculty members of Isfahan University of Medical Sciences.

This was a descriptive-correlational study. The study subjects included the total of faculty members of University of Isfahan (491 people) and Isfahan University of Medical Sciences (594) during academic years 2009-2010 who were selected through proportionate stratified random sampling (300). Data collection tools included a Baldrige questionnaire based on the TQM model and knowledge management components based on Pastor standard questionnaire. The content and face validity of questionnaires were confirmed and reliability through Cronbach's alpha coefficient were obtained as 0.87 and 0.91, respectively.

Mean of all the TQM criteria were higher than average in University of Isfahan except leadership, strategic planning and human resource management. It was the same in Isfahan University of Medical Sciences except criteria like focusing on customer, information analysis, strategic planning and process management. All the components of knowledge management were more than average level in Isfahan University of Medical Sciences, and except refining the knowledge in University of Isfahan. Correlation coefficient between scores of TQM and knowledge management components was significant (P ≤ 0.05). In addition, multiple regression showed that the correlation between TQM and knowledge management was statistically significant.

TQM criteria can be effective in line with appropriate functioning of knowledge management and its impact on organizational performance can also increase the efficiency of the organization.

This study aimed to describe the concepts and characteristics of Wilson's information seeking behavior model, as the highly cited pattern in information seeking behavior debates and tracing its completion, expansion and development process. Wilson's information seeking behavior model is the base for other subsequent related models. It has been the highly cited model amongst other information seeking behavior models worldwide. Having revised four times since 1981, the model has been revised by many researchers as a theory rather than a theoretical framework. In other words, despite the role of theory in its final formation, the aim of the model is to connect theory to practice. It is important to note that Wilson's general model has been constructed and evolved continuously and the understanding of the connections and relations of the charts and conceptions embedded in the model in details has been important for its explanation. No pattern is complete by itself and for showing the growth trends of research ideas from the model, it is necessary to revise the charts and concepts embedded in both 1981 and 1996 Wilson's model varieties and practice accordingly. In this study, concepts and features of Wilson's information seeking model have been expressed, and a brief overview of the information seeking behavior theories and analysis of the Wilson's information seeking behavior models have been performed.

One of the most important institutions of a city is hospital as it is directly involved with life of the citizens. This review article aimed to study the circumstance of establishing newer hospitals in Isfahan city, which was started in late Qajar Dynasty era with a pause during the constitutional era and was extended to Reza Shah Pahlavi in its modern form. The main references for this study were the reports of local newspapers and press. It is obvious that these types of resources would shed light on the real healthcare situation dominated on the life of the citizens. This is partly due to the official reports which may not contain the real city dweller's opinions. On the other hand, the audience cycle of the newspapers that covered the majority of the ordinary people's views seems more advantageous rather than merely referring to the bureaucratic documents and reports by the administrative authorities view. This article will also show that since the constitutional era, 1906 to 1941, six hospitals have been established in Isfahan, either by local government or non-governmental charities (municipalities and religious delegations). The role of the governmental authority in this regard was mainly suport and encouragement. The urban renewal system, enhanced health situation in the reign of Reza Shah Pahlavi and the partnership between private sectors, semi-private sectors and government caused to meet demand for hospitals in Isfahan during that period.

Direct and rapid access to information is one of the main necessities of the users in new technological world. Nowadays, information users, particularly medical information in which rapid access is of necessity, do not have enough time to search and access to information. Therefore, the present study aimed to determine strategies to access required information as soon as possible. This study was performed using library research and content analysis to provide strategies for content and services integration in central library software of Iranian Universities of Medical Sciences. Since there is one central library in each university, all central libraries of 46 Iranian Universities of Medical Sciences affiliated to Ministry of Health and Medical Education, constituted the study population. Descriptive statistics and Excel software were used in order to analyze, describe, and evaluate the findings. Findings of this study illustrated that central libraries in the studied universities as well as their used software for storage and retrieval of bibliographic information and also some of the data software do not care about information exchange and consequently integration of information with other academic central libraries. 71.4% of the studied libraries used Pars Azarakhsh Software. The mentioned software uses MARC metadata format. In addition, 86% of the studied applications could offer standard output metadata format. Given the findings of this study, it is possible to use integration strategies in order to exploit the existing data. Therefore, the studied libraries should integrate their bibliographic data. Thus, it is recommended to use simultaneous searching model, Z39.50 protocol and ISO 2709 standard to integrate their data.