نشریه مدیریت سلامت
پیاپی 57 (پاییز 1393)

This article proposes a method which could improve the performance of an Emergency Department (ED) in a large hospital in Tehran، where the long waiting times cause patients’ and ED staff ’s dissatisfaction. ED is considered as a bottleneck in hospitals. To reduce long waiting time and improve patient satisfaction، application of system improvement methods is required. Using discrete- event simulation، it first models patient flow and identifies bottlenecks. In simulation model، patient arrival is assumed to be non-homogenous and operations of medical tests are detailed and consequently patient queues and virtual specimen queues can be considered separately. The analytic hierarchy process (AHP) was used to specify weights for each criterion and PROMETHEE to rank scenarios. Based on simulation results and important criteria، what-if scenarios were designed to evaluate system reactions. Using this method، 10 scenarios were designed. Implementing the best scenario would reduce waiting time by approximately 6%. Conclustion: Considering ED overcrowding، simulation is used to reflect current situation. Based on the simulation reports، what-if scenarios were used to design scenarios which could improve ED performance. Multi criteria decision making method was used to find the best scenario based on criteria like waiting time، utilization، leave with own responsibility (LWOR) and cost.

Peer-review is one of the important pre-publication steps for academic papers. It usually assures the readers about the high-quality reporting of scientific findings. Since objective and subjective criteria used by the reviewers are effective factors on the quality of journal، this study aims to assess these criteria for the accepted and rejected manuscripts of Journal Health Administration. We used both quantitative and qualitative methods in this study. Mentioned items in peer-review checklist were considered as objective criteria and content analysis used to get the subjective criteria from reviewers’ comments. Peer-review checklists of accepted or rejected manuscripts between 2011 and 2013 (330 manuscripts) were the sample of this cross-sectional study. There were 10 sets containing 29 subsets for objective criteria and 224 subsets for subjective criteria beside 1978 comments from reviewers. Problem statement، data gathering methods، compatibility of discussion with findings، and ethical issues were the main criteria which were different between accepted and rejected papers. Variation of subjective criteria in reviewers’ comments makes the process of decision making more complicated for the editors. So، we tried to include all of the obtained objective and subjective criteria in one peer-review checklist to help the reviewers in assessing the papers.

About 10-15 percent of Iranian couples are infertile which is due to different causes determining particular diagnostic and treatment methods. In this study، the model presented is based on basic features and simple tests، helping physicians predict the causes of infertility The data were taken from Sarem hospital infertility data bank by using data mining methods. First، K-means clustering was run; then، support vector machine and artificial neural network classification methods were used to predict the type of infertility، and finally، the results of two classification algorithms were compared. In addition، SPSS Clementine 12. 0 was used to analyze the data and implement the algorithm in modeling part. In k-means clustering، the data were divided into five clusters. In each cluster، one or more causes of infertility were observed. Then، by applying SVM and artificial neural network classification algorithms، the SVM algorithm with a polynomial kernel appeared to have the maximum accuracy. The findings of this study، could contribute to the understanding of the factors responsible for infertility and pave the way for future investigations. These findings can be used in future studies to develop a system for applying this model since by diagnosing the causes of infertility prior to secondary stages and before performing heavy tests، a considerable amount of time and cost will be saved، and physical burden on patient will be decreased.

Databases have very important roles in providing health information; therefore، their technical quality is of great importance. The technical assessment of WebDa news in Medical Universities in Iran was the aim of the study. In this descriptive cross-sectional study، 16 WeDda from among all WeDda of the Medical Universities were selected through systematic stratified sampling based on the ranking of the universities (three Type I، eight Type II، and five Type III universities). A valid questionnaire for technical evaluation of health information Web site with the Alpha 0. 93 was used for data collection. Data analysis was done through SPSS using descriptive tests. None of the websites could achieve a high score concerning the given indicators. The highest mean scores were related to easy access and loading (4)، formatting (3. 4)، ease of use (3. 4) and the lowest mean scores were related to user right (1. 4)، interaction with users (2. 5) and layout (2. 7). Also، the mean scores for ease of use، graphics quality and logos were 3. 3 and 3. 1 and 3. 1، respectively. The majority of technical indicators in information WebDa news are at intermediate level. Therefore، in order to enhance the technical level of WebDa، it is suggested to increase the visual attraction and interaction with users along with improving the contents.

While hospital care has always been one of the basic requirements، Payment Method of treatment is an important factor to create equity in utilization of care. On the other hand، length of stay is one of the key indicators in hospital performance showing the efficiency of hospital care in resource consumption. The purpose of this study was to survey the effect of Payment Method of Treatment cost on the patient length of stay in educational and health centers in Qazvin in 2014.

In this cross-sectional descriptive-analytic study، 640 samples were randomly selected from among inpatients'' documents at Qazvin’s selected educational and health centers. Data entry form was used for data gathering and Kolmogorov-Smirnov، Mann Whitney and Kruskal- Wallis tests were used for data analysis.

The mean and standard deviation for inpatient length of stay were 5. 454 and 6. 143، respectively. Demographic factors such as age، occupation، marital status affected the length of stay (P <0. 001). The maximum length of stay was related to the patients with insurance from the Committee of Help (8. 8days) and the minimum length of stay belonged to the patients without any type of health insurance (3days). It was also found that basic and supplemental health insurance affected the patients length of stay.

Concerning the limited resources of health system in hospital sector and the influence of Payment Method of treatment on patient length of stay، proper use of insurance for appropriate and adequate utilization of hospital care and reducing unnecessary accommodation are undoubtedly necessary.

One of the important requirements of an accreditation center is the provision of documents and policies in different departments of an organization including medical records departments. The present study was aimed at investigating the impact of formulating and implementing the policies and procedures of medical records on the scores of accreditation policies of medical record departments in the hospitals affiliated to Shahrekord University Of Medical Sciences in 2013. The present study was performed on the basis of an interventional method in 2013. All hospitals in Shahrekord province were included. Following the intervention of the formulation and implementation of policy on accreditation of medical records، re-rating policy on accreditation of medical records was measured. The instrument for data collection was a standard checklist and the data were analyzed by SPSS18 using statistical parameters of descriptive and analytical statistics. According to the results of the study، the score for policies of medical records showed a significant difference before and after the intervention indication an increase in scores of policies of medical records accreditation after the intervention (p<0/01). Given the fact that the performance of medical record departments in the policies regarding audit checklist of all parts of the medical records such as discharging، monitoring and completing medical records within 14 days after discharge، ending the incomplete medical records and making conformity between outpatient and inpatient records after the intervention was very poor and poor، the authorities of medical record departments of hospitals should attempt to develop and practice policies which could be put into practice.

Unmet needs are defined as the difference between services judged necessary to deal appropriately with health problems and services actually received. Unmet needs are considered as simple tools in monitoring the accessibility and the extent of inequity in access and use of health care.

This is a cross-section health survey. The sample consists of 792 households living in Tehran. Data were collected by the WHO (households) questionnaire in 2012، and were analyzed using Logistic Model and STATA12 software.

The outcomes show that economical problems، lack of time، self-treatment، long distance to reach health facilities، deprivation of insurance coverage، and lack of adequate information about the locations of health care centres are all factors affecting patients’ willingness to refer to these centres. The socio-economic factors which can enhance the probability of fulfilment of health care needs were found to be settlement ownership and poverty reduction

Unmet needs can cause detrimental effects، such as worsening health situation and quality of life، increasing the risk of mortality and causing mental and psychosomatic disorders; therefore، policy makers should give high priority to eliminating socio-economic barriers، as lack of insurance coverage، as well as reducing the costs and economic inequalities، and payment systems reform. Key words: Equity in health، Health care accessibility، Unmet needs، Tehran households، Logistic Model

The purpose of this study was to show the major challenges and opportunities related to Health Technology Assessment (HTA) that most countries have faced with when launching and developing an HTA system for making appropriate decisions in policy making. Review of studies: This was a review study in the field of HTA and health policy. All literature potentially relevant to this issue had been studied via library and the Internet search of data bases related to HTA to select and present materials extracted. The search was focused on English papers published in 1980-2014. The impact of HTA depends in large part on the quality and transparency of the assessment and decision-making processes، as well as institutional، organizational، political and cultural dynamics broader than the scopes of national health care systems. As many countries increasingly gear their health systems towards policies emphasizing measurement، accountability، transparency and evidence-based practices، the challenges of HTA should be addressed in order to achieve concurrent health care system goals، and support those services offering large value of money and impact on health care outcomes. The role of HTA offering extensive opportunities to support governments and other stakeholders in decision-making has grown substantially. Countries should، therefore، seek to capitalize on the strengths of established HTA systems، while pioneering solutions to address major challenges and strengthening the HTA enterprise.