سال:1399 | دوره: | شماره: |تعداد مقالات:8

Introduction: The clinical pathways are an approach to standardizing care process which supports the use of clinical guidelines and protocols. The aim of this study was to investigate the association between the evidence-based organization of pathways and quality management system in acute myocardial infarction (AMI) and stroke in Tehran Hospitals. Methods: A random sample of 21 hospitals were studied. The anonymous questionnaire of Quality management system index (QMSI) was conducted through quality manager of these hospitals. The validity and reliability of the 40-item questionnaire were obtained. 450 patient’ s records in two acute conditions of acute myocardial infarction (MI) and stroke were reviewed with evidence-based organization pathway (EBOP) checklist. Data were analyzed using descriptive statistics, Pearson corelation coefficient, ANOVA, T-Test, alpha Cronbach and multiple linear regression analysis. SPSS version 21 was used to analyze the data. Results: There was a positive association between quality management system and evidencebased organization pathway in (AMI) (β : 0. 654). PR>t: 0. 014: and stroke (β : 0. 833), PR>t: 0. 01, respectively. Hospital characteristic and QM were not related. Conclusion: We concluded that compliance of QM at the highest level of the hospital could improve the quality of special performance inpatient with two acute conditions in AMI and stroke. This study revealed that QM strategies were effective.

Introduction: Considering the high proportion of hospital expenditures in out-of-pocket payments and the importance of controlling and managing hospital expenditures to prevent catastrophic costs, the main purpose of this study was to investigate the factors affecting the hospital expenditures of Iranian urban household with emphasis on maternal education. Methods: The present study is a descriptive-analytical and applied research conducted at national level using econometrics Heckman two-step model. The sample size included 15740 urban households of Iranian provinces in 2017 that was selected according to Cochran formula and three-stage sampling by the Statistical Centre of Iran. The data were also extracted from different sections of the standard questionnaire “ Urban Household Cost-Income” of the Statistical Centre of Iran and processed in Stata 10 software. Results: Higher education and employment of mothers have led to a decrease in the probability of household facing hospital expenditures, by 0. 002% and 0. 9%, respectively. Mother’ s employment, having supplementary health insurance, and bachelor’ s or higher education of mother resulted in a decrease in per capita hospital expenditures of households by 2058123, 1361437 and 3647518 Rials, respectively. An increase in household size, having children under the age of seven and elderly persons over sixty years old, and mothers with elementary education led to an increase in household hospital expenditures by 1347241, 4406778, 1602637 and 1674286 Rials, respectively. Conclusion: Regarding the greater impact of aging of mothers, compared to fathers, and having children and elderly persons in the household and increased hospital expenditures, protection and support of such households is necessary to achieve better health status and reduce household hospital expenditures, which can be achieved through improving and discounting insurance coverage and preventive health care. Also, investing in education to provide an appropriate condition for education of most people in the community, as well as enhancing parental health literacy through health education, is recommended.

Introduction: Nursing profession has a key role in providing health services. The present study is an attempt to survey the relationship between organizational commitment and occupational burnout in nurses working in Shahid Sadoughi Hospital-Yazd in 2017. Methods: This descriptive-correlative study was conducted on 195 nurses working in Shahid Sadoughi Hospital. Based on the sample size, the participants were selected through stratified sampling. Data gathering tool included Maslach’ s standard occupational burnout questionnaire and Allen Meyer’ s organizational commitment questionnaire. The collected data were analyzed through SPSS using statistical tests like Pearson’ s correlation. Results: The mean score of organizational commitment was 75. 42 and that of occupational burnout was 81. 70; both of them were at moderate level. Organizational commitment, emotional sub-aspect, and continuous sub-aspect were directly and significantly related to occupational burnout (P≤ 0. 01). In addition, there was a significant relationship between occupational burnout and gender so that it was higher in women compared with men (P≤ 0. 01). Conclusion: Managers can create proper and effective relationship with nurses and avoid the serious qualitative and quantitative outcomes of occupation burnout in nurses through introducing official and unofficial support strategies.

Introduction: Health care planning in low-and-medium-income countries can be intellectually demanding. However, users’ centric planning approach is intuitively promising to enhance utilization, resource allocation, and strengthening of the health system. This study examines the relative importance of health status and access on intention to use the health services and the mediating role of prior experience and perceived quality of care on utilization intention. Methods: This study was a cross-sectional survey method in a suburban location in Nigeria with administration of a questionnaire on a random sample of voluntary and nonremunerated participants. The study utilized structural equation model that encompasses the relationship between these variables based on survey data from five hundred and nineteen (519) respondents. Results: The study found that access was a stronger determinant of intention to use health services than self-rated health status; in addition, negative prior experiences in the health system was found to be a disincentive to intentions to use health services. Conclusion: It seems of benefit to initiate and encourage programs that seek to improve the health care professionals’ competence in management of individual-health facilities contact experience and strengthen the bond between perceived health status and responsive attitude to use health services. Health facilities planning approach need to consider the location models that facilitate physical access and seek to deconstruct administrative barriers to obtaining care.

Introduction: There is a significant relationship between the appropriate treatment plans and accurate medical diagnosis. Admission and discharge diagnoses in hospitals are often different and this has significant implications on patient care and safety. The aim of this study was to explore the discrepancies between the admission diagnosis and the discharge diagnosis. Methods: This was a longitudinal study conducted at Zanjan University of Medical Sciences (ZUMS). The study sample included admitted patients in hospitals during 2012-2019. The ICD-10 codes between I00 and I99 were selected as Cardiovascular Diseases. Data analysis was conducted by R (v3. 6. 0) and Rstudio (v1. 2. 1335) software. Agreement analysis was conducted by Cohen’ s Kappa statistics, and Chi Square statistic was used for examining the relationships between categorical variables. Results: Agreement analysis of cardiovascular diseases subgroups showed that the values of Kappa coefficient range were varied between κ =0. 34 for Chronic rheumatic heart diseases and κ =0. 93 for Acute rheumatic fever diseases. The values of the Kappa coefficient for the 10 most common ICD-10 codes were in the range from κ =0. 44 for I25. 9 to κ =0. 77 for I80. 2. Conclusion: The results of this study showed that there was a significant difference between ADx and DDx, and the values of kappa coefficient were not the same between CVDs subgroups. There are definite needs for improvement on diagnostic accuracy, especially in regard to CVDs cases with acute condition.

Introduction: Induced demand is an important challenge in national healthcare systems, and can waste their resources. The likelihood of induced demand and the intensity of its effects are the results of an interaction between a wide range of factors. Therefore, this study was designed for structural modeling of the factors affecting induced demand. Methods: This applied study was carried out using a descriptive-analytic design. First, the factors affecting induced demand were identified by a thorough literature review. Then, using interpretive structural modeling (ISM), the relationship between the factors was determined and categorized, and the final model developed. In addition, using MICMAC analysis, the types of variables have been identified with respect to their driving and dependency power. Results: Lack of clinical guidelines, increased number of providers, weakness of education system, weakness of Health Supervisory System, poor supervision of insurance companies, improper payment system, providers’ insufficient knowledge, skills and clinical uncertainty, defensive medicine, patient preferences, information asymmetry, the collusion of service providers, and their incentives to earn more income were identified as the most important factors affecting management and control of induced demand. Conclusion: Induced demand reduction requires finding the relationships between the key factors to provide a clear framework for determining the best controlling policies, thereby preventing the loss of healthcare resources. This study provided a new insight into the factors affecting induced demand leading to prioritization of decision-making and policymaking measures.

Introduction: Green human resource management (GHRM) is responsible for creating awareness, information, and interaction between the employees of the organization regarding the environment and environmental factors. In addition, with the use of green policies, green HRM leads to social responsibility among the staff, in a way that they would be guided toward adhering to their responsibilities as to the environment. This study aimed to design and explain a green HRM model with an emphasis on social responsibility. Methods: This is an applied research in terms of goal, and a mix method study and descriptivesurvey regarding the nature and methodology. The study population included two groups of experts familiarized with green HRM, who were scattered across the country and were entered into the study by selective sampling. The views of these people have been used to design and explain the research model. The second population includes employees of Shiraz University of Medical Sciences. In total, 292 subjects were selected by simple sampling based on the Cochran’ s formula and 95% confidence interval. Data were collected using Jabour green HRM questionnaire (2010) and the Carroll social responsibility questionnaire (1991). Moreover, in-person interviews were conducted to design the model. Furthermore, data analysis was carried out in SPSS and PLS using the structural equations modelling. Results: The evaluation of the fit indices was indicative of the relatively suitable fit for the research data and the conceptual model. In this study, there was a positive, significant relationship between green HRM and social responsibility. In addition, the value of this impact was estimated at 0. 230, 0. 371, 0. 211, and 0. 306, based on the regression coefficient in the standard state. Conclusion: Environmental questions must be included in recruitment interviews to assess the knowledge level of job applicants in this area. It is suggested that the recruitment exams should be carried out electronically.

Introduction: The purpose of this study is to propose a novel waste-finding framework to facilitate implementing Lean hospitals and examine the capability of the framework in a real situation. Methods: This research utilized a constructive research approach to develop the proposed framework. The data were collected through several sources, including annual hospital performance report, observation and timing using chronometer, and designed forms. The pilot study was conducted in Hazrat Zeinab Hospital in Shiraz city. A total of 15 hospital experts and employees in the NICU of the hospital participated in the study. TOPSIS and value stream mapping (VSM) methods were used to analyze the data. To achieve this purpose, we used MS Excel and eVSM software. Results: The proposed framework consists of three phases, including (I) selecting a ward, (II) mapping the value stream, and (III) identifying the wastes. To select the ward for implementing Lean initiatives, the criteria are comprised of bed admission ratio, bed occupancy ratio, bed turnover, and bed turnover interval. The weights of the criteria are considered 10%, 30%, 10%, and 50%, respectively. The results of the TOPSIS method revealed that NICU was the best ward in the hospital for implementing Lean initiatives. The VSMs of the five main processes of NICU uncovered the wastes, 20 of which were confirmed. They waste approximately 119 man-hours per month. Conclusion: According to the results, the proposed framework is able to select a suitable ward and uncover the wastes. It implies that Lean efforts must be guided through incremental initiatives.