Identifying factors affecting about outsourcing in paraclinical services: a systematic review of literature

Objective: Outsourcing refers to the transfer of services or functions to an outsider supplier, which controls them through a contract or cooperative. The main problem of senior managers in health organizations is determining the services which should be outsourced. The present study seeks to identify the factors that affect decision about outsourcing.Methods: We systematically searched relevant databases including Pub Med, Scopus, Science Direct and Web of Science databases using terms “Outsourcing AND Decision Making OR Policy AND health OR hospital OR health care OR health services OR healthcare”. Studies were identified and screened in accordance with the preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) published in English or Farsi, determining factors that affect making decision about outsourcing a health organization services.Results: The search retrieved (2585) citation of which 14 studies were eligible. Across the eligible articles,10 overarching themes including 40subthemes that affectdecision maker to outsource a service or not, emerged.Conclusions: Results of this study offer evidence for a comprehensive approach todesign and implement a strategic planthat can be used as guidance for policy makers, micro and macro healthcare authorities and managers, and other stakeholders in this area to select and apply the best strategies to make outsourcing in the best possible way.Keywords: Outsourcing, Health Services, Effective factors, Health Organizatio

Developing of the appropriateness evaluation protocol for public hospitals in Iran

Background: Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems. Objectives: This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran. Patients and Methods: The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients� medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses. Results: Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92, while the specific appropriate agreement and specific inappropriate agreement were > 88 and > 83, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively. Conclusions: The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context. © 2015, Iranian Red Crescent Medical Journal

Relationship between social well-being and health related quality of life level among senior retirees of tehran university of medical sciences

Introduction: Senior citizens or the elderly people are a group of people in the society considered as a growing population with special needs in the developed contemporary world. Since they have special needs, it is essential to care about the quality of their life because of the dangers which threaten them. Since the social health of the retirees is decreased as a result of exiting from the workplace and directly affecting their life quality, the researcher has done the present study. Methodology: This paper which is a descriptive- analytic study has been periodically done in the second half of 2013. The participants were 227 senior retirees of Tehran University of Medical Sciences. The data have been collected through a reliable and valid questionnaire of life quality related to health (sf-36) and social well-being of KEYES. The data then were analyzed using SPSS.19 and descriptive statistics and paired t-test, one way ANOVA test and Pearson correlation were use as well. Findings: There is a significant linear relation between life quality variable related to the health and social well-being components (P<0.05). There is also a significant correlation between the variables like age, sex, marital status, duration of employment and life quality. Results: Regarding the findings of the study, it seems that the policy makers and planners need to create a kind of active integration and balance in society according to the available devices and facilities, and try to apply a proper information system to eliminate the cultural problems, reinforce the social relations and coherences in order to increase the life quality of senior retires. © 2015, Canadian Center of Science and Education. All rights reserved

Determinant criteria for designing Health benefit package in selected countries

Health benefit package described as primary health interventions that provided with government using general funds for all regardless their financial ability. This study was aimed at determine appropriate pattern for Iran using comparative survey of Health benefit package in various countries. A review exploration was done, scholars was selected population of both developed and developing countries, required information was also extracted by articles, searches and reports of reliable sources and date were analyzed by SPSS, in brief. The vast majority frequencies was respectively allocated to accessibility (40.7%), cost- effectiveness (29.6%), prioritize, efficacy and cost (22.2%). most countries located in WHO African region were selected cost-effectiveness and accessibility, WHO southeast Asia region were selected, coverage, prioritize, efficacy and quality and finally most WHO Europeans region were elected effectiveness and services costs for including services in Health benefit package. According to most Health benefit package designer emphasis on criteria including accessibility and costeffectiveness, to design Health benefit package for Iran, these criteria must be noticed

Proposing a model of �hospital value-based purchasing� in selected teaching hospitals in isfahan, Iran: 2015 - 2016

Background: Recently, HVBP has been a tool for improving the quality of healthcare services and managing costs. This study was conducted to identify and propose an appropriate model of HVBP in the general selected teaching hospitals in Isfahan, Iran. Objectives: The purpose of this study was to propose an Iranian model of HVBP in the selected teaching hospitals in Isfahan, Iran, 2015 - 16. Methods: This study was a theoretical and qualitative study. It was cross-sectional and prospective in terms of time, direction, and trend. The sample was determined purposefully in Delphi methods. Three types of Delphi methods were conducted including: theory, policy, and implementation Delphi. The sample size in Delphi methods respectively included 9, 13, and 21 that were selected in type of experts sampling and cascading in 2015 - 16. Inclusion and exclusion criteria were designated to select sample in all three types of Delphi methods. Results: According to the results of the study, the proposed Iranian model of HVBP had seven dimensions including structure, process, outcome, patient experience, quality of clinical care, sensitivity of care team, and efficiency with the weight percentages of 5, 5, 25, 20, 15, 15, and 15, respectively. Each of the dimensions had 5, 6, 5, 7, 5, 4, and 1 components/component, respectively. Conclusions: This study identified and proposed a model of HVBP in the Isfahan selected general teaching hospitals. The practical application of the findings was to determine the dimensions and components of HVBP in Isfahan general teaching hospitals. According to the findings of this study, it is suggested that a series of related research be conducted to complete the identification process of HVBP in Iran in other types of hospital settings. © 2017, Iranian Red Crescent Medical Journal

Proposing a model of �hospital value-based purchasing� in selected teaching hospitals in isfahan, Iran: 2015 - 2016

Background: Recently, HVBP has been a tool for improving the quality of healthcare services and managing costs. This study was conducted to identify and propose an appropriate model of HVBP in the general selected teaching hospitals in Isfahan, Iran. Objectives: The purpose of this study was to propose an Iranian model of HVBP in the selected teaching hospitals in Isfahan, Iran, 2015 - 16. Methods: This study was a theoretical and qualitative study. It was cross-sectional and prospective in terms of time, direction, and trend. The sample was determined purposefully in Delphi methods. Three types of Delphi methods were conducted including: theory, policy, and implementation Delphi. The sample size in Delphi methods respectively included 9, 13, and 21 that were selected in type of experts sampling and cascading in 2015 - 16. Inclusion and exclusion criteria were designated to select sample in all three types of Delphi methods. Results: According to the results of the study, the proposed Iranian model of HVBP had seven dimensions including structure, process, outcome, patient experience, quality of clinical care, sensitivity of care team, and efficiency with the weight percentages of 5, 5, 25, 20, 15, 15, and 15, respectively. Each of the dimensions had 5, 6, 5, 7, 5, 4, and 1 components/component, respectively. Conclusions: This study identified and proposed a model of HVBP in the Isfahan selected general teaching hospitals. The practical application of the findings was to determine the dimensions and components of HVBP in Isfahan general teaching hospitals. According to the findings of this study, it is suggested that a series of related research be conducted to complete the identification process of HVBP in Iran in other types of hospital settings. © 2017, Iranian Red Crescent Medical Journal

Identifying and classifying indicators affected by performing clinical pathways in hospitals: A scoping review

Aim: To analyse the evidence regarding indicators affected by clinical pathways (CPW) in hospitals and offer suggestions for conducting comprehensive systematic reviews. Methods: We conducted a systematic scoping review and searched the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OVID, Science Direct, ProQuest, EMBASE and PubMed. We also reviewed the reference lists of included studies. The criteria for inclusion of studies included experimental and quasi-experimental studies, implementing CPW in secondary and tertiary hospitals and investigating at least one indicator. Quality of included studies was assessed by two authors independently using the Critical Appraisal Skills Program for clinical trials and cohort studies and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. Results: Forty-seven out of 2191 studies met the eligibility and inclusion criteria. The majority of included studies had pretest-posttest quasi-experimental design and had been done in developed countries, especially the United States. The investigation of evidence resulted in identifying 62 indicators which were classified into three categories: input indicators, process and output indicators and outcome indicators. Outcome indicators were more frequent than other indicators. Complication rate, hospital costs and length of hospital stay were dominant in their own category. Indicators such as quality of life and adherence to guidelines have been considered in studies that were done in recent years. Conclusion: Implementing CPW can affect different types of indicators such as input, process, output and outcome indicators, although outcome indicators capture more attention than other indicators. Patient-related indicators were dominant outcome indicators, whereas professional indicators and organizational factors were considered less extensively. What is known about the topic? � The concept and content of the clinical pathways � The feasibility of implementing the clinical pathways � The effects of clinical pathways on limited indicators What does this article add? � Indicators affected by performing clinical pathways � The effects of clinical pathways on all identified indicators in secondary and tertiary hospitals � Suggestions for conducting full systematic reviews. © 2018 University of Adelaide, Joanna Briggs Institute

Customer focus level following implementation of quality improvement model in Tehran social security hospitals

Purpose - The key factor for the success of total quality management programs in an organization is focusing on the customer. The purpose of this paper is to assess customer focus level following implementation of a quality improvement model in social security hospitals in Tehran Province. Design/methodology/approach - This research was descriptive-comparative in nature. The study population consisted of the implementers of quality improvement model in four Tehran social security hospitals. The data were gathered through a checklist addressing customer knowledge and customer satisfaction. Findings - The research findings indicated that the average scores on customer knowledge in Shahriar, Alborz, Milad, and Varamin hospitals were 64.1, 61.2, 54.1, and 46.6, respectively. The average scores on customer satisfaction in Shahriar, Alborz, Milad, and Varamin hospitals were 67.7, 65, 59.4, and 50, respectively. The customer focus average scores in Shahriar, Alborz, Milad, and Varamin hospitals were 66.3, 63.3, 57.3, and 48.6, respectively. The total average scores on customer knowledge, satisfaction and customer focus in the investigated hospitals proved to be 56.4, 60.5, and 58.9, respectively. Originality/value - The paper is of value in showing that implementation of the quality improvement model could considerably improve customer focus level. © Emerald Group Publishing Limited

Identifying and classifying indicators affected by performing clinical pathways in hospitals: A scoping review

Aim: To analyse the evidence regarding indicators affected by clinical pathways (CPW) in hospitals and offer suggestions for conducting comprehensive systematic reviews. Methods: We conducted a systematic scoping review and searched the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OVID, Science Direct, ProQuest, EMBASE and PubMed. We also reviewed the reference lists of included studies. The criteria for inclusion of studies included experimental and quasi-experimental studies, implementing CPW in secondary and tertiary hospitals and investigating at least one indicator. Quality of included studies was assessed by two authors independently using the Critical Appraisal Skills Program for clinical trials and cohort studies and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. Results: Forty-seven out of 2191 studies met the eligibility and inclusion criteria. The majority of included studies had pretest-posttest quasi-experimental design and had been done in developed countries, especially the United States. The investigation of evidence resulted in identifying 62 indicators which were classified into three categories: input indicators, process and output indicators and outcome indicators. Outcome indicators were more frequent than other indicators. Complication rate, hospital costs and length of hospital stay were dominant in their own category. Indicators such as quality of life and adherence to guidelines have been considered in studies that were done in recent years. Conclusion: Implementing CPW can affect different types of indicators such as input, process, output and outcome indicators, although outcome indicators capture more attention than other indicators. Patient-related indicators were dominant outcome indicators, whereas professional indicators and organizational factors were considered less extensively. What is known about the topic? � The concept and content of the clinical pathways � The feasibility of implementing the clinical pathways � The effects of clinical pathways on limited indicators What does this article add? � Indicators affected by performing clinical pathways � The effects of clinical pathways on all identified indicators in secondary and tertiary hospitals � Suggestions for conducting full systematic reviews. © 2018 University of Adelaide, Joanna Briggs Institute