The Effect of the Payment System of Diagnosis-Related Groups on the Treatment Costs of Cardiovascular Patients, Admitted to the Selected Hospitals of Tehran in 2018

Introduction: Today, financing the treatment of cardiovascular diseases is one of the main problems of low-income and middle-income families. The aim of this study was to determine the effect of the payment system of diagnostic-related groups on the treatment costs of cardiovascular patients admitted to the selected hospitals in Tehran. Materials and Methods: The present study was a descriptive-correlational study. The study population included cardiovascular patients admitted to specialized teaching hospitals in cardiovascular diseases affiliated to Tehran University of Medical Sciences and Health Services (Tehran Heart Center), Shahid Beheshti (Shahid Rajaei Heart) and also 502 Army Heart Hospital and Tehran Bu Ali Hospital, affiliated to the Islamic Azad University of Medical Sciences. The cluster sampling method was used and samples were systematically selected within the clusters.  Results: Implementation of payment system related to diagnosis is effective on the variables of number of days of hospitalization, drug costs and medical equipment, costs of nursing services and medical costs of cardiovascular patients hospitalized in selected hospitals in Tehran, with their relationship being at the level of p <0.001. Conclusion: It seems that the implementation of the payment system related to the diagnosis could be used to reduce the cost of treatment and the number of days of hospitalization of cardiovascular patients admitted to selected hospitals.  Diagnostic-related groups system can significantly affect the financial health of hospitals and the availability of quality patient-care

Factors Affecting the Preferences of Primigravida Women for Choosing a Public Hospital

Introduction: Finding the factors affecting patients’ tendency to a hospital, can improve the health system. The purpose of this study was to recognize the factors affecting primigravidas’ preferences to select a public hospital, in order to determine the correlation on these preferences. Methods: In this cross-sectional study, 220 primigravida women who had admitted for delivery or cesarean in the Kamali public hospital in Karaj were selected using random sampling in 2014. Data collected by semi-structured questionnaire were analyzed by using structural equation modeling method and Lisrel Software. Results: Among the six studied indicators (services, processes, providers, cost, advertisements, and place), the most effective factor was the type of service (regression weight 0.89), and the lowest effective factor was services’ cost (regression weight 0.64). Moreover, providers and services had the most correlation and processes and services cost had the least correlation.  Conclusion: The clients’ requests must be considered to improve the quality and quantity of services and processes. Authorities should try to solve medical problems and provide medical facilities and welfare in hospitals in order to attract clients’ confidence

Short-and Long–Term Follow–up in the Elderly Patients With ST–Elevation Myocardial Infarction Receiving Primary Angioplasty or Thrombolytic Therapy

Introduction: The ischemic time serves as the most important parameter for treatment choice in patients with ST–elevation myocardial infarction (STEMI). The current study aimed at comparing the short– and long–term follow–up of elderly patients with STEMI undergoing primary angioplasty (PCI) or thrombolytic therapy.Methods: The current cross sectional study was conducted on all patients aged >65 years, admitted to the emergency department of Imam Hossein Hospital, Tehran, Iran from January 2014 to July 2016, diagnosed with STEMI . The demographics, medical history, family history, and mediation history were recorded for all patients. Patients received PCI or thrombolytic therapy based on the ischemic time and the treatment outcome and the following events were recorded. Patients were contacted after six months and data of their death or used treatments were recorded. All data were compared between the groups.Results: Of all patients, 38 subjects received thrombolytic therapy and 62 PCI. There was no significant difference between the groups in terms of mean age and gender (P=0.5 and 0.1, respectively). The frequency of positive medical history and smoking did not differ between the groups. There was no difference in the mean values of vital signs or serum parameters, mean ischemic time, left ventricular ejection fraction (LVEF), frequency of pulmonary emboli, cardiogenic shock, the involved vessel, and post-treatment complications between the groups (P>0.05). Of the 14 cases that died after six months, five were in the thrombolytic therapy group and nine in the PCI group (P=0.8). Mean hospital stay was not different between the groups (P=0.5).Conclusions: The results of the present study on two groups with similar demographics showed no significant difference between the groups in terms of the short– and long–term follow–up of PCI and thrombolytic therapy. The results indicated the appropriateness of treatment choice based on ischemic time and the available methods

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

  Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI) versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI).Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase) needs to be discussed.Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events) including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction) was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups.Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02). Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05). Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01).Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy seems to represent a safe alternative to PPCI. Higher costs for patients with PPCI may be decreased with shorter duration of hospital stays according to guidelines

Evaluation and monitoring the health of media staff using the occupational health management model

Objective: Considering the necessity of creating, maintaining and promoting the health of employees as the main organizational capital, this study was conducted with the aim of comprehensive and complete observation of the health status of employees in individual, occupational and organizational dimensions in order to achieve a comprehensive occupational health management model. Materials and Methods: This study is an applied, qualitative and survey research in terms of objective, and is a qualitative study of survey and observational studies in terms of method, conducted during the years 2016 to 2018 in 300 workstations in 5 government buildings with sampling and snowball methods and data were collected with field method using technical apparatus and designed forms finalized by focus group discussions. Results: Creating a health management model resulted in creating a database on the individual health status of employees and their workplace health and creating a management dashboard for instant monitoring of organizational health status. Using this model, it was possible to evaluate and monitor the personal and occupational health of employees at any time. Conclusion: A managerial approach was achieved while classifying media related jobs by designing this occupational health model that, at each moment a clear, realistic and complete picture of the health status of the community was created and, strategies regarding the health status of the staff in accordance with the health status of the staff were adjusted, implemented and communicate

Identifying the Outcomes of Healthy Lifestyles in the Post-COVID-19 Era

Introduction: This study aims to identify the outcomes of healthy lifestyles during the post-COVID-19 era. Materials and Methods: A qualitative field study was conducted based on the interpretive paradigm and inductive reasoning using theoretical and non-probability sampling techniques. Our study adopted the grounded theory approach, and semi-structured interviews were employed as data collection tools. While theoretical saturation was reached by the end of the thirteenth interview, the interviews continued until the fifteenth for further certainty. Faculty members and experts with doctoral degrees at Mashhad University of Medical Sciences constituted the statistical population from whom 15 individuals were recruited based on inclusion and exclusion criteria. The hidden content of interviews was summarized, coded, and analyzed using the MAXQDA software version 2020. Results: The researcher and supervising professors extracted 37 initial concepts, of which six remained after eliminating duplicates. The outcomes of healthy lifestyles during the post-COVID-19 era emerged from the intuitive opinions of experts, namely, the promotion of social capital, the promotion of psychological capital, and the movement toward development. Conclusion: Providing and maintaining health is not a simple act and is fraught with complexities, as numerous biological, individual, family, cultural, social, economic, political, and health factors are involved. Realization of appropriate health platforms, prevention of chronic diseases, and promotion of healthy lifestyles among citizens are not targets to be fulfilled merely by health-related organizations and bodies; rather, they require extensive coordination and empathy among all educational, health, cultural, service, and even political institutions and bodies

Analysis of Physicians' Retention Policies in Deprived Areas of the Islamic Republic of Iran

Introduction: The concentration of physicians in urban areas and the lack of specialist physicians in deprived ‎areas is a global challenge. It is necessary to adopt specific, scientific and evidence-based policies ‎to increase the health sector’s resources and reduce inequality in the distribution and allocation of ‎these resources in different regions of the‏ ‏country. The Ministry of Health and Medical ‎Education, as the most important custodian of planning and policy-making for distribution of ‎specialized manpower in Iran, has designed policies.Methods: This study aimed to analyze the incentive ‎policies for the retaining physicians in deprived areas of the country. This study has a qualitative ‎‎– retrospective design to analyze the most effective policies using the Walt and Gilson policy ‎model. Various methods were used to analyze the policies, including reviewing texts and ‎documents.Results: Findings of the study were classified based on the policy context, policy content, ‎policy-making process and role makers in the four law (policies or plan) of service of physicians ‎and paramedics, family physician plan, health transformation plan, and instructions on how to ‎distribute the Specialized medical graduates. Five legal, political-economic, socio-cultural, ‎international and structural factors were identified as policy making factors‏. ‏‎ In addition, ‎attention to upstream documents and the use of evidence in policy-making were identified as ‎strong points, and stakeholder ignorance and a top-down approach to planning were identified as ‎common weak points of policies.Conclusion: Considering the priority of needs, provision of resources and ‎requirements, constructive interaction of planners, and continuous evaluation of programs are ‎required to formulate and implement policies and interventions

Identifying and Prioritizing Barriers to Health Tourism Using the Analytical Hierarchy Process

Introduction: Iran offers many advantages for health tourism, e.g., low costs, high quality healthcare, qualified doctors, and abundant natural attractions, but there are also obstacles to the development of health tourism in Iran. This study aimed to identify and prioritize the barriers to health tourism in hospitals affiliated with Tehran University of Medical Sciences.Methods: This cross-sectional study was conducted in the first 6 months of 2016. Six main components were identified based on experts’ opinions; then, based on these components, a questionnaire for pairwise comparison was produced and completed by the same experts. The Analytical Hierarchy Process (AHP) model was used to prioritize the identified factors.Results: Results showed that among the barriers to health tourism in the investigated hospitals, the most important obstacle is the unfamiliarity of medical staff with foreign languages with a weight of 0.268. Lack of manpower and inappropriate physical were ranked second and third in priority with weights of 0.214 and 0.157, respectively.Conclusion: Considering the available capacities and potentials, effective and impressive steps can be taken to economically develop the medical tourism industry in Iran

Evaluating the Type and Number of Errors in Medical Records Documentation in Tehran Ayatollah Taleghani Hospital

Introduction: Recording Medical information in hospital records are in fact documentation of the medical team activities in the hospital. Therefore, correct, accurate, and timely record of patients' information can play a vital role in improving educational, medical, research, legal, and statistical activities. This study aimed to investigate the type and amount of errors in medical records documentation and its effective factors in Ayatollah Taleghani Hospital. Methods: This descriptive-analytic study was cross-sectional. A sample of 330 patients' records in Ayatollah Taleghani Hospital was investigated through a self-made checklist. Data were analyzed by the SPSS software and descriptive and analytical methods. Results: The amount of error in the records showed that, among the examined errors, the lack of record in diagnosis and drug use time in more than 50% of the cases were not accurately recorded. The least error was due to the absence of time and stamp. There was a significant relationship between medical record errors and some demographic characteristics. Conclusion: According to the results and the existence of errors in recording files, hospital doctors and nurses' efforts to promote the documentation of cases were necessary. Rewardingly, some methods, such as initial training of newly arrived residents, encouraging methods, and periodic evaluation of cases can be used

Investigation of the relationship between structural empowerment and reduction of nurses’ occupational stress and job burnout (case study: nurses of public hospitals in Tehran)

Introduction: Empowerment is one of the most importantsolutions for creating traits such as creativity, innovationand superior job performance. For this, the purposeof this study was to investigate the relationship betweennurses’ structural empowerment and reduction of theiroccupational stress and job burnout (case study: nurses ofpublic hospitals in Tehran)Method: This is a descriptive - correlational study that investigates400 nurses of the selected hospitals of TehranUniversity of Medical Sciences. The statistical populationincludes the nurses with undergraduate degrees who havespent the period of human resource planning ( at least2 years of work experience ) without sick leave of morethan 1 month in the last 6 months and certain chronicconditions that affect burnout, such as severe migraineheadaches and backache. Maslach Burnout Questionnaire,Spreitzer’s Structural Empowerment Questionnaireand Job Stress Questionnaire were used to collect data forthe research. Then, SPSS, version 18.0 and statistical testof regression were used to analyze the data.Results: The structural empowerment of nurses had aninverse correlation with job stress and burnout, while jobburnout had a direct relationship with job stress (P<0.001).Regression results showed that structural empowerment hada greater impact on job burnout compared to job stress.Conclusion: Structural empowerment is an internal motivationfactor that is reflective of the active role of staff inthe organization. Supportive working environment is themost important factor for job satisfaction among nurses.Using the results of this research, nursing managers canprovide adequate work environment to continue their activitiesby increasing organizational support. Consideringthat job burnout reduces the quality of nursing care, increasesstress and ultimately reduces the satisfaction ofpatients, its prevention is effective in improving nursingservices, increasing the satisfaction of patients, reducingnurses stress and preventing their burnout at work