A Survey of the Strengths of the Performance-Based Scheme in Selected Teaching Hospitals of Isfahan, Iran, in 2014: A Qualitative Study

Introduction: In the year 1995, the novel hospital administration plan (fee for service) was presented. Based on this plan, a percentage of specific revenues are allocated as a fee to the hospital staff. This plan was implemented in hospitals for 20 years. In early September 2104, the new guideline entitled the performance-based fee was designed with the aim of eliminating the deficiencies in the previous plan and implemented in hospitals in Isfahan, Iran. Therefore, the present study was performed with the aim of studying the strengths of the performance-based scheme in selected teaching hospitals of Isfahan in 2014. Method: This was a qualitative study. In-depth interviews were used to collect data. The study participants consisted of 11 middle managers and executive managers of university hospitals and university headquarters, faculty members, and hospital officials. The subjects were selected through purposive sampling method. All interviews were recorded and transcribed verbatim. The duration of the interviews varied between 30 to 60 minutes. Data analysis in this research was based on thematic analysis. Results: In this research, the 4 main strengths of "defining and developing appropriate guidelines, improving the monitoring system, improving the management information system, and organizing the fee payment system" were obtained. Conclusion: The results of the present study revealed the 4 main strengths of the performance-based scheme. Thus, in order for the health system to be effective, the strengths of the performance-based plan must be evaluated and used to reduce the dissatisfaction of hospital staff. Keywords: Hospital, Payment system, Executive managers, Fee for service

Patient Safety Behavior in Physicians: How is it Predicted?

Background: Patient safety is a serious global public health issue. Estimates show that every day many patients are harmed while receiving hospital care. Health care staff plays a key role in providing quality and safe patient care, especially physicians who are main members of the medical team and a critical element in patient safety efforts. Objective: The current study used a Theory of Planned Behavior (TPB) framework to investigate predictors of patient safety intentions and behavior of physicians. Methods: This descriptive analytical study was conducted in 8 hospitals with 52 physicians participating. A researcher-designed questionnaire was prepared to investigate patient safety behaviors and behavior constructs of physicians based on the guidelines of constructing a TPB Questionnaire: Conceptual and Methodological Considerations. The content validity and reliability of the questionnaire were confirmed. Binary logistic regression analysis was performed using SPSS18. Results: The total mean score of physician safety behavior indicated that 3.8±0.92. 42% of physicians reported their safety behavior at a good level. There was no significant difference between the patient safety function of physicians in public and private hospitals (P=0.8) and working in medical or surgical wards (P=0.4). Among TPB constructs, “normative beliefs” had the greatest influence on physician intention for safety behaviors (wald=3.828, P=0.05). Conclusion: The results showed that “normative beliefs” had the greatest influence on physician intention for safety behaviors; therefore, it seems that patient safety must be the most important concern of all health care staff, specifically managers and executives throughout health care centers

Economic Reform Strategies to Improve the Performance of Surveillance and Infrastructure for Implementation of New Fee for Service Guidelines, 2014: A Qualitative Study

Introduction: In year 1995, new hospital administration plan system (fee for service) was notified. Under the scheme, a dedicated percentage of specific revenues allocated as a fee for the hospital staff. In the early September 2014, new guidelines as performance-based fee for service plan with the aim to fix the deficiencies in the previous plan was reviewed and implemented in hospitals in Isfahan, Iran. This study aimed to investigate strategies for economic reforms to promote performance monitoring and improve infrastructure for implementation of the new fee for service guidelines in 2014. Method: In this qualitative study, in-depth interviews were used to collect the data. Eleven samples consisting of middle managers and senior headquarters of university hospitals, and some faculty members and hospital officials were chosen via purposive sampling method. All interviews were recorded and then written on paper. The duration of interviews varied between 30 to 60 minutes. Data analysis in this research was based on content analysis. Results: In this study, six main themes of strategies for economic reforms to promote performance monitoring and improve infrastructure for implementation of the new fee for service guidelines were obtained including payment system reform, price reform, defined package of services in public hospitals, financial and economic policies, reform and implementation of family physician referral system, and support of the insurers. Conclusion: Our results define strategies for economic reforms to promote performance monitoring and improve infrastructure for implementation of the new fee for service guidelines. The most notable findings include pay reform, price reform, and financial and economic policies. These findings can help policy makers to consider the proposed revisions with appropriate strategies to monitor and improve the implementation of new fee for service plan. Keywords: Hospitals, Fee for service, Monitorin

Bone mineral density is not related to angiographically diagnosed coronary artery disease

Based on data, there may exist an association between low bone mineral density (BMD) and atherosclerosis. Thisstudy aimed to investigate the association between BMD and coronary artery disease (CAD). In this study the possible association of BMD with CAD in 65 men with CAD and in 49 men with normal angiography as well as in 51 women with CAD and in 51 normal women was investigated. Both spinal and femoral BMD values for men were higher than those of women (P<0.05). Neither femoral nor spinal BMD values were different in patients with or without CAD. In addition, BMD values were not associated with the severity of CAD. Body massindex (BMI) was positively correlated with BMD both in men and women, whereas age and anti-diabetic treatment were linked with lower BMD in women. In conclusion, in this study CAD was not related to low BMD. However, BMI was an independent predictor of diminished BMD

The Effect of Topical Lidocaine Gel, Intrauterine Lidocaine Injection and Combination of these Two Methods for Relieving Pain during Curettage: A Double Blind Randomized Clinical Trial

Introduction: Curettage is one of the most common gynecological surgeries in women. Its complication is pain which increases dissatisfaction in patients. Therefore, it is necessary to find a way to treat this complication. This study was performed with aim to compare the effects of three methods of using lidocaine gel in the cervix, intrauterine injection of lidocaine, and a combination of two methods to reduce pain during curettage. Methods: This clinical trial study was performed in 2017 on 120 patients candidates for curettage in Qazvin Kosar Hospital. Patients were randomly divided into three groups of topical lidocaine gel in the cervix, intrauterine injection of lidocaine and a combination of these two methods, and the drugs were prescribed before curettage. Vital signs and pain were recorded in patients and other information was collected by completing the questionnaire. Data analysis was performed using statistical software (version 22) and chi-square and ANOVA tests. P<0.05 was considered statistically significant. Results: The intrauterine and intra cervical injection of lidocaine (0.3±0.72) and then injection of intra cervical lidocaine (0.45±0.84) alone significantly reduced pain during curettage in women (P=0.04). On the other hand, no severe hemodynamic changes were observed in these patients. No complications such as nausea and vomiting and no instability of vital signs were observed in any of the groups (P>0.05). Conclusion: Intrauterine administration along with addition of topical lidocaine gel to the cervix can be used as a simple, low-cost, and safe method as to control pain during and after curettage

"Familial" versus "Sporadic" intellectual disability: contribution of common microdeletion and microduplication syndromes

<p>Abstract</p> <p>Background</p> <p>Interstitial Microdeletion and Microduplication syndromes have been proposed as a significant cause of sporadic intellectual disability (ID) but the role of such aberrations in familial ID has not yet been investigated. As the balanced chromosomal abnormalities commonly lead to the recurrent ID or multiple congenital anomalies, this study was designed to evaluate whether it was justified to investigate such aberrations in familial ID patients. Three hundred and twenty eight patients from 101 unrelated Iranian families with more than two ID patients in the first-degree relatives, have been investigated. Assessment of a panel of 21 common Microdeletion and Microduplication syndromes (CMMS) was carried out using Multiplex Ligation-Dependent Probe Amplification (MLPA) technique.</p> <p>Results</p> <p>Among the families studied, 27.7% had 4-12, 35.6% had 3 and 36.6% had 2 affected individuals in the first-degree relatives. An autosomal dominant inheritance of Williams-Beuren syndrome (WBS) was detected in a family with no clinical suspicion of WBS. The prevalence of CMMS was therefore,0.99%.</p> <p>Conclusion</p> <p>This is the first investigation of a panel of CMMS in a large sample set of "familial ID patients". The findings of this study showed the low prevalence of CMMSs in "familial ID" patients in spite of the significant contribution of such aberrations in "sporadic ID" which has a very useful practical impact by avoiding unnecessary diagnostic tests in "familial ID" patients.</p

Health System Responsiveness: A Case Study of General Hospitals in Iran

Background : Considering patients’ needs and expectations in the process of healthcare delivery improves the quality of services. This study aimed to investigate the responsiveness of general public and private hospitals in Mashhad, Iran. Methods : In this cross-sectional and explanatory study, hospitalized patients (with at least 2 days of stay) in general private and public hospitals in Mashhad were investigated. In total 425 patients (259 from private and 166 from public hospitals) were selected using a stratified and simple random sampling. Standard responsiveness questionnaire was used as the data collection tool. Data were analysed using descriptive statistics, independent t-tests and ANOVA by SPSS 16 at a significance level of 0.05. Results : Access to the social support during hospitalization as well as confidentiality of the patient’s information achieved the highest score (3.21±0.73) while the patient participation in decision-making process of treatment received the least score (2.34±1.24). Among the research population 1.6%, 4.1%, 17.6%, 63.3% and 13.2% commented on the responsiveness level as very low, low, moderate, good, and excellent, respectively. There was no significant difference between the overall responsiveness scores of public and private hospitals ( P ≥0.05). Conclusion : The hospitals have enough potential to improve various aspects of their responsiveness. We suggest a number of measures can help improve the non-clinical aspects of care. These include: using educational courses to improve the knowledge and attitudes of medical and nonmedical staff, changing the resource allocation method, and using quality tools such as reengineering to modify the healthcare delivery processes

Prevalence of diabetic retinopathy in Tehran province: a population-based study

<p>Abstract</p> <p>Background</p> <p>To determine the prevalence and characteristics of diabetic retinopathy (DR) among Iranian patients with diabetes.</p> <p>Methods</p> <p>Design: population-based cross-sectional study.</p> <p>Participants: patients with diabetes aged 25 to 64 years in Tehran province, Iran. This survey was conducted from April to October 2007. The study sample was derived from the first national survey of risk factors for non-communicable disease. Diabetes mellitus was defined as a fasting plasma glucose of ≥ 7.0 mmol/l (126 mg/dl) or more, use of diabetic medications, or a physician's diagnosis of diabetes. All patients known to have diabetes underwent an eye examination by bio-microscope and indirect ophthalmoscope to check for any signs of DR through dilated pupils by + 78 lens. Participants were also interviewed and examined to determine their demographic characteristics, medical conditions and the regularity of their eye visits.</p> <p>Results</p> <p>Among 7989 screened patients, 759 (9.5%) had diabetes. Of them, 639 patients (84.2%) underwent eye examination. Five patients (0.7%) with media opacity were excluded. Of 634 examined patients with diabetes, 240 had some degree of diabetic retinopathy, and the overall standardized prevalence of any retinopathy was 37.0% (95% CI: 33.2-40.8), including 27.3% (95% CI: 23.7-30.8) (n = 175) with non-proliferative and 9.6% (95% CI: 7.3-11.9) (n = 65) with proliferative diabetic retinopathy. Clinically significant macular edema and vision-threatening retinopathy were detected in 5.8% (95% CI: 4.0-7.7) (n = 38) and 14.0% (95% CI: 11.3-16.7) (n = 95) of patients, respectively. Only 143 patients (22.6%) with diabetes had a history of regular eye examination.</p> <p>Conclusion</p> <p>This study demonstrated a high prevalence and poor control of DR in Tehran province. This suggests the need for adequate prevention and treatment in patients with diabetes.</p