Journal of

---

Background: Pay-for-performance (P4P) is a payment model which tries to pay for the measured aspects of performance and encourage health care providers by providing financial incentives in order to achieve pre-defined goals. This research was done to assess the impact of P4P on efficiency of medical laboratory of Imam Reza hoapital in Tabriz in 2013.

Materials & Methods: This interventional research was a before-and-after study. In order to recognize any changes, efficiency indexes of laboratory were measured and compared whole the year. The data were collected manually assessing the related documents. For comparing efficiency before and after intervention, descriptive statistics were used.

Results: Findings showed that costs didn’t differ significantly after the intervention, but revenue was a little increased slightly (14364 to 16874). Laboratory errors were also increased after the intervention. (0 to 17 cases).

Conclusion: Regarding the results of survey , it seems that we can conclude that this bonus payment system can be used in all levels in which care is provided such as primary health care centers, drug stores, diagnostic centers and hospitals through setting pre-defined goals and considering negative point for any staff who makes an error. 

---

Background: Patient transfer requires the wide variety of functions such as collaboration, appropriate communication and coordination between hospitals and the Center for Treatment Guidance and Information (CTGI). This study aimed at determining the influencing factors in the coordination of patient transfer and also explaining the situation of the CTGI in patient transfer process coordination.

Materials and Methods: This study was a qualitative study (phenomenology) conducted using three Focus Group Discussions (FGD) and thirty interviews with participants who were involved in the process of patient transfer in a referring hospital, six patient receiver hospitals and CTGI in Tabriz. Purposive sampling was used to select study participants. Data was analyzed using content analysis.

Results: The effective factors of the patient transfer coordination were categorized in four main themes including weakness in the exchange of clinical information, data constraints, legal protections weakness and guidelines implementation and lack of clinical empowerment in managing patient. Eighteen sub-themes were identified which include legal protections weakness and guidelines implementation in center for treatment guidance as sector problems.

Conclusion: There are some problems in coordination of patient transfer process which is relate to non adherence a specific procedure for admission , ineffective interactions and information exchange. In order to achieve uninterrupted medical treatment, the patient transfer coordination should be improved. The center for treatment guidance and information should be obtained its position as a supervising authority.

---

Background: Information technology application in health care is increasing. The aim of  this study, is to introduce a scientific model for designing an electronic system for managing patient transfer.
Materials and Methods: This study is an exploratory qualitative study. At first a review of literature was carried out for identifying clinical, managerial and process indicators necessary for patient transfer. Then 30 experts, who had vast experiences on patient transfer, were selected using purposive sampling approach and their informational needs were extracted using focus group discussion and semi-structured interviews. Then clinical indicators extracted from literature review and informational needs collected from interviews were distributed among 51 experts in the form of Delphi questionnaires. Process indicators were also distributed among 35 experts to summarize all necessary indicators for designing patient transfer system. At the final step an expert panel approved the model.
Results: Thirty eight process indicators and 249 clinical and managerial components were finalized for designing the system. The process indicators were used for designing “monitoring and reports sections” of the system. The clinical indicators were used for designing “main sections” of the system including request for patient transfer, automatic algorithm for selecting destination hospital, information flow cycle, communicating clinical data and documentation. Final model also includes user interfaces relevant to responsibility of the user.
Conclusion: The proposed model, which contains necessary indicators for patient transfer, can communicate clinical information among hospitals and by providing proper infrastructure, will be able to improve patient transfer process.