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Reza Safdari, Seyed Sina Marashi Shooshtari, Marzieh Esmaeili, Fozieh Tahmasbi, Zohreh Javanmard,
Volume 13, Issue 6 (2-2020)
Volume 13, Issue 6 (2-2020)
Abstract
Background and Aim: The importance of managing medicines and medical devices as vital resources in healthcare industry cannot be ignored. Therefore, the application of coding systems could be of great help in the control of the required processes. This study aims to develop a coding system for medicines and medical devices in Iran.
Materials & Methods: This descriptive study was planned to be carried out in four phases from September 2018 to August 2019. To identify the requirements of designing a coding system for the classification of medicines and medical devices, library resources were studied, and the existing coding systems in the area of medicines and medical devices came under scrutiny. Then, based on the expert opinion on the results, the initial model of the coding system was designed.
Results: Thirty-five coding systems were identified and investigated. To design the proposed system, two coding systems -- ATC/DDD and UMDNS -- were selected as a core for medicines and medical devices, respectively. Then, based on expert opinion, the axes for the place of consumption and the placement of products and also the application of Quick Response (QR) code for data encoding were added.
Conclusion: The design and development of a comprehensive coding system–which is in compliance with the international protocols and capable of including both medicines and medical devices simultaneously – could be very helpful. Besides, using the location axis in the structure of coding system can improve the management of these products.
Materials & Methods: This descriptive study was planned to be carried out in four phases from September 2018 to August 2019. To identify the requirements of designing a coding system for the classification of medicines and medical devices, library resources were studied, and the existing coding systems in the area of medicines and medical devices came under scrutiny. Then, based on the expert opinion on the results, the initial model of the coding system was designed.
Results: Thirty-five coding systems were identified and investigated. To design the proposed system, two coding systems -- ATC/DDD and UMDNS -- were selected as a core for medicines and medical devices, respectively. Then, based on expert opinion, the axes for the place of consumption and the placement of products and also the application of Quick Response (QR) code for data encoding were added.
Conclusion: The design and development of a comprehensive coding system–which is in compliance with the international protocols and capable of including both medicines and medical devices simultaneously – could be very helpful. Besides, using the location axis in the structure of coding system can improve the management of these products.
Akbar Jafari, Ali Asghar Safae ,
Volume 13, Issue 6 (2-2020)
Volume 13, Issue 6 (2-2020)
Abstract
Background and Aim: Implementation of virtual reality systems in the field of health care has recently made significant progress. This article aims to examine a virtual reality-based system designed for patients with two types of phobia: darkness and height.
Materials and Methods: The present paper is the result of a study conducted by searching valid scientific sources including Springer, PubMed and Science Direct(Elsevier), and observing and examining similar virtual reality systems. According to the performed studies, patients enter the virtual reality environment based on their phobia and physician opinion. To assess the effect of phobia, a series of questionnaires are used before and after the test; and using these questionnaires, physicians can evaluate the extent of their patients' recovery.
Results: One of the ways to treat phobia is to put the patient in real environment; but in terms of cost and feasibility, it is not possible to provide the environment for physicians and patients in many cases. However, by using virtual reality technology and in the system designed in this paper, psychiatrists can implement real environments as virtual reality in front of the patient's eyes.
Conclusion: In the system presented in this study, the existence of several diverse and appropriate virtual reality environments for the care and treatment of patients with darkness and height phobia is one of its distinct points because in many studies only a fixed environment is used for patients.
Materials and Methods: The present paper is the result of a study conducted by searching valid scientific sources including Springer, PubMed and Science Direct(Elsevier), and observing and examining similar virtual reality systems. According to the performed studies, patients enter the virtual reality environment based on their phobia and physician opinion. To assess the effect of phobia, a series of questionnaires are used before and after the test; and using these questionnaires, physicians can evaluate the extent of their patients' recovery.
Results: One of the ways to treat phobia is to put the patient in real environment; but in terms of cost and feasibility, it is not possible to provide the environment for physicians and patients in many cases. However, by using virtual reality technology and in the system designed in this paper, psychiatrists can implement real environments as virtual reality in front of the patient's eyes.
Conclusion: In the system presented in this study, the existence of several diverse and appropriate virtual reality environments for the care and treatment of patients with darkness and height phobia is one of its distinct points because in many studies only a fixed environment is used for patients.
Azita Yazdani, Reza Safdari, Roxana Sharifian, Maryam Zahmatkeshan, Marjan Ghazi Saeedi,
Volume 14, Issue 2 (5-2020)
Volume 14, Issue 2 (5-2020)
Abstract
Background and Aim: When clinical decision support systems are developed, implementing solutions that enable these systems to be -used on a large scale can reduce the production costs associated with the creation, maintenance and by sharing these systems, producing multiple clinical decision support systems will be prevented. In recent years, one of the approaches used for this purpose in combination with clinical decision support systems is the service-oriented architecture approach. The purpose of this study was to investigate the role and importance of service-oriented architecture in delivering scalable architectures of clinical decision support systems focusing on different approaches to this architecture.
Materials and Methods: This article is a simple review article. Bibliographic databases of IEEE Explore, Science Direct, Springer, Web of Science, and Scopus were reviewed. The keywords "Service Oriented Architecture" and "clinical decision support systems" were used as keywords along with related terms for searching these databases.
Results: The clinical decision support systems based on service-oriented architecture brings benefits such as Facilitate knowledge maintenance, reducing costs and improving agility. Point-to-point communication, enterprise service bus, service registry, clinical and engine guiding engine, and service choreography and orchestration are general architectural designs that are evident in the use of web-based clinical decision support systems based on a service-oriented architecture approach.
Conclusion: Service-oriented architecture is a potential solution for delivering scalable platforms for clinical decision systems.
Materials and Methods: This article is a simple review article. Bibliographic databases of IEEE Explore, Science Direct, Springer, Web of Science, and Scopus were reviewed. The keywords "Service Oriented Architecture" and "clinical decision support systems" were used as keywords along with related terms for searching these databases.
Results: The clinical decision support systems based on service-oriented architecture brings benefits such as Facilitate knowledge maintenance, reducing costs and improving agility. Point-to-point communication, enterprise service bus, service registry, clinical and engine guiding engine, and service choreography and orchestration are general architectural designs that are evident in the use of web-based clinical decision support systems based on a service-oriented architecture approach.
Conclusion: Service-oriented architecture is a potential solution for delivering scalable platforms for clinical decision systems.
Reza Safdari, Abdorreza Naser Moghadasi, Sahar Khenarinezhad, Ehsan Ghazanfarisavadkoohi,
Volume 14, Issue 5 (1-2021)
Volume 14, Issue 5 (1-2021)
Abstract
Background and Aim: Taking a wide range of medications in Multiple sclerosis (MS) patients can lead to side effects and drug interactions. Therefore, the use of intelligent systems such as drug monitoring systems can help in the effective and timely treatment of MS disease. In this regard, the present study was conducted to design, development, and evaluation of the drug monitoring system for multiple sclerosis patients.
Materials and Methods: The present descriptive-developmental study was performed in four stages. In the first stage, by searching the library resources and valid guidelines, the minimum data set was determined and provided to neurologists and MS fellowships in the form of checklists for validation. Then the software was designed logically and coded based on the opinion of experts. In the last stage, the software was evaluated by end-users.
Results: The information elements in the software design were categorized into patient demographic information, medical history, clinical signs, imaging procedures, laboratory tests for ocrelizumab and fingolimod drugs, counseling, and treatment data. Finally, the performance of the drug monitoring system was evaluated with an average of 7.9 and was approved by users.
Conclusion: The results of software evaluation showed that the drug monitoring system can help general practitioners, neurologists, and MS fellowships in monitoring and follow-up of patients and lead to increased patient safety.
Materials and Methods: The present descriptive-developmental study was performed in four stages. In the first stage, by searching the library resources and valid guidelines, the minimum data set was determined and provided to neurologists and MS fellowships in the form of checklists for validation. Then the software was designed logically and coded based on the opinion of experts. In the last stage, the software was evaluated by end-users.
Results: The information elements in the software design were categorized into patient demographic information, medical history, clinical signs, imaging procedures, laboratory tests for ocrelizumab and fingolimod drugs, counseling, and treatment data. Finally, the performance of the drug monitoring system was evaluated with an average of 7.9 and was approved by users.
Conclusion: The results of software evaluation showed that the drug monitoring system can help general practitioners, neurologists, and MS fellowships in monitoring and follow-up of patients and lead to increased patient safety.
Mohamad Jebraeily, Ali Rashidi, Taher Mohitmafi, Rooghayeh Muossazadeh,
Volume 14, Issue 6 (1-2021)
Volume 14, Issue 6 (1-2021)
Abstract
Background and Aim: Electronic prescription systems can improve patient safety and the quality of health care services. These systems must provide the capabilities required to reduce medical errors and enhance the performance of health care providers. The purpose of this study is to evaluate the capabilities of the e-prescription system from the perspective of physicians in the polyclinics of the Social Security Organization (SSO) of Urmia.
Materials and Methods: The present study is a descriptive cross-sectional study that was conducted in 2020. The study population consisted of 82 physicians working in 3 polyclinics of the SSO in Urmia, which was determined by census. The instrument used in this study is a self-designed questionnaire that the validity of it was determined based on the opinions of experts and its reliability was evaluated by Cronbach's alpha coefficient. Data analysis was performed using SPSS software.
Results: The results showed that in the section of documentation and access to information, the highest score was related to the possibility of drug prescribe (4.58), request for examination and radiology (4.44). In terms of decision support capabilities, the highest score for providing alerts related to drug interactions (4.18) and controlling the amount of medication prescribed for chronic patients (3.83) and also in the field of technical capabilities, the highest score related to easy to use (3.87) and fit of user interface (3.66).
Conclusion: The e-prescription system under survey has gained fewer score in some capabilities, such as access to pharmaceutical information based on reliable sources, advice to treatment options based on original diagnosis and the customized system. Therefore the system developer should be improved capabilities of it through communicating properly with users and understanding their real needs.
Materials and Methods: The present study is a descriptive cross-sectional study that was conducted in 2020. The study population consisted of 82 physicians working in 3 polyclinics of the SSO in Urmia, which was determined by census. The instrument used in this study is a self-designed questionnaire that the validity of it was determined based on the opinions of experts and its reliability was evaluated by Cronbach's alpha coefficient. Data analysis was performed using SPSS software.
Results: The results showed that in the section of documentation and access to information, the highest score was related to the possibility of drug prescribe (4.58), request for examination and radiology (4.44). In terms of decision support capabilities, the highest score for providing alerts related to drug interactions (4.18) and controlling the amount of medication prescribed for chronic patients (3.83) and also in the field of technical capabilities, the highest score related to easy to use (3.87) and fit of user interface (3.66).
Conclusion: The e-prescription system under survey has gained fewer score in some capabilities, such as access to pharmaceutical information based on reliable sources, advice to treatment options based on original diagnosis and the customized system. Therefore the system developer should be improved capabilities of it through communicating properly with users and understanding their real needs.
Hossein Dargahi, Farugh Nomani, Mohammad Rahim Ghohestani,
Volume 15, Issue 2 (5-2021)
Volume 15, Issue 2 (5-2021)
Abstract
Background and Aim: Managers’ sufficient awareness about rules and regulations and the legal issues of health system may lead to their optimal performance in organizations. Therefore, this study is conducted to determine senior managers’ level of knowledge about legal rules and regulations related to the health system in Tehran University of Medical Sciences (TUMS).
Materials and Methods: The present descriptive-analytical cross-sectional study was conducted in 2017. The sample consisted of 75 senior managers. The research tool was a researcher-made questionnaire whose face validity was confirmed using the opinions of 7 specialists and experts in the field of medical law, health care and medical services management; besides, regarding its reliability, Cronbach's alpha and test-retest reliability coefficients were 0.89 and 0.79, respectively. With SPSS software, data analysis was performed using descriptive statistics including absolute and relative frequency and inferential statistics including Pearson and Ka-square correlation tests.
Results: The level of knowledge of the studied managers was below average in most legal areas and legal standards related to the health system. There was a significant inverse relationship between the level of knowledge of organizational, financial and transactional areas, and administrative and employment of managers with passing relevant training courses (P=0.01 and P=0.04).
Conclusion: TUMS senior managers' level of knowledge in the three areas of organizational, financial, and rules and regulations is at medium and lower than medium levels. To raise the awareness of managers, necessary arrangements such as holding training courses with new methods such as simulation, screenwriting, case study and experimentation and using new technologies such as hybrid knowledge management and technology integration are suggested. Also, creating managers' strategic competency system at the levels of general and specific skills, along with continuous training and monitoring the accountability and feedback provided in management processes, will ensure future reforms.
Materials and Methods: The present descriptive-analytical cross-sectional study was conducted in 2017. The sample consisted of 75 senior managers. The research tool was a researcher-made questionnaire whose face validity was confirmed using the opinions of 7 specialists and experts in the field of medical law, health care and medical services management; besides, regarding its reliability, Cronbach's alpha and test-retest reliability coefficients were 0.89 and 0.79, respectively. With SPSS software, data analysis was performed using descriptive statistics including absolute and relative frequency and inferential statistics including Pearson and Ka-square correlation tests.
Results: The level of knowledge of the studied managers was below average in most legal areas and legal standards related to the health system. There was a significant inverse relationship between the level of knowledge of organizational, financial and transactional areas, and administrative and employment of managers with passing relevant training courses (P=0.01 and P=0.04).
Conclusion: TUMS senior managers' level of knowledge in the three areas of organizational, financial, and rules and regulations is at medium and lower than medium levels. To raise the awareness of managers, necessary arrangements such as holding training courses with new methods such as simulation, screenwriting, case study and experimentation and using new technologies such as hybrid knowledge management and technology integration are suggested. Also, creating managers' strategic competency system at the levels of general and specific skills, along with continuous training and monitoring the accountability and feedback provided in management processes, will ensure future reforms.
Simin Momenzadeh, Atefeh Zarei, Phd Seyed Ali Akbar Famil Rouhany, Leila Dehghani,
Volume 15, Issue 2 (5-2021)
Volume 15, Issue 2 (5-2021)
Abstract
Background and Aim: This study aimed to propose a consistent architecture to design integrated and flexible information systems for the Vice-Chancellor for Research and Technology of Ahvaz Jundishapur University of Medical Sciences (AJUMS).
Materials and Methods: This applied research employed an integrated design based on business system planning (BSP) and James Martin's model for the design of information systems. The statistical population of this study included 27 managers and experts of AJUMS Vice-Chancellorship department for Research and Technology. Data collection was carried out using structured interview, observation, and document analysis. A contrast matrix was then used for data analysis.
Results: In total, 53 processes and 60 data classes were identified. Using a multi-layered architectural model (presentation, process, data and infrastructure), the results were presented in the form of a proposed architecture. In the proposed architecture, 12 subsystems and the relationships among them were identified; such subsystems as library, research activities, sabbatical leave, conference, fellowship, publication, innovation and technology, laboratory information, theses, budget and planning, social subsystem and knowledge-management networks. The results also showed that the level of coverage of the processes, data classes, and objectives by existing information systems were 53%, 50%, and 55%, respectively, and increased to full coverage in proposed or optimal modes.
Conclusion: By identifying the required information systems, it is possible to accurately plan and successfully use these systems in this study. The results of the present study can be used to implement the architecture of information systems of Research and Technology Departments of other universities of medical sciences (UMSs) in Iran, which can have a significant effect on saving cost and time.
Materials and Methods: This applied research employed an integrated design based on business system planning (BSP) and James Martin's model for the design of information systems. The statistical population of this study included 27 managers and experts of AJUMS Vice-Chancellorship department for Research and Technology. Data collection was carried out using structured interview, observation, and document analysis. A contrast matrix was then used for data analysis.
Results: In total, 53 processes and 60 data classes were identified. Using a multi-layered architectural model (presentation, process, data and infrastructure), the results were presented in the form of a proposed architecture. In the proposed architecture, 12 subsystems and the relationships among them were identified; such subsystems as library, research activities, sabbatical leave, conference, fellowship, publication, innovation and technology, laboratory information, theses, budget and planning, social subsystem and knowledge-management networks. The results also showed that the level of coverage of the processes, data classes, and objectives by existing information systems were 53%, 50%, and 55%, respectively, and increased to full coverage in proposed or optimal modes.
Conclusion: By identifying the required information systems, it is possible to accurately plan and successfully use these systems in this study. The results of the present study can be used to implement the architecture of information systems of Research and Technology Departments of other universities of medical sciences (UMSs) in Iran, which can have a significant effect on saving cost and time.
Haleh Mohammadiha, Gholam Reza Memarzadeh, Parham Azimi,
Volume 15, Issue 3 (8-2021)
Volume 15, Issue 3 (8-2021)
Abstract
Background and Aim: Health systems have played an important role in improving and increasing life expectancy. However, there is a large gap between health systems’ potential and their current performance, most of which relate to governance issues. The purpose of this study is to provide a model for improving the governance of the country's health system.
Materials and Methods: The present study is applied-developmental in terms of purpose. After reviewing the theoretical foundations and previous research, the governance strategies of the health system were identified. Then, using Fuzzy Delphi Method (FDM) and surveying 13 academic and executive experts who were purposefully selected, the research model was designed. Finally, in order to validate the model, 169 managers and specialists of health system departments in Tehran were interviewed with a questionnaire, and the data were analyzed using structural equation modeling (SEM) and SmartPLS software. At this stage, the sampling method was available and the sample size was calculated by Cochran's method.
Results: According to the research findings, in order to promote health governance, 10 main strategies and 58 sub-strategies should be considered. Identified strategies include strategic orientation, optimal financial resource management, stakeholder partnership development, knowledge resource development, administrative health promotion, technical knowledge development, value and ethical orientation, executive and operational platform development, Service delivery capacity management and Balanced and integrated stewardship. Also, the coefficient of determination for the outcome variable is 0.549 and the intensity of the effect of intervening/ facilitating and contextual factors on governance strategies is equal to 0.610 and 0.533, respectively.
Conclusion: The results showed that the governance of the health system is a multifaceted and complex phenomenon and in order to improve it, a set of strategies must be implemented. In addition, it is suggested that according to the issues and threats facing the health system, a roadmap and a long-term plan should be developed in order to move towards the governance model proposed in the present study.
Materials and Methods: The present study is applied-developmental in terms of purpose. After reviewing the theoretical foundations and previous research, the governance strategies of the health system were identified. Then, using Fuzzy Delphi Method (FDM) and surveying 13 academic and executive experts who were purposefully selected, the research model was designed. Finally, in order to validate the model, 169 managers and specialists of health system departments in Tehran were interviewed with a questionnaire, and the data were analyzed using structural equation modeling (SEM) and SmartPLS software. At this stage, the sampling method was available and the sample size was calculated by Cochran's method.
Results: According to the research findings, in order to promote health governance, 10 main strategies and 58 sub-strategies should be considered. Identified strategies include strategic orientation, optimal financial resource management, stakeholder partnership development, knowledge resource development, administrative health promotion, technical knowledge development, value and ethical orientation, executive and operational platform development, Service delivery capacity management and Balanced and integrated stewardship. Also, the coefficient of determination for the outcome variable is 0.549 and the intensity of the effect of intervening/ facilitating and contextual factors on governance strategies is equal to 0.610 and 0.533, respectively.
Conclusion: The results showed that the governance of the health system is a multifaceted and complex phenomenon and in order to improve it, a set of strategies must be implemented. In addition, it is suggested that according to the issues and threats facing the health system, a roadmap and a long-term plan should be developed in order to move towards the governance model proposed in the present study.
Reza Safdari, Seyyed Farshad Allameh, Ms Fariba Shabani,
Volume 15, Issue 6 (3-2022)
Volume 15, Issue 6 (3-2022)
Abstract
Background and Aim: Many risk factors can cause biliary system diseases. Hence, this category of diseases is amongst the most common ones. Active patient cooperation is very important in disease management, self-care, and clinical outcomes improvement. A mobile phone application has a high potential in supporting the patients’ self-management. Therefore, this study was conducted to recognize and define data elements to develop a self-care application for biliary patients.
Materials and Methods: The current descriptive study was conducted in 2 stages, resource investigation, and data elements’ need assessment. In the first stage, scientific articles available in databases were used for defining required data elements to develop the application for biliary patients, and a checklist of data elements was prepared. In the second stage, a questionnaire was made based on the checklist. Content and face validity were accepted by the research team and the reliability was calculated 87.2%, using the Cronbach’s alpha test. The mentioned questionnaire was given to Gastroenterologists at Imam Khomeini Hospital complex, and the elected data elements were recognized.
Results: In this application, data elements were categorized into seven sections, including demographic and clinical information, data related to the biliary system diseases, postoperative lifestyle information of the biliary patients, reminders, disease management, and informing. Sixty point five percent of the responders gave the highest importance to data elements in the demographic and clinical data section. Data elements related to patients’ education were considered highly important by 54.2% of the responders. Forty three point eight percent gave the highest importance to data elements in interventional applications’ sections, and only 4.2% gave the least importance to this section.
Conclusion: Based on the identified data elements, a self-care application was designed and developed and can be used as a supplement to specialized care for biliary patients.
Materials and Methods: The current descriptive study was conducted in 2 stages, resource investigation, and data elements’ need assessment. In the first stage, scientific articles available in databases were used for defining required data elements to develop the application for biliary patients, and a checklist of data elements was prepared. In the second stage, a questionnaire was made based on the checklist. Content and face validity were accepted by the research team and the reliability was calculated 87.2%, using the Cronbach’s alpha test. The mentioned questionnaire was given to Gastroenterologists at Imam Khomeini Hospital complex, and the elected data elements were recognized.
Results: In this application, data elements were categorized into seven sections, including demographic and clinical information, data related to the biliary system diseases, postoperative lifestyle information of the biliary patients, reminders, disease management, and informing. Sixty point five percent of the responders gave the highest importance to data elements in the demographic and clinical data section. Data elements related to patients’ education were considered highly important by 54.2% of the responders. Forty three point eight percent gave the highest importance to data elements in interventional applications’ sections, and only 4.2% gave the least importance to this section.
Conclusion: Based on the identified data elements, a self-care application was designed and developed and can be used as a supplement to specialized care for biliary patients.
Ahmad Siar Sadr, Roohollah Tavallaee, Mohammad Ali Afshar Kazemi,
Volume 16, Issue 1 (3-2022)
Volume 16, Issue 1 (3-2022)
Abstract
Background and Aim: Enterprise Architecture based on laboratory needs, and by using of the commons of valid and existing enterprise architecture frameworks, leads to the aligns of needs with organizational strategies and goals and information technology infrastructure. The aim of this study was the investigation of the effect of enterprise architecture model implementation on laboratory information management systems.
Materials and Methods: In this quantitative study in 2020, proposed enterprise architecture model which was based on the compilation of Zachman and service-oriented architecture models was investigated by the maturity of enterprise architecture at Sharif University. The statistical community of this study was 100 laboratory specialists based on Morgan sample determination table CCM (Capacity Maturity Model), which was designed based on the Likert spectrum, was used as a questionnaire assessment tool. For data analysis, descriptive indicators such as frequency, percentage and one-sample t-test to compare the mean in SPSS software was used.
Results: Assessing the maturity of enterprise architecture including four areas of IT (Information Technology) planning and organization, IT development and implementation, IT service and support, and IT monitoring and evaluation. Among the various dimensions of enterprise architecture maturity, the lowest average was related to the field of monitoring and evaluation and the highest average was related to the field of service and support. Dimensions in terms of status were: service and support dimension, planning and organizing dimension, development and implementation dimension, monitoring and evaluation dimension, respectively. The test results were significantly different in the areas related to the maturity of enterprise architecture, including the planning and organization areas, development and implementation, service and support (P<0.0001). There was no significant difference in monitoring and evaluation.
Conclusion: The use of enterprise architecture specific to laboratory management systems causes the optimal use of resources and ease of interaction. Evaluation of the implementation of the proposed architectural framework in the laboratory environment showed that the proposed model has matured in the three areas of planning and organization, development and implementation, service and support. In order to improve the maturity of enterprise architecture, more attention should be paid to the field of monitoring and evaluation and the reform program should start from this field.
Materials and Methods: In this quantitative study in 2020, proposed enterprise architecture model which was based on the compilation of Zachman and service-oriented architecture models was investigated by the maturity of enterprise architecture at Sharif University. The statistical community of this study was 100 laboratory specialists based on Morgan sample determination table CCM (Capacity Maturity Model), which was designed based on the Likert spectrum, was used as a questionnaire assessment tool. For data analysis, descriptive indicators such as frequency, percentage and one-sample t-test to compare the mean in SPSS software was used.
Results: Assessing the maturity of enterprise architecture including four areas of IT (Information Technology) planning and organization, IT development and implementation, IT service and support, and IT monitoring and evaluation. Among the various dimensions of enterprise architecture maturity, the lowest average was related to the field of monitoring and evaluation and the highest average was related to the field of service and support. Dimensions in terms of status were: service and support dimension, planning and organizing dimension, development and implementation dimension, monitoring and evaluation dimension, respectively. The test results were significantly different in the areas related to the maturity of enterprise architecture, including the planning and organization areas, development and implementation, service and support (P<0.0001). There was no significant difference in monitoring and evaluation.
Conclusion: The use of enterprise architecture specific to laboratory management systems causes the optimal use of resources and ease of interaction. Evaluation of the implementation of the proposed architectural framework in the laboratory environment showed that the proposed model has matured in the three areas of planning and organization, development and implementation, service and support. In order to improve the maturity of enterprise architecture, more attention should be paid to the field of monitoring and evaluation and the reform program should start from this field.
Leila Shahmoradi, Niloofar Kheradbin, Ahmad Reza Farzanehnejad, Niloofar Mohammadzadeh, Atefeh Ghanbari Jolfaei,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Identifying risk factors is recommended as the first step for depression management in children and adolescents. This study aims to determine the data elements required for developing a clinical decision support system for screening major depression in young people.
Materials and Methods: This research was a descriptive-analytical study. The research population included a variety of mental health specialists that were both psychologists and students in psychiatry and guidance & counseling majors as well as electronic databases including Scopus, Pubmed, Embase, PsychInfo, WOS and Clinical key. The data collection tool was a questionnaire designed in three main sections which was answered by a convenient sample of 8 people who were specialists in the field. To analyze the extracted data Content Validity Ratio (CVR) and Mean measures were calculated for each item in questionnaire. Content Validity Index (CVI) and Cronbach’s Alpha (using SPSS software) were calculated which were equal to 0.74 and 0.824 respectively which confirmed validity and reliability of the research tool.
Results: According to Lawshe’s table, data elements with CVR between 0 and 0.75 and Mean less than 1.5, like “Ethnicity and race” (CVR=-0.25, Mean=1.125), were rejected. Items such as “Gender” (CVR=0.5) with a CVR equal to or less than 0.75, as well as items with a CVR between 0 and 0.75 and a Mean equal to or more than 1.5, like “Marital status” (CVR=0.5, Mean=1.625) were retained and considered to be included as the minimum data set for screening major depression in ages 10 to 25 years. Data elements were categorized in three categories: Demographic, Clinical and Psychosocial
Conclusion: Clinical decision support systems can facilitate providing healthcare at different levels such as screening major depression. These systems can be used for screening major depression risk factors to improve accessibility to mental health practitioners, assure the implementation of guidelines and provide a common language between different levels of healthcare. Determining the minimum data set for screening major depression in ages 10 to 25 years, is the first step toward developing a clinical decision support system for screening individuals for major depression.
Materials and Methods: This research was a descriptive-analytical study. The research population included a variety of mental health specialists that were both psychologists and students in psychiatry and guidance & counseling majors as well as electronic databases including Scopus, Pubmed, Embase, PsychInfo, WOS and Clinical key. The data collection tool was a questionnaire designed in three main sections which was answered by a convenient sample of 8 people who were specialists in the field. To analyze the extracted data Content Validity Ratio (CVR) and Mean measures were calculated for each item in questionnaire. Content Validity Index (CVI) and Cronbach’s Alpha (using SPSS software) were calculated which were equal to 0.74 and 0.824 respectively which confirmed validity and reliability of the research tool.
Results: According to Lawshe’s table, data elements with CVR between 0 and 0.75 and Mean less than 1.5, like “Ethnicity and race” (CVR=-0.25, Mean=1.125), were rejected. Items such as “Gender” (CVR=0.5) with a CVR equal to or less than 0.75, as well as items with a CVR between 0 and 0.75 and a Mean equal to or more than 1.5, like “Marital status” (CVR=0.5, Mean=1.625) were retained and considered to be included as the minimum data set for screening major depression in ages 10 to 25 years. Data elements were categorized in three categories: Demographic, Clinical and Psychosocial
Conclusion: Clinical decision support systems can facilitate providing healthcare at different levels such as screening major depression. These systems can be used for screening major depression risk factors to improve accessibility to mental health practitioners, assure the implementation of guidelines and provide a common language between different levels of healthcare. Determining the minimum data set for screening major depression in ages 10 to 25 years, is the first step toward developing a clinical decision support system for screening individuals for major depression.
Mostafa Shanbehzadeh, Hadi Kazemi-Arpanahi, Raoof Nopour,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Breast cancer is one of the most common and aggressive malignancies in women. Timely diagnosis of breast cancer plays an important role in preventing the progression of this disease, timely treatment measures, and aftermath reducing the mortality rate of these patients. Machine learning has the potential ability to diagnose diseases quickly and cost-effectively. This study aims to design a CDSS based on the rules extracted from the decision tree algorithm with the best performance to diagnose breast cancer in a timely and effective manner.
Materials and Methods: The data of 597 suspected people with breast cancer (255 patients and 342 healthy people) were retrospectively extracted from the electronic database of Ayatollah Taleghani Hospital in Abadan city with 24 characteristics, mainly pertained to lifestyle and medical histories. After selecting the most important variables by using the Chi-square Pearson and one-way analysis of variance (P<0.05), the performance of selected data mining algorithms including RF, J-48, DS, RT and XG -Boost was evaluated for breast cancer diagnosis in Weka 3.4 software. Finally, the breast cancer diagnostic system was designed based on the best model and through C# programming language and Dot Net Framework V3.5.4.
Results: Fourteen variables including personal history of breast cancer, breast sampling, and chest X-ray, high blood pressure, increased LDL blood cholesterol, presence of mass in upper inner quadrant of the breast, hormone therapy with estrogen, hormone therapy with Estrogen-progesterone, family history of breast cancer, age, history of other cancers, waist-to-hip ratio and fruit and vegetable consumption showed a significant relationship with the output class at the P<0.05. Based on the results of the performance evaluation of selected algorithms, the RF model with sensitivity, specificity, accuracy, and F- measure equal to 0.97, 0.99, 0.98, 0.974, respectively, AUC=0.936 had higher performance than other selected algorithms and was suggested as the best model for breast cancer diagnosis.
Conclusion: It seems that using modifiable variables such as lifestyle and reproductive-hormonal characteristics as input to the RF algorithm to design the CDSS, can detect breast cancer cases with optimal accuracy. In addition, the proposed system can be effectively adapted in real clinical environments for quick and effective disease diagnosis.
Materials and Methods: The data of 597 suspected people with breast cancer (255 patients and 342 healthy people) were retrospectively extracted from the electronic database of Ayatollah Taleghani Hospital in Abadan city with 24 characteristics, mainly pertained to lifestyle and medical histories. After selecting the most important variables by using the Chi-square Pearson and one-way analysis of variance (P<0.05), the performance of selected data mining algorithms including RF, J-48, DS, RT and XG -Boost was evaluated for breast cancer diagnosis in Weka 3.4 software. Finally, the breast cancer diagnostic system was designed based on the best model and through C# programming language and Dot Net Framework V3.5.4.
Results: Fourteen variables including personal history of breast cancer, breast sampling, and chest X-ray, high blood pressure, increased LDL blood cholesterol, presence of mass in upper inner quadrant of the breast, hormone therapy with estrogen, hormone therapy with Estrogen-progesterone, family history of breast cancer, age, history of other cancers, waist-to-hip ratio and fruit and vegetable consumption showed a significant relationship with the output class at the P<0.05. Based on the results of the performance evaluation of selected algorithms, the RF model with sensitivity, specificity, accuracy, and F- measure equal to 0.97, 0.99, 0.98, 0.974, respectively, AUC=0.936 had higher performance than other selected algorithms and was suggested as the best model for breast cancer diagnosis.
Conclusion: It seems that using modifiable variables such as lifestyle and reproductive-hormonal characteristics as input to the RF algorithm to design the CDSS, can detect breast cancer cases with optimal accuracy. In addition, the proposed system can be effectively adapted in real clinical environments for quick and effective disease diagnosis.
Saman Mohammadpour, Reza Rabiei, Elham Shabahrami, Kamyar Fathisalari, Maryam Khakzad, Mostafa Langarizadeh,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Cancer is the second leading cause of death in the world, which leads to the death of more than 10 million people in the world every year. Its early diagnosis, management and proper treatment play an important role in reducing complications and mortality. One of the support tools in early diagnosis, treatment and management of this disease are Clinical Decision Support System (CDSS), which are divided into two groups, rule-based and non-rule-based. Rule-based decision support systems are created based on clinical guidelines, while non-rule-based decision support systems use machine learning. In this research, the effects of decision support systems, rule-based and non-rule-based, on cancer diagnosis, treatment and management were measured.
Materials and Methods: The present study was conducted using a systematic review method, which was conducted by searching the Web of Science, Scopus, IEEE and PubMED databases until 12/31/2021. After removing duplicates and evaluating the characteristics of the inclusion and exclusion criteria, studies related to the goal were selected. The selection of articles was based on the title, abstract and full text The data collection tool was the data extraction form, which included year of study, type of study, system of body, organ of body, the service provided by the decision support system, type of decision support system, effect, effect index and the score of effect index. Narrative synthesis were used for data analysis.
Results: Out of 768 articles, 16 articles related to the objectives of the study were identified. Studies were presented in two categories of clinical decision-support systems: Rule-based and non-Rule based. The effects evaluated in the clinical decision support systems were Rule-based, dose adjustment, symptoms, adherence to treatment guidelines, care time, smoking, need for chemotherapy and pain management, all of which except pain management were significant and positive. The effects evaluated were in the category of non-Rule based clinical decision support systems, diagnostic and therapeutic decisions, controlling neutropenia, all of which were significant and positive except controlling neutropenia.
Conclusion: The results obtained for the effectiveness of both Rule-based and non-Rule-based decision support systems indicated different benefits of these two categories. Therefore, using their combination in the field of cancer can bring very useful results.
Materials and Methods: The present study was conducted using a systematic review method, which was conducted by searching the Web of Science, Scopus, IEEE and PubMED databases until 12/31/2021. After removing duplicates and evaluating the characteristics of the inclusion and exclusion criteria, studies related to the goal were selected. The selection of articles was based on the title, abstract and full text The data collection tool was the data extraction form, which included year of study, type of study, system of body, organ of body, the service provided by the decision support system, type of decision support system, effect, effect index and the score of effect index. Narrative synthesis were used for data analysis.
Results: Out of 768 articles, 16 articles related to the objectives of the study were identified. Studies were presented in two categories of clinical decision-support systems: Rule-based and non-Rule based. The effects evaluated in the clinical decision support systems were Rule-based, dose adjustment, symptoms, adherence to treatment guidelines, care time, smoking, need for chemotherapy and pain management, all of which except pain management were significant and positive. The effects evaluated were in the category of non-Rule based clinical decision support systems, diagnostic and therapeutic decisions, controlling neutropenia, all of which were significant and positive except controlling neutropenia.
Conclusion: The results obtained for the effectiveness of both Rule-based and non-Rule-based decision support systems indicated different benefits of these two categories. Therefore, using their combination in the field of cancer can bring very useful results.
Reza Abbasi, Fatemeh Rangraz Jeddi, Shima Anvari, Reza Khajouei,
Volume 16, Issue 3 (8-2022)
Volume 16, Issue 3 (8-2022)
Abstract
Background and Aim: Hospital managers are one of the key decision-makers in the implementation of health information systems. This study aimed to determine the implementation challenges of health information systems based on the hospital managers’ perspective.
Materials and Methods: This descriptive-analytical study was conducted in 2019 on the hospital managers of three provinces (Kerman, Yazd, Sistan and Baluchestan). Data were collected using a self-administrated questionnaire. The face validity of this questionnaire was approved by experts in health informatics and health information management and its reliability was confirmed by Cronbach’s alpha (α=96.7%). Data were analyzed using SPSS. To investigate the relationship between the mean of each challenge with demographic variables, Pearson, Independent T-test, and ANOVA tests were used.
Results: In this study, the factors related to ignoring the hospital manager’s needs in system selection (1.333 out of 2 points), hardware purchase cost, insufficient user training to using the system (1.238), inadequate manpower and health informatics specialists (1.19), software purchase cost, insufficient financial resources (1.142), high cost of system launching, the lack of integration and interoperability among information systems, lack of support from health care professionals (1.047), and lack of management experience in choosing the best system (one out of 2) had the highest scores (out of 2 points). Also, personnel training costs to work with the system (-0.092) and Lack of improvement in work processes (-0.047) obtained the lowest scores. Data analysis showed that managers with clinical backgrounds considered financial and human challenges more important than non-clinical managers (P<0.031).
Conclusion: The hospital managers believed that financial, human, technical, managerial, and organizational factors are the most important challenges in implementing health information systems in Iran’s hospitals respectively. The health policy-makers and planners at large and small levels can address many of the challenges before implementing systems by focusing on identified priorities.
Materials and Methods: This descriptive-analytical study was conducted in 2019 on the hospital managers of three provinces (Kerman, Yazd, Sistan and Baluchestan). Data were collected using a self-administrated questionnaire. The face validity of this questionnaire was approved by experts in health informatics and health information management and its reliability was confirmed by Cronbach’s alpha (α=96.7%). Data were analyzed using SPSS. To investigate the relationship between the mean of each challenge with demographic variables, Pearson, Independent T-test, and ANOVA tests were used.
Results: In this study, the factors related to ignoring the hospital manager’s needs in system selection (1.333 out of 2 points), hardware purchase cost, insufficient user training to using the system (1.238), inadequate manpower and health informatics specialists (1.19), software purchase cost, insufficient financial resources (1.142), high cost of system launching, the lack of integration and interoperability among information systems, lack of support from health care professionals (1.047), and lack of management experience in choosing the best system (one out of 2) had the highest scores (out of 2 points). Also, personnel training costs to work with the system (-0.092) and Lack of improvement in work processes (-0.047) obtained the lowest scores. Data analysis showed that managers with clinical backgrounds considered financial and human challenges more important than non-clinical managers (P<0.031).
Conclusion: The hospital managers believed that financial, human, technical, managerial, and organizational factors are the most important challenges in implementing health information systems in Iran’s hospitals respectively. The health policy-makers and planners at large and small levels can address many of the challenges before implementing systems by focusing on identified priorities.
Manouchehr Karami, Payam Kabiri, Farzaneh Fazli, Nahid Ramezanghorbani,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: One of the most important challenges in the field of research information management is the use of reliable and qualified software to manage research resources in health domain. This study aimed to develop a validation tools for research information management systems in Iran to utilize by universities in the process of using existing research information management systems.
Materials and Methods: This was a descriptive study conducted in two stages. In the first stage, a validation tool for research information management systems (Pajoohan, Pajooheshyar, Jiro, Yektaweb, Kuiper) was designed, and in the next stage, in order to ensure the validity of the produced tool, a self-assessment survey was conducted by users of research information management systems in medical sciences universities. Therefore, this tool was completed by 104 researchers from all over the country. The collected data were analyzed by Excel and SPSS software.
Results: The developed validation tool of research information management systems included four components and 82 indicators: software design and architecture (17 indicators), usability and user environment (16 indicators), professional use (36 indicators) and management (13 indicators). Based on the self-declared results of the users, this tool has 57 mandatory features, 26 preferred and 4 optional features. The results of the validation of research information management systems based on this tool showed that the highest rank in the component of architecture, professional use and software management was related to the Kuiper system, and in the component of usability and user environment was related to the Pajoohan system. In the self-declaration done by the users ,12 cases of Jiro system ,11 cases of Kuiper system ,11 cases of Pajoohan system ,7 cases of Pajooheshyar, and 5 cases of Yektaweb system have received confirmation above 75%.
Conclusions: The validation tool which developed by this study can be used in the evaluation of current research information management systems and the selection of new systems for use in the research field. In addition, it can be used to improve current systems and purchase new systems by academic universities and research centers.
Materials and Methods: This was a descriptive study conducted in two stages. In the first stage, a validation tool for research information management systems (Pajoohan, Pajooheshyar, Jiro, Yektaweb, Kuiper) was designed, and in the next stage, in order to ensure the validity of the produced tool, a self-assessment survey was conducted by users of research information management systems in medical sciences universities. Therefore, this tool was completed by 104 researchers from all over the country. The collected data were analyzed by Excel and SPSS software.
Results: The developed validation tool of research information management systems included four components and 82 indicators: software design and architecture (17 indicators), usability and user environment (16 indicators), professional use (36 indicators) and management (13 indicators). Based on the self-declared results of the users, this tool has 57 mandatory features, 26 preferred and 4 optional features. The results of the validation of research information management systems based on this tool showed that the highest rank in the component of architecture, professional use and software management was related to the Kuiper system, and in the component of usability and user environment was related to the Pajoohan system. In the self-declaration done by the users ,12 cases of Jiro system ,11 cases of Kuiper system ,11 cases of Pajoohan system ,7 cases of Pajooheshyar, and 5 cases of Yektaweb system have received confirmation above 75%.
Conclusions: The validation tool which developed by this study can be used in the evaluation of current research information management systems and the selection of new systems for use in the research field. In addition, it can be used to improve current systems and purchase new systems by academic universities and research centers.
Ehsan Zarei, Kheyrollah Chavosh Sani, Mohammad Saadati, Soheila Khodakarim,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: In recent years, public trust in health system has been considered one of the performance evaluation indicators of health systems. However, most of the research on public trust in health system is related to developed countries, and research in this regard is limited in Iran. A better understanding of trust in health system and some influential factors helps to develop targeted interventions to increase trust. The present study was conducted to investigate the level of public trust in health system in Rasht County.
Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups.
Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P<0.05).
Conclusion: The results showed that despite people’s trust in the expertise and knowledge of physicians and other providers, public trust in health system was relatively moderate, indicating deficiencies in the health system’s performance. Focusing on physician-patient communication and improving communication skills, establishing electronic records and sharing patient information between health service providers, and respecting patient rights can build greater trust in the health system.
Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups.
Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P<0.05).
Conclusion: The results showed that despite people’s trust in the expertise and knowledge of physicians and other providers, public trust in health system was relatively moderate, indicating deficiencies in the health system’s performance. Focusing on physician-patient communication and improving communication skills, establishing electronic records and sharing patient information between health service providers, and respecting patient rights can build greater trust in the health system.
Ali Maleki, Marivan Noori, Rezvan Zomorodi, Fakhredin Saba,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Ami: Identifying the genotype of blood groups in different communities will give the decision makers of the health system to take the necessary measures to prevent and identify the possible side effects of blood transfusion, including the production of alloantibodies. Duffy blood group has increased the possibility of alloantibody production in beta-thalassemia major patients who regularly need blood transfusion due to different types of genotype with different prevalence. However, no study has been conducted regarding the frequency of Duffy blood group distribution in beta-thalassemia Kurd patients dependent on blood transfusion.
Materials and Methods: This case-control study was conducted on 100 patients with beta thalassemia major, as case group and 50 healthy individuals, as control group, in Bostan Clinic, Kermanshah University of Medical Sciences. After collecting peripheral blood samples from people participating in the study, DNA was extracted from peripheral blood mononuclear cells. Then, using PCR-RFLP and electrophoresis, Duffy genotypes including FYA/A, FYB/B and FYA/B were identified.
Results: The results of Chi-square test showed that in the patient group, there is no statistically significant difference between the two genders in terms of the frequency of distribution of Duffy genotypes (P=0.588). On the other hand, in the healthy group too, there was no statistically significant difference between the two sexes in terms of the frequency of distribution of Duffy genotypes (P=0.707). According to nominal regression results, although the distribution ratio rate (95% confidence interval) of FYA/FYA and FYB/FYB genotypes as compared to FYA/FYB genotype (reference category) in the patient group as compared to healthy people was 2.42 (0.7 to 8.34) and 0.76 (0.36 to 1.64) respectively, but there was no statistically significant difference between the case and control groups in terms of the distribution frequency of these genotypes (P<0.05).
Conclusion: The frequency distribution of Duffy genotypes in beta-thalassemia major patients is similar to that of healthy people, and there is no relationship between the distribution of Duffy genotypes and beta-thalassemia disease. FYB genotype has the highest frequency in both case and control groups
Materials and Methods: This case-control study was conducted on 100 patients with beta thalassemia major, as case group and 50 healthy individuals, as control group, in Bostan Clinic, Kermanshah University of Medical Sciences. After collecting peripheral blood samples from people participating in the study, DNA was extracted from peripheral blood mononuclear cells. Then, using PCR-RFLP and electrophoresis, Duffy genotypes including FYA/A, FYB/B and FYA/B were identified.
Results: The results of Chi-square test showed that in the patient group, there is no statistically significant difference between the two genders in terms of the frequency of distribution of Duffy genotypes (P=0.588). On the other hand, in the healthy group too, there was no statistically significant difference between the two sexes in terms of the frequency of distribution of Duffy genotypes (P=0.707). According to nominal regression results, although the distribution ratio rate (95% confidence interval) of FYA/FYA and FYB/FYB genotypes as compared to FYA/FYB genotype (reference category) in the patient group as compared to healthy people was 2.42 (0.7 to 8.34) and 0.76 (0.36 to 1.64) respectively, but there was no statistically significant difference between the case and control groups in terms of the distribution frequency of these genotypes (P<0.05).
Conclusion: The frequency distribution of Duffy genotypes in beta-thalassemia major patients is similar to that of healthy people, and there is no relationship between the distribution of Duffy genotypes and beta-thalassemia disease. FYB genotype has the highest frequency in both case and control groups
Ali Mohammad Mosadeghrad, Parvaneh Isfahani,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: Induced demand is the provision of healthcare services to patients by the influence of healthcare providers. Induced demand causes excessive use of health services, increases the waiting time for receiving health services, increases the price of health services, increases the costs and reduces the efficiency of the health system. Policymakers and health managers should take measures to reduce induced demand. Hence, they should understand the reasons for induced demand in the health system. Therefore, this research aimed to identify the reasons for induced demand in the health system.
Materials and Methods: This research was carried out using the scoping review method. All published articles and documents about the reasons for induced demand in the health system until June 21, 2023 were searched in nine databases and Google Scholar search engine. Finally, 38 articles were selected and reviewed. The data were analyzed by thematic analysis method and using MAXQDA10 software.
Results: Thirty-eight studies about the reasons of induced demand in the health system were published between 1974 and 2021. The number of researches in this area has been growing since 2011. Overall, 32 reasons for induced demand in the health system were identified and grouped into three categories: macro (health system), meso (health care organization) and micro (provider and receiver of health services). The most frequent reasons for healthcare induced demand in the literature include inappropriate policies, insufficient monitoring, inappropriate payment system, large number of physicians, lack of attention to clinical guidelines, financial motivation of healthcare providers, patient insurance coverage, unreasonable patients’ expectations, inappropriate price of health services, the complexity of the health service and patients’ inadequate medical knowledge.
Conclusion: Induced demand has negative effects on the health system and will lead to an increase in health costs, waste of health resources, a decrease in the efficiency of the health system, and finally, a decrease in people’s access to essential health services. Several factors at different levels of the health system lead to induced demand for health services. Therefore, interventions should be systematically applied at three levels of the health system, healthcare organizations, and providers and recipients of health services to prevent and reduce healthcare induced demand.
Materials and Methods: This research was carried out using the scoping review method. All published articles and documents about the reasons for induced demand in the health system until June 21, 2023 were searched in nine databases and Google Scholar search engine. Finally, 38 articles were selected and reviewed. The data were analyzed by thematic analysis method and using MAXQDA10 software.
Results: Thirty-eight studies about the reasons of induced demand in the health system were published between 1974 and 2021. The number of researches in this area has been growing since 2011. Overall, 32 reasons for induced demand in the health system were identified and grouped into three categories: macro (health system), meso (health care organization) and micro (provider and receiver of health services). The most frequent reasons for healthcare induced demand in the literature include inappropriate policies, insufficient monitoring, inappropriate payment system, large number of physicians, lack of attention to clinical guidelines, financial motivation of healthcare providers, patient insurance coverage, unreasonable patients’ expectations, inappropriate price of health services, the complexity of the health service and patients’ inadequate medical knowledge.
Conclusion: Induced demand has negative effects on the health system and will lead to an increase in health costs, waste of health resources, a decrease in the efficiency of the health system, and finally, a decrease in people’s access to essential health services. Several factors at different levels of the health system lead to induced demand for health services. Therefore, interventions should be systematically applied at three levels of the health system, healthcare organizations, and providers and recipients of health services to prevent and reduce healthcare induced demand.
Roya Balaghiinaloo, Alireza Noruzi, Mohammadreza Esmaeili Givi,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: It is not possible to provide health information services in health crises without a comprehensive understanding of these services and how to provide them due to the health crisis. Based on this, the aim of the current research was to obtain comprehensive information about the components of providing health information services in health crises.
Materials and Methods: The current research was conducted with a qualitative approach and a meta-combined method, using the seven-step method of Sandelowski and Barroso. The statistical population consisted of articles and theses published in persian and international databases between 1991 to 2022 AD and 1370 to 1400 solar. Out of a total of 8363 resources identified based on the critical skills assessment program, 40 resources were approved. Extracted information was coded and coding reliability was measured and confirmed using Kappa coefficient.
Results: From the results of the research, 74 codes were extracted in 21 concepts and 6 categories in the field of providing health information services to patients. which categories and codes include health information needs assessment (disease, health, health information sources, patients); accessibility and dissemination of health information (health information, access ways); Awareness and notification of health information (information, tools); Education (patients, managers and staff of hospital libraries, methods); Planning (health crisis, resources, budget, infrastructure, patients, librarians and Medical Information Specialists) and obstacles and limitations (expert force, budget, facilities and infrastructure and resources) were categorized.
Conclusion: Dealing with the issue and components of providing health information services to patients in health Disasters in hospital libraries can cause policymakers in this field to know more about the dimensions, concepts, and consequences of providing these services in order to provide access to health information for everyone, especially patients. According to the identified components, efforts can be made to prepare the necessary infrastructure in order to plan to strengthen the strengths and eliminate the existing weaknesses and make appropriate policies in order to play the role of health counseling and launch the health information service department in hospital libraries.
Materials and Methods: The current research was conducted with a qualitative approach and a meta-combined method, using the seven-step method of Sandelowski and Barroso. The statistical population consisted of articles and theses published in persian and international databases between 1991 to 2022 AD and 1370 to 1400 solar. Out of a total of 8363 resources identified based on the critical skills assessment program, 40 resources were approved. Extracted information was coded and coding reliability was measured and confirmed using Kappa coefficient.
Results: From the results of the research, 74 codes were extracted in 21 concepts and 6 categories in the field of providing health information services to patients. which categories and codes include health information needs assessment (disease, health, health information sources, patients); accessibility and dissemination of health information (health information, access ways); Awareness and notification of health information (information, tools); Education (patients, managers and staff of hospital libraries, methods); Planning (health crisis, resources, budget, infrastructure, patients, librarians and Medical Information Specialists) and obstacles and limitations (expert force, budget, facilities and infrastructure and resources) were categorized.
Conclusion: Dealing with the issue and components of providing health information services to patients in health Disasters in hospital libraries can cause policymakers in this field to know more about the dimensions, concepts, and consequences of providing these services in order to provide access to health information for everyone, especially patients. According to the identified components, efforts can be made to prepare the necessary infrastructure in order to plan to strengthen the strengths and eliminate the existing weaknesses and make appropriate policies in order to play the role of health counseling and launch the health information service department in hospital libraries.
Mohamad Jebraeily, Shima Touraj, Farid Khorrami,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: In the health system, reimbursement methods are an important criterion for the allocation of resources and the performance of service providers. The use of diagnosis-related groups (DRG) system reduces the length of stay and additional costs of the patient, prevents unnecessary treatment, increases resource efficiency and transparency of health care services. The development of the DRG system focuses on the accurate documentation of medical records and the correct coding of diagnoses and procedures. The purpose of this research is to evaluate the documentation and coding requirements of medical records in the implementation of a payment system based on diagnosis-related groups in Iran.
Materials and Methods: This research was descriptive-cross-sectional and was conducted in 2022. The data collection tool was a researcher-made checklist, the validity of which was confirmed based on the opinion of experts (health information management health economics) and its reliability was obtained by calculating Cronbach’s alpha (0.83). The research population consisted of 418 medical records in five medical training centers affiliated to Urmia University of Medical Sciences, which were selected through stratified-proportional sampling. Data were analyzed using SPSS software.
Results: The results of the evaluation of the documentation and coding requirements of medical records for the implementation of the DRG system showed that the demographic/administrative variables including age, sex, type of admission, length of stay, health insurance, and doctor’s expertise were completely recorded. Evaluation of clinical variables also showed that the main diagnosis, main procedure, secondary diagnosis and other procedures were documented in medical records in 98%, 97%, 88% and 75% respectively. Regarding the coding of the main diagnosis and the main procedure, 100%, secondary diagnosis 68% and other procedures 80% have been done.
Conclusion: Considering that some essential clinical variables for the implementation of DRG, especially co-morbidities, complications and other procedures are not recorded separately and completely, therefore it is necessary to define separate information elements in medical records and HIS for accurate recording of these variables and proper interaction between coders and doctors is established to increase the possibility of correct coding. It is also suggested that the DRG system be implemented in our country in a phased and gradual approach so that necessary changes are made in the documentation process and hospital information systems.
Materials and Methods: This research was descriptive-cross-sectional and was conducted in 2022. The data collection tool was a researcher-made checklist, the validity of which was confirmed based on the opinion of experts (health information management health economics) and its reliability was obtained by calculating Cronbach’s alpha (0.83). The research population consisted of 418 medical records in five medical training centers affiliated to Urmia University of Medical Sciences, which were selected through stratified-proportional sampling. Data were analyzed using SPSS software.
Results: The results of the evaluation of the documentation and coding requirements of medical records for the implementation of the DRG system showed that the demographic/administrative variables including age, sex, type of admission, length of stay, health insurance, and doctor’s expertise were completely recorded. Evaluation of clinical variables also showed that the main diagnosis, main procedure, secondary diagnosis and other procedures were documented in medical records in 98%, 97%, 88% and 75% respectively. Regarding the coding of the main diagnosis and the main procedure, 100%, secondary diagnosis 68% and other procedures 80% have been done.
Conclusion: Considering that some essential clinical variables for the implementation of DRG, especially co-morbidities, complications and other procedures are not recorded separately and completely, therefore it is necessary to define separate information elements in medical records and HIS for accurate recording of these variables and proper interaction between coders and doctors is established to increase the possibility of correct coding. It is also suggested that the DRG system be implemented in our country in a phased and gradual approach so that necessary changes are made in the documentation process and hospital information systems.
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