Saeed Karimi; Kamal Gholipour; Peyman Mottaghi; Mohammad Hossein Yarmohammadian; Azad Shokri
Volume 12, Issue 3 , June 2015, , Pages 356-366
Abstract
Introduction: Quality of care from the perspective of patients is increasingly considered an important component of comprehensive chronic disease management and as instrument that use for evaluation of quality. This study aimed to assess of quality of delivered care among patients with rheumatoid ...
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Introduction: Quality of care from the perspective of patients is increasingly considered an important component of comprehensive chronic disease management and as instrument that use for evaluation of quality. This study aimed to assess of quality of delivered care among patients with rheumatoid arthritis based on a model of Comprehensive Quality Measurement in Health care (CQMH).Methods: A cross-sectional study was conducted with 170 people with rheumatoid arthritis who were received care from specialist clinics of Isfahan University of medical sciences in 2013. Validity of The study questionnaires were reviewed and confirmed by 8 specialist in rheumatology and research and there reliability was confirmed according to Cronbach's alpha index (Service Quality (SQ); α = 0.721, Technical Quality (TQ); α = 0.766, Costumer Quality (CQ); α = 0.803). Final scores for each dimension were referred on a 0-100 scale with high values indicating better quality. Data analyzed using the SPSS-19 statistical package. Independent Samples Test, ANOVA Tests were conducted to compare CQ, SQ, TQ and QI score between categorical variables.Results: The average Quality Index was 72.70 of a 0-100 scale and average SQ, TQ, CQ score were 79.09, 68.54, and 70.25 respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there was a significant gap between what Rheumatoid Arthritis (RA) care they received and what was recommended in the guideline for TQ and the concept of service quality was poorly developed in many cases, specifically "availability of support group" that was the lowest scores.Conclusion: According to the present study quality of care the patient’s perspective was low, thus its need to pay attention to patient partnership and empowering them to manage their condition. Also there are need to Promote compliance and establish association of rheumatology patients.
Farokh Mojahed; Reza-Gholi Vahidi; Mohammad Asgari Jafarabadi; kamal Gholipoor; Naser Mehri
Volume 12, Issue 1 , May 2015, , Pages 88-98
Abstract
Introduction: payment systems can be an important tool in health policy. We evaluate the impact of different methods of payment (capitation, salary, fee for service payment) on the performance indicators of family physicians. The study aim is to identification and making priorities of family physician ...
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Introduction: payment systems can be an important tool in health policy. We evaluate the impact of different methods of payment (capitation, salary, fee for service payment) on the performance indicators of family physicians. The study aim is to identification and making priorities of family physician performance indicators to select an appropriate payment mechanism.Methods: this study used mixed methodology. There, several and different tools are used to gather data at any stage. Literature review has been done to identify Family physician performance indicators, in addition to literature review, expert panel also used and to prioritize performance indicator, payment mechanisms based on performance indicators and to choose best payment, AHP technique has been used. The data were analyzed by Excel 2007 and Expert choice 11 software's.Results: Of the 63 family physician performance indicators, the expert panel members achieved positive consensus on 10 performance indicator. With inconsistent of 0.08, Cost, preventive care and health promotion rate, patient satisfaction, physician satisfaction, referral rate, quantity, physician retention in underserviced area have been choose to be the most key performance indicators. in prioritization of payment mechanisms due to performance indicators, capitation method with inconsistency ratio of 0.04 was selected to be the best model.
Jafar Sadegh Tabrizi; Kamal Gholipour; Mohammad Asghari Jafarabadi; Mojtaba Mohammad Zadeh; Mostafa Farahbakhsh
Volume 10, Issue 1 , May 2014, , Pages 128-137
Abstract
Introduction: Evaluation is a suitable way to improve the healthcare quality. At the other hand, qualityand validity of information is an important factor in this process. The aim of this study was to assessadjustment and agreement between medical records data and pregnant women reported healthcare data ...
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Introduction: Evaluation is a suitable way to improve the healthcare quality. At the other hand, qualityand validity of information is an important factor in this process. The aim of this study was to assessadjustment and agreement between medical records data and pregnant women reported healthcare data inprenatal maternity care.Methods: A cross-sectional study was conducted on 185 pregnant women who were selected randomlyand received maternity care from 40 urban health centers and health posts in Tabriz, Iran. Technicalquality data were obtained from two different sources medical record and pregnant women reported data.Questionnaire’s content validity was reviewed and confirmed by 10 experts and its reliability wasconfirmed based on Cronbach's alpha (α = 0.748). Weighted Kappa and ICC (intra-class correlationcoefficient) were used to analyze each item. Data were analyzed using the STATA ver.10 and SPSSver.17 statistical packages.Results: There was a weak agreement between the two data sources. Only in some services there was amoderate agreement such as number of care (Kappa = 0.56), blood pressure and weight measurement(Kappa = 0.55). In registration time to health center (P = 0.95, 95%CI 0.931-0.962) and awareness ofpregnancy (P = 0.87, 95%CI 0.824-0.903) there was a strong agreement between medical document andcustomers reported data.Conclusion: For some services such as pregnancy education, it is preferred to use pregnant womenreported data, because such data are a form of output assessment. Furthermore, due to a defect in therecording services, customers’ reported data were more valid than the health records.
Mohammad Hossein Yarmohammadian; Farrokh Mojahed; Reza Gholi Vahidi; Kamal Gholipour; Azad Shokri; Vahid Rasi
Volume 9, Issue 7 , December 2012, , Pages 1006-1016
Abstract
Introduction: Discharge against medical advice (DAMA) may expose patients to an increased risk ofadverse medical outcomes. We conducted an intervention based on the factors associated with dischargeagainst medical advice for reducing DAMA.Methods: This was a pretest-posttest intervention conducted in ...
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Introduction: Discharge against medical advice (DAMA) may expose patients to an increased risk ofadverse medical outcomes. We conducted an intervention based on the factors associated with dischargeagainst medical advice for reducing DAMA.Methods: This was a pretest-posttest intervention conducted in Dr. Soulati Hospital in Urmia, Iran, in2011-2012. We analyzed the data extracted from the clinical governance office forms about self-discharge.After determining causes of discharge against medical advice (DAMA) according to data in 2011, wedesigned an intervention in clinical governance team to reduce the rate of self-discharges. Interventions likeeffective relationship among physician and patient, financial support in DAMA cases, and assessing patients’decision-making capacity were designed. Four months after implementing, we analyzed self-dischargesprevalence rate and result was compared with the previous year. Data were analyzed using the Excelsoftware and information presented by descriptive statistics.Results: The rate of DAMA in the study hospital was found to be 4.6% which decreased to 2.8 percent ofall the discharged patients 4 months after the intervention. Among patients who discharged againstmedical advice in this study, family or financial obstacle, patient’s healthy feeling, dissatisfaction withtheir care, dislike of the hospital environment, prolonged hospitalization, and patient judgment ofimprovement were the most important factor for their decision.Conclusion: Discharge against medical advice comes from many factors and information about thereasons for DAMA is necessary for identifying implementable strategies to reduce the likelihood andadverse health consequences of DAMA. Enhancement of doctor-patient communication, improvement ofhospital environment and social workers could reduce the DAMA rate. The need for a clearly documentedsystem or guidelines for assessing and managing such patients is highlighted.
