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سال یازدهم شماره 3 (پاییز 1391)

The first step of developing a proper model for delivering nursing care in hospitals will be identifying relevant components to apply a model. The aim of this study was identify relevant components to apply nursing care models in Shahid Beheshti University of Medical Sciences training hospitals. This study was a qualitative research which was conducted by using content analysis approach. Participants were 6 faculty members and nurse managers of Shahid Beheshti University of Medical Sciences selected by purposeful sampling frame. Data gathered via semistructured interviews and analyzed by thematic analysis. In this study, extracted themes included caring based on client satisfaction, nurse's knowledge and skills, importance of cooperative care, quantity and expertise of nurses, efficient supervision on nurse's performance, and strategies of health system in higher level. These themes were categorized in three dimensions including structure, process and outcome. Findings of this study would be used for developing a nursing care models in Shahid Beheshti University of Medical Sciences hospitals in future research.

Health service providers’ attitude profoundly influence quality of patient care and safety, and lead to increase effectiveness, cost controlling and decreasing complaint. This study aims to examine staff attitudes’ about patients’ safety culture in Noor & Ali Asghar hospitals in Isfahan province. The survey was a cross-sectional study and was done in 2011. Data were collected from all the staff groups in hospital (n=106). A standard questionnaire from Agency of Healthcare Research and Quality (AHRQ) with  =79% is used to evaluate staff attitudes’ toward different aspects of patients’ safety culture. This study used SPSS 16.0 to perform the statistical analysis. The response rate for the survey was 89%. The study revealed that 53.7% of the personnel were not reporting errors in 12 months before. Results showed that the average of staff attitudes’ scale toward patients’ safety culture was (64±5.28); the highest scale was belong to supervisor/ manager expectations & actions promoting patient safety (72.8±15.8) and the lowest one to handoffs & transitions (56.4±14.8). According to scale of staff attitudes about patients’ safety culture and its effect on service quality, doing reengineering of work environment, Patients’ Safety Initiatives including personnel collaborative, communication openness about error, designing of education plan and making error reporting should be recommended.

Regarding to the escalating costs of health care and limited resources in this field, the appropriate identification and control of costs is inevitable. This Study aimed to determine the unit cost of radiology services, in selected hospitals of TUMS.

This was a descriptive retrospective study. At first, we selected two hospitals (Shariati and Sina) out of general - teaching hospitals of TUMS randomly. After gathering data, using activity based costing method, the unit costs of radiography services in these centers in 1389 fiscal year (2010-2011) were calculated.

The unit costs of radiography services in Shariati and Sina hospitals were 251255,5 and 334996,2 respectively. Building rent and human resources costs included the most share of total costs.

The unit cost of radiography services in this study is very different comparing with other studies. Calculated building rent costs in this study could be one of the possible reasons of this difference (other studies did not consider this costs). The other point is that, regarding the high share of human resources and building costs from total costs, special attention to these sources of costs and appropriate and adequate use of them, can be an important step toward improving the efficiency and cost savings in our national health system.

Performance evaluation could provide information to managers that they need to evaluate and monitor of the current status and activities in hospitals. The PABON LASSO model was applied to evaluate performing of hospitals affiliated with Ahwaz Jundishapour University of Medical Sciences to produce the information that used by policy makers in their attempt to make more productivity health care system. This cross-sectional & descriptive study involved in 26 hospitals, with 3824 available beds. Data for this study extracted from computerized databases within statistical department of vice- chancellor for clinical affairs. This study used the PABON LASSO model combining with three major indicators of hospital performance named as average length of stay, bed occupancy rate, and bed turnover which analyzed in PABON LASSO model. The statistical software SPSS-13 used to derive three basic performance indicators. Based on 10 hospitals in Zone 3 of the model the satisfactory level of efficiency indicated. Results in 2 hospitals demonstrated the inefficiency and underutilization of resources by falling into Zone 1 and 7 hospitals in zone 2 and 7 hospitals placed in Zone 4. The overall average length of stay, bed occupancy and bed turnover rates were 3.57 days, 63.13% and 79.37 times respectively. The performance of hospitals affiliated with Ahwaz Jundishapour University of Medical Sciences was in a relatively desirable level. Future research should be focused on why and how this situation could be improved in the hospitals with low efficiency.

Health literacy is the degree to which individuals have the capacity to obtain, process, and understanding basic health information and services needed to make appropriate health decisions. The aim of this study was to assess relationship between health literacy and knowledge of women with type 2 diabetes.

In this cross sectional survey, 160 women with type 2 diabetes were selected by convenience sampling method. Data collected by using a STOHFLA standard questionnaire and knowledge was measured by self-administrated questionnaire. Obtained data analyzed by SPSS16 software in two categories of descriptive and inferential statistics (Chi-square and Pearson coefficient).

The mean age of studied population was 52.73±8.56 years old. The means of health literacy and knowledge was 40.57±15.87 and 21.52±2.94, respectively. There was a relation between occupation, education and family history with knowledge and health literacy score, and also between incomes with knowledge. There was reverse significant relation between age and disease duration with knowledge and health literacy.

Results indicated that patients did not have the appropriate knowledge in type 2 diabetes, as well as health literacy which was also moderate. These results confirmed the need to develop of education for improving and increasing the appropriate knowledge and health literacy among studied women.

People give you an idea about variety of behaviors when confronting diseases. Different factors such as age, sex, economic and social situations have effect on its. Recognition of these behaviors helps politicians to deliver better services. This study aimed to identify health seeking behaviors of Zoroastrian residing in Yazd province due to advanced number of them in comparison to the other provinces. This study is a cross sectional. The sample size was 196 cases which selected by using simple sampling method. The data was collected via the questionnaire, then data were analyzed by spss.11 software with two test of chi square and exact test of Fisher. The findings showed that 64.3% of the population was female whereas remaining 35.7% were male. 15.58% of participants were single, 76.5% married and the rest of them 7.7%) were widow. Data indicated that 4.1% of individuals were illiterate, 17.3% were high school, 51.3% had diploma, 23.5% had Bachelors degree and 3.6% had Masters Degree or Ph.D. 43.4% of studied population were unemployed and the rest of them (46.7%) were employed. 94.4% of participants had health insurance whereas 5.6% did not had uninsured card. The results showed that the following direct variables had relation with the following mentioned indirect variables; sex with the action during the period of being sick, Place of born with reasons of neglecting sickness, marital status with action during the period of being sick, educational status with action during the period of being sick and referring to practitioner in different stages if sickness and using consultation of different groups, occupational status with the first place to get medical treatment, economical status with reasons of neglecting sickness and completion of treatment period and having health insurance with action during the period of being sick and using consultation of different groups. Considering the fact that educational, occupational and economic status have relation with health seeking behaviors in individuals, developed in education and occupation status could be lead a chance to choose a better health behavior in people.

Insurance coverage has a tendency to alter the consumer and provider’s behavior. Moral hazard is a serious problem in all risk pooling systems, such as insurance and taxes-based financial systems that cause negative consequences as increased costs in the health system. Therefore we decide, at this review article, to discuss about moral hazard, in different classifications and effects on the insurance marketing and health system. This is a review article. Relevant materials selected from published articles, studies, and sites. The databases of Medline, Web of Science, Science Direct, Google Scholar, and Springer were explored to use the key words of moral hazard and health insurance. Insurance covered individuals, knowing that their health expenditures will be reimbursed by insurance in the time of illness, and their demand medical services are more than un insurance covered individuals. On the other hand the providers have financial incentive to provide unnecessary and excess medical services. Different types of moral hazard like as ex ante and ex post moral hazard; hidden information and hidden action moral hazard; provider and consumer moral hazard may arise due to insurance coverage. These lead to negative consequences such as consumption of unnecessary care services, alteration of consumption pattern for inefficient use of resources, welfare loss, and an increase in the health expenditures. Studying and controlling the effects of moral hazards seems necessary to prevent unwelcome outcomes as well as misallocation of financial resources.