مجله تحقیقات نظام سلامت حکیم
سال هفدهم شماره 2 (پیاپی 65، تابستان 1393)

The p hilosophy of creating Boards of Trustees of Universities (BTU) has been to provide a law making reference at the top of organizational hierarchy of higher education institutes in order to administrate and supervise all affairs (education، research and services). Considering Iran''s Vision 2025، performance of this important system should be harmonized and improved based on the upstream documents'' objectives. This descriptive study was conducted on members and responsible individuals of the secretariats of the BTUs. Data were gathered on the areas of the BTU challenges and improving approaches using a self-written questionnaire. Problems and improving approaches of the secretariats of the BTUs were also collected through running several focus group discussion sessions with responsible individuals. Satisfaction of the respondent BTU members were high on the following issues: implementing the decisions made by the BTUs، current composition of the BTUs stipulated in the Act، members selection of the BTUs، supervisory mechanism of the Ministry of Health and Medical Education (MOHME) on medical universities، BTUs'' current structure (secretariat، experts، working processes) and all the powers delegated to the BTUs based on the Act and Article 49 of the Fourth Development Plan. Satisfaction rate of the BTU performance regarding collection of donation from private sector and people contribution was low. Members believed that the current composition of the BTUs should be complemented by representatives of the faculties and people. Main context of the BTUs including financial and trading issues should be placed with «policy making، observatory and high supervision on the university objectives». Executive secretariats with regularity، effective system and competent human resources should be established in the universities. MOHME believes in university autonomy genuinely and give priority to empowerment of the BTU members and try to apply this idea by creating expert and consultancy system in the headquarters of the MOHME and running objective training courses for them. Establishing incentives، competitive policies، and monitoring systems among the BTUs of the universities will improved their performances in short-term.

Infant mortality rate is a main community health assessment indicator. This study aimed to identify risk factors of infant mortality rate in Shahroud in the North Eastern of Iran. In this case-control study، 117 cases of infant deaths were identified and selected in the study. For each case، two controls were entered the study، matching on time and place of birth (234 controls). Data were gathered for all related variables and were analyzed using univariate and multivariate conditional logistic regression for estimation of crude and adjusted odds ratios. Based on the univariate analysis، there were significant statistical associations (P<0. 05) between infant mortality and low birth weight (<2500 g) (OR=15. 14)، prematurity (<37 weeks of gestational age) (OR=9. 85)، and high risk pregnancy (OR=3. 13). Multivariate analysis showed significant statistical associations (P<0. 05) between infant mortality and low birth weight (OR=8. 04) and prematurity (OR=3. 51). According to our findings، low birth weight and prematurity were the most important risk factors of infant mortality.

Behvarzes are at the first contact level of delivering health services in rural areas of Iran. The objective of this study was to investigate viewpoints of Behvarzes on their ability in delivering health services. In t his cross-sectional survey، 2500 male and female Behvarzes were selected through multi-stage random sampling. Data were gathered through a valid and reliable questionnaire (α= 0. 97). The questionnaire included 104 variables categorized into two areas including demographic، local service delivery unit variables and topics of training materials. Data were analyzed using the t-student and Chi-squared test in the SPSS. Mean age was 35 ± 6. 7 in the female Behvarzes and 39. 1± 7. 4 in the male behvarzes. More than half (62%) of the participants were living in the rural areas; and 68% had a high school diploma degree (12 years of education). The ability of working with computer and software was weak in 95% of the Behvarzes. The skills in the 34% of the areas were reported as excellent and in 65% of the areas were reported as mid-level by the Behvarzes. The viewpoints of the Behvarzes on their ability to deliver health services could help to provide new approaches in Behvarzes trainings. Improving quality of the training workshops via changes in the content of the curriculum will positively affect more than 32000 Behvarzes working in halth system in Iran. Conducting regional and local needs assessments is suggested to improve plans of action.

The aim of this two-phase study was to develop standards for stewardship of oral health system of Iran and to evaluate the current attainments regarding them. Based on the modified RAND-UCLA method، a comprehensive review of related electronic databases and the official web-site of international organizations، effective policy statements related to stewardship components were selected. Standards were categorized according to the six sub-functions of stewardship including generating and disseminating intelligence; defining strategic policy direction; ensuring alignment of policy objectives and organizational structure، regulation; exerting influence over all related sectors via inter-sectoral leadership and ensuring accountability. Then the level of relevancy and importance of standards were assessed using the experts’ opinions. In phase two، using the finalized list of standards، semi-structured interviews with key stakeholders in oral health system at different levels of policymaking were conducted and the stewardship of oral health system was critically evaluated. The results of regulation sub-function are presented in this study. From 38 finalized standards appropriate for evaluating the stewardship of oral health system according to the opinion of experts، 18 were related to regulation. Most of the standards rejected were included in dental health insurance regulation. Evaluation of this sub-function determined that currently there are deficiencies in meeting regulations concerned with evaluating the safety and cost effectiveness of dental materials، and quality of provided dental care to patients. Also it was shown that implementation of penalties and sanctions commensurate with instances of malpractice at individual and institutions were not completed attained. Regulations such as water fluoridation، property rights and regulations to ensure the basic conditions of market exchanges were either absent or only partially implemented. There were also some weaknesses in regulations concerning the supply of dentists، especially their distribution. The fields that currently had some regulations، were those in relating to labeling on products used in dentistry and covering the needs of disadvantaged populations. While the Ministry of Health and Medical Education has achieved some stewardship measures in the field of regulation، there are some problems in enforcing the regulatory framework especially in the private sector.

An overview of the statistics published by various international organizations in various fields of health risk assessment، shows that medical errors (errors in diagnosis، prescription، treatment)، and system management in hospitals and medical centers have important roles in imposition of high costs and increasing rates of injury and death in the world. Heart disease، as the leading cause of death in industrialized countries and the second leading cause of death in Iran has always been a controversial topic for researchers in the treatment area. Due to the potential risk of this area، the occurrence of any error even small errors is a big risk that could ultimately endanger patients'' lives and incur costs to patients and hospitals. This paper attempted to identify، classify and evaluate the failures in open heart surgery using Healthcare Failure Mode and effect analysis (HFMEA) technique and present some solutions in order to control and reduce these failures. U sing the HFMEA، the open heart surgery process was reviewed and four processes، 22 sub-processes، and 82 activities، and 160 risks for these activities were extracted. Besides، the reasons of failures were determined and four failure modes were identified as the most important ones using qualitative and quantitative analysis and solutions were presented for them. Incomplete visit and injury of the saphenous nerve were extracted as the failure modes occurred due to inattention of examiner and incomplete examination and similarity of saphenous nerve and vessel causes injury of the saphenous. Tariff changes and the maneuvers of the second evaluator were proposed strategies to reduce failures mentioned before. Also wrong adaption of coronary with angiography and wrong estimation of the vessels length were two other identified failure modes. The lack of accurate angiography interpretation and carelessness of the surgeon and surgeon assisting in measuring the vessel’s length were the root causes of failures، respectively. Solutions such as performing angiography in multiple views and in a three-dimensional way (3D)، and also measuring the length of vessel using angiography were suggested solutions to reduce these failures. In open-heart surgery، such as inaccurate documentation، inadequate patient justification and lack of modern facilities to identify the precise and explicit situation seems obvious factors.

Hospitals are the most important healthcare organizations. The aim of the present study was to develop a questionnaire for assessing outpatients’ satisfaction in hospitals of Tehran University of Medical Sciences. In this cross-sectional study، we selected 400 outpatients admitted to the hospitals of Tehran University of Medical Sciences. The preliminary items were gathered using a systematic review of the related literature. Data were analyzed using the correlation matrix، t-test، ANOVAs and confirmatory factor analysis. Totally، 66. 2% of the outpatients were satisfied with the clinics’ healthcare services. The Cronbach’s alpha was calculated as 0. 81. According to the component matrix، the most loads (0. 148، 0. 147) were related to recommendation of the clinics to others، and total satisfaction with clinics’ healthcare services (item 12 and 14). Furthermore، the least load (0. 05) was related to satisfaction with the waiting time (item 2). There was a statistically significant correlation between the outpatients’ satisfaction and other factors including gender، type of hospital، education، age and employment. The findings of the present study can help to identify weaknesses، threats، strengths and opportunities in providing healthcare services in hospitals.

Achieving the policy goals is a main challenge for policymakers in every country. Given the importance of health policies، policy making processes become very important. Success in policymaking in health sector requires an accurate analysis of all policy options and influential factors on policy outcomes. Knowledge of various approaches and methods of policy analysis is an important step for a successful policy analysis. In this study، we explored the roles، approaches and methods of policy analysis، especially in the health sector. In this review study، we searched local and international databases of published research using related keywords. We also reviewed referensecs of the collected resources. Finally، we read 84 papers and books for this review. Policy analysis includes a broad area and involves studying the content of policy، policy adoption، formulation، implementation and policy outcomes. There are different frameworks، approaches and methods for policy analysis which can be used based on the disciplinary framework، goals and objectives of analysis. Using approaches and methods of policy analysis helps a better understanding of the elements of a policy. Policy analysis is useful to better understand the policy process and provide related policy evidence for problems and policy changes. We provide a summary of these approaches and frameworks in this paper. Applying appropriate frameworks، approaches or methods of policy analysis is important in better understanding of the policy and problems. Proper policy analysis can help policy researchers in understanding of health policy outcomes.

Air pollution may affect health through increasing respiratory and cardiovascular morbidities and mortalities. In this study، we investigated the correlation between the concentration of the PM2. 5 and lung cancer in Tehran. In this study، the MODIS images were used to estimate the concentration of the PM2. 5 in air. Using statistical regression methods، the relationship between air pollution and the residential areas of individuals with lung cancer have been assessed. There was a positive correlation between the increases of particulate matter smaller than 2. 5 micrometers in the air and increase in the index relative individuals affected by the lung cancer in different parts of Tehran. The value of this correlation was 65% (R2=0. 43) which means that living in the more pollutant areas may increase the risk lung cancer (relative risk coefficient=1. 32). A weak positive correlation was found between the PM2. 5 concentration and lung cancer. We did not take into account the other correlates of the disease. Producing daily maps of pollution distribution in Tehran and highlighting the critical points may provide an alarm for people and the official administrative agents.

Participation of people and local organizations can be achieved by activities of the Board of Trustees and health volunteers. This study was conducted to evaluate the participation rate of local organizations in health centers performing rural insurance and family physician program in the Northern provinces of Iran. This cross-sectional study was conducted during the second half of 2012. Twenty five per cent of health centers performing family physician program in three provinces of Golestan، Mazandaran، and Gillan (139 centers out of 552 ones) were selected randomly from certain clusters of the study. In each selected center، participation rate of local organizations were evaluated. A validity and reliable researcher-made questionnaire was used for data gathering. Data were analyzed in the SPSS-18 with significant level of p<0. 05. Fifty seven health centers out of 139 ones (41%) had established a Board of Trustees. The Board of Trustees establishment was more in the Northern provinces (p=0. 001). In 61 health centers (43. 9%)، health volunteers were employed with a more significant employment rate in the Northern provinces (p=0. 001). The mean request rate of health homes and health centers from local organizations to take part in health problem solving were 2. 7 ± 1. 6 and 1. 7 ± 1. 3 times، respectively. The request rate for providing resources and facilities in performing health interventions were 1. 8 ± 1. 3 and 1. 1 ± 1. 0 times، respectively; and the request rate for participation in formal meetings were 3. 1 ± 1. 7 and 1. 9 ± 1. 3، respectively. The request rates of health homes for providing resources and participation in formal meetings were significantly different in the provinces (p=0. 009 and p=0. 005، respectively). This study showed that a large number of health centers did not follow community participation measurements. Interventional programs should be planned and conducted to improve community participation in health centers.