ABSTRACT
Background@#Accreditation is an approach toward quality improvement which has been increasingly implemented in healthcare. This study aimed at developing a national functional accreditation model for primary healthcare with emphasis on family practice in Iran. @*Methods@#This mixed-method study utilizes a set of research methods purposefully. Initially, the reference models were used for benchmarking accreditation standards through a systematic review. Then, the primary accreditation standards were developed and then they were assessed and approved by the experts of the field via Delphi technique. In the following and after developing essential parts of the standards, the necessary changes in developed model were done according to the pilot test results. @*Results@#The results of systematic review suggested the superiority of accreditation models of the United States, Australia, Canada, and the United Kingdom globally; and the models of Jordan, Saudi Arabia, Lebanon, and Egypt in Eastern-Mediterranean region. Then, the primary standards including 39 functional standards with 231 measures were developed according to the benchmarked models, and were approved by the experts in Delphi-based study. In pilot test step, the compliance rate of developed standards by primary healthcare centers was calculated 61.61% and 26.37% for self-evaluation and external evaluation phases, respectively. @*Conclusion@#Regarding the comprehensiveness of developed accreditation model due to its focus on all functional dimensions and the consensus over the developed standards by the experts, it can be an underlying ground for the establishment and evaluation of functional improvement programs in Iranian primary healthcare system.
ABSTRACT
Background@#Accreditation is an approach toward quality improvement which has been increasingly implemented in healthcare. This study aimed at developing a national functional accreditation model for primary healthcare with emphasis on family practice in Iran. @*Methods@#This mixed-method study utilizes a set of research methods purposefully. Initially, the reference models were used for benchmarking accreditation standards through a systematic review. Then, the primary accreditation standards were developed and then they were assessed and approved by the experts of the field via Delphi technique. In the following and after developing essential parts of the standards, the necessary changes in developed model were done according to the pilot test results. @*Results@#The results of systematic review suggested the superiority of accreditation models of the United States, Australia, Canada, and the United Kingdom globally; and the models of Jordan, Saudi Arabia, Lebanon, and Egypt in Eastern-Mediterranean region. Then, the primary standards including 39 functional standards with 231 measures were developed according to the benchmarked models, and were approved by the experts in Delphi-based study. In pilot test step, the compliance rate of developed standards by primary healthcare centers was calculated 61.61% and 26.37% for self-evaluation and external evaluation phases, respectively. @*Conclusion@#Regarding the comprehensiveness of developed accreditation model due to its focus on all functional dimensions and the consensus over the developed standards by the experts, it can be an underlying ground for the establishment and evaluation of functional improvement programs in Iranian primary healthcare system.
ABSTRACT
Objectives: To validate the triage ratings performed by the Electronic Triage System [ETS] using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures
Methods: In this retrospective cross-sectional study the medical records of 387 patients were reviewed in a one-week period. The data included triage category and the outcome measures were hospitalization, length of stay, in-hospital mortality, patient bill, and used resources. The association between the triage category and hospitalization and death was assessed. The association between the triage category and the number of resources, length of stay, and the bill was also assessed
Results: The mean age of the patients was 43.65+/-21.17 years. Women comprised 40% [n=155] of 387 people who were included in the study. The frequency of Emergency Severity Index [ESI] 1, 2, 3, 4 and 5 categories were 18, 61, 127, 181 and 0 respectively. Phi and Cramer's V for hospitalization and death were 0.365 [p<0.001] and 0.305 [p<0.001]
Spearman's rho for bill, length of stay, and resource use were -0.483 [p<0.001], -0.228 [p<0.001] and -0.490 [p<0.001]
The association between triage category and resource consumption was stronger than other outcomes
Conclusion: The ETS was valid in predicting all studied patient outcomes. The ETS has also the advantages of providing quick reports, giving feedback and providing data for research purposes?
ABSTRACT
Objective: To examine the inter-rater reliability of triages performed by the Electronic Triage System [ETS] which has recently developed and used in hospital emergency department [ED]
Methods: This cross-sectional study was conducted prospectively and studied 408 visitors of Tabriz Imam Reza hospital's ED. The variables of interest were age, sex, nurse-assigned triage category, physician-assigned triage category, disease type [trauma, non-trauma], and the referred room within the ED. Cohen's un-weighted kappa, linear weighted kappa, and quadratic weighted kappa were used to describe the reliability
Results: Un-weighted kappa observed to be 0.186 [95% CI: 0.123-0.249]. Linear weighted kappa observed as 0.317 [95% CI: 0.251-0.384] and quadratic weighted kappa as 0.462 [95% CI: 0.336-0.589]. In general, low agreement was seen between the triage nurses and ED physicians. For trauma patients and for those who were referred to the cardiopulmonary resuscitation room [CPR], all three types of kappa were higher than other visitors of the ED
Conclusion: Inter-rater reliability of the triages performed by the ETS observed as ranging from poor to moderate. Implementing interventions that would create a common language between nurses and physicians about the triage of the ED visitors seems necessary. The more agreement on the triage of trauma and CPR patients might be due to their condition and the more attention to them
ABSTRACT
Smoking is the cause for many preventable deaths worldwide. The rate of smoking has not increased in Iran in the past two decades, but its increase among adolescents and young adults is a concern. This study investigates the risk factors of initiation and continuation of smoking in Iran using a qualitative approach. This is a qualitative content analysis study conducted on 12 smokers and 6 non-smokers in 4 selected cities in Iran. Data were collected with deep and semi-structured interviews, verbatim transcription and simultaneously coding. Then, they were analyzed through content analysis. Three themes and 16 subcategories emerged. The themes were personal inefficacy with 6 subgroups included inadequate information, low age, curiosity, consideration of smoking not as a major problem, wrong beliefs, and making reasons. Family inefficacy with 4 subgroups included poor authority, lack of reaction, existence of stressors, and history of smoking. Vulnerable social environment with 6 subgroups included poverty, social stressors, magnification of smoking, network of cigarette smoking, smoking as a norm and convenience of access. Recognition of smoking among children, modification of wrong beliefs about smoking, empowerment of the individuals against smoking from the very childhood, consideration of familial stress and crisis, and ultimately, paying attention to the role of social variables will play a major role in prevention of smoking and encouraging individuals to quit smoking
Subject(s)
Humans , Male , Female , Qualitative ResearchABSTRACT
The primary health care has notable effects on community health and accreditation is one of the appropriate evaluation methods that led to health system performance improvement, therefore, this study aims to developing of national accreditation model for rural health centers in Iran Health System. Firstly the suitable accreditation models selected to benchmarking worldwide via systematic review, the related books and medical university's web site surveyed and some interviews hold with experts. Then the obtain standards surveyed from the experts' perspectives via Delphi technique. Finally, the obtainedmodel assessedvia the experts' perspective and pilot study. The researchers identified JCAHO and CCHSA as the most excellent models. The obtained standards and their quality accepted from experts' perspective and pilot study, and finally the number of 55 standards acquired. The designed model has standards with acceptable quality and quantity, and researchers' hopeful that its application in rural health centers led to continues quality improvement