Does intradisciplinary conflict influence to outcomes of emergency medicine residency program? a mixed methods study

Objective: to explore impact of emergency medicine residency program on patient waiting times in emergency department [ED] and determine the associated factors

Methods: a two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach

Results: the most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time [p<0.0001], which increased [instead of reducing], and the average time interval between physician start time and first treatment measure [p<0.0001], which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits

Conclusion: this study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED

[ impact of family physician program on health indicators in Iran [2003-2007]]

Objective[s]: Family Physician" program has been launched since 2005 as a fundamental health plan in Iran. In spite of valuable information gathered through vital horoscope, only a few studies have been done in order to evaluate the performance of this program. So this research has been carried out to assess the impact of this program on heath indicators

Methods and Results: The research involved collecting data about 11 main health indicators extracted from the official annual report of the deputy for health from 2001 to 2006 and analyzing them through t- paired test in SPSS. Statistical analysis shows that the changes in 6 main indicators during these years including infant mortality rate [IMR], crude birth rate, under-5 mortality rate [U5MR], neonatal mortality rate [NMR], maternal mortality rate [MMR], and percentage of deliveries attended by unskilled persons were significant [P<0.05] and all of the above indicators have decreased during these years . Although other 5 indicators such as crude death rate [CDR], general fertility rate, percentage of deliveries in hospitals ,percentage of family planning coverage and still birth rate had an appropriate improvement during these years, their changes were not statistically significant [P>0.05]

Conclusion: Findings indicates that there is an acceptable improvement in many of the health indicators since starting this program. But this does not mean that the other factors that might have affect on these indicators should not be considered

[Information criteria for basic health insurance package in Iran from health insurance organization's view]

Neglecting to define important criteria in developing a basic health insurance package and to notice their real roles will result in defining a package which is politically unacceptable, non-economical, technically inefficient or mixed of them. Therefore development of basic health insurance package should be according to appropriate composition of influential criteria. This study was carried out to determining Information Criteria to define basic health insurance package and their importance. The study was qualitative, descriptive, and cross-sectional, conducted in 2008. At the first stage 20 health insurance experts and involved people were interviewed. At the second stage the notified criteria in these interviews in addition to other criteria, revealed from conceptual study were viewed by experts of Iranian basic health insurance companies [52 people]. The first stage data were analyzed in Atlas-Ti and the second stage data were analyzed in SPSS. The revealed criteria from the first stage were classified as 32 criteria in six groups. Iranian health insurance experts believed that most important factors involved in defining Iranian basic health insurance package were applicability, the view of politic individuals and groups, interventions cost, and patients' membership in vulnerable patient groups. The study participants indicated cost-effectiveness of services, effectiveness of services, quality of evidence, and equity as the main factors by which the basic health insurance package can be defined appropriately. According to results the current influence of some criteria such as the view of politic individuals and groups, and vulnerable patient groups were much more than their appropriate influence in defining Iranian basic health insurance package. Also some criteria like cost- effectiveness, quality of evidence, long-term sustainability, and safety of manipulations were focused less than what was appropriate for defining the package. According to the results of this study it is suggested that for defining basic health insurance package more appropriately, cost-effectiveness studies should be facilitated and the results of such studies should replace such criteria like the influence of different groups in defining basic health insurance package

comparative study on community-based disaster management [CBDM] in selected countries and proposing a model for Iran

To compare CBDM in various selected countries in order to design a model for Iran. A descriptive-comparative study was conducted in six steps in which few countries have been chosen based on their contribution to issues such as policy making, planning, coordination, and control. The related information then was assessed. The results show that in order to achieve a successful disaster management, there is a need for the participation of the community in various disaster management cycle, although the type of this contribution may differ according to the characteristics of each specific country. This paper proposes a model emphasizing on contribution of community in the local level in the villages and neighborhood areas

[Preparation aspects of supplies provision encounter disasters in selected hospitals of Iran university of medical sciences]

One of the most important problems in health care centers, especially hospitals encounter disasters, is incorrect planning to hospital preparation which would cause imbalance between needs and accessible resources that face hazard in provision quality of medical services. This was a descriptive study in which the educational hospitals of Iran University of Medical Sciences were assessed. A checklist was completed for each hospital by observation and interview with different persons according to case [hospital manager, matron, secretary of disaster board, and...]. The data was analyzed descriptively SPSS software. In planning perspective of supplies, Navab and Haftometir hospitals earned the highest score mean percent [66.6] and Hasheminezhad, Shafayahyaeian, Rasoul and Firozgar hospitals earned the lowest score mean percent [60.0]. The organizations that do not prepare for crisis, do not characterize organizational structures during and after disaster, do not form responsiveness teams, and do not plan for securing and storing of materials and supplies, etc encounter irreparable financial and life loss. Also regard to deficiency supplies in surveyed hospitals, developing a stress plan is necessary in order to effectiveness use of available resources and prevention part of resources

[Knowledge management of emergency department in Rasul Akram hospital based on Baldrige Excellence Model in 2007]

Baldrige model is the most important performance measurement system in world class. The forth criterion of this model is measurement, analysis, and knowledge management in health care. This was a descriptive and cross sectional study implementing applied manner. Data were collected and compare with response of the 2007 version of the model questionnaire. The score for the emergency room of the studied hospital was 27.55 out of 90 points in measurement, analysis, and knowledge management criteria. The emergency room of the studied hospital had the second level of excellence. Since the baldrige model scoring system is used for continues improvement of performance and excellence in organizations, it is recommended that this evaluation and improvement process continue to increase the scores and improve the performance