Hospital performance evaluation indicators: a scoping review.

BACKGROUND: Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. METHODS: We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. RESULTS: We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. CONCLUSION: The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.

Costs and outcomes of colorectal cancer screening program in Isfahan, Iran.

BACKGROUND: Colorectal cancer is one of the most prevalent gastrointestinal cancers in Iran i.e., the fourth and the second prevalent cancer among Iranian males and females, respectively. A routine screening program is effective in the early detection of disease which can reduce the cancer burden both for individuals and society. In 2015, Iran's Package of Essential Non- communicable Diseases program had been piloted in Shahreza city in Isfahan province. Colorectal cancer screening for the population aged 50-70 was a part of this program. So far, there was no study about the cost and outcomes of that program. Thus, this study aimed to analyze the costs and outcomes of colorectal cancer screening done from 2016 to 2019 in Shahreza. METHODS: This cost-outcome description study used the data of 19,392 individuals who were 50-70 years old experienced a fecal immunochemical test (FIT) and had an electronic health record. All direct costs including personnel, building space, equipment, training, etc. were extracted from the financial documents existing in the Isfahan province Health Center. The outcome was defined as positive FIT, detection of adenoma or malignancy as recorded in the E-integrated health system. RESULTS: The results of this study indicated that the direct costs of the colorectal cancer screening program during the years 2016-2019 were 7,368,707,574 Rials (321,029 PPP$) in Shahreza, Isfahan province. These costs resulted in identifying 821 people with a positive FIT test, of those 367 individuals were undergone colonoscopy. Of whom 8 cases of colorectal cancer, and 151 cases with polyps were diagnosed. CONCLUSION: This study showed that by paying a small amount of 320 thousand international dollars we could prevent 151 cases of polyps to be progressed to colorectal cancer,resulting in a significant reduction in colorectal cancer incidence.

Adaptation of Clinical Practice Guideline for Colorectal Cancer Screening in People with Average Risk in Isfahan Province.

Background: Colorectal cancer (CRC) is the third most common cancer among adults in Iran. The aim of colorectal cancer screening is to reduce the cancer burden in the population by diagnosing the disease in its early stages. Methods: We adapted this guideline for the moderate CRC risk population for Isfahan to determine how to screen them and when to start and end the CRC screening. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of Iranian association of gastroenterology and hepatology. Results: In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years. In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years. In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally. In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice. Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested.

The use and the cost of outpatient diagnostic procedures for cardiovascular diseases in Isfahan province: A utilization study.

BACKGROUND: Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017. MATERIALS AND METHODS: This descriptive study used insurance claim data (time period: 2011-2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts' opinions. RESULTS: The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011-2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost. CONCLUSIONS: The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction.

Comparative Study of Medical Equipment Procurement in Selected Countries.

Background: Despite the fact that medical equipment is critical for providing good health services and also incurs significant expenditures for the health system, little is known about how to procure it effectively. To date, only a few comparative studies on the procurement framework for medical equipment between nations have been conducted. Thus, the purpose of this study was to examine this issue between the leading countries. Methods: To conduct this comparative study, Canada, the United Kingdom, Australia, Spain, Italy, Turkey, Thailand, and Iran were selected. Medical devices, medical equipment, procurement, purchasing, and acquisition were keywords considered to search PubMed, ProQuest, Web of Science, Scopus, Science Direct, and Google scholar databases. Also, the websites of the related organizations, such as the World Health Organization (WHO), the World Bank, and the Ministry of Health of respective countries were searched for the gray literature. Providing information about the procurement framework and availability of evidence in the English language was considered as the inclusion criteria and the lack of access to full texts, letters, and commentary article designs were the exclusion criteria. The results were summarized and reported using comparative tables. Results: Most of the countries involved in this study are trying to align procurement activities with national health care priorities. In view of this, there is a trend toward centralized procurement, especially in Italy, Spain, England, Italy, Canada, and Iran. While a range of actors participate in the procurement process, a greater role for physicians and patients is necessary to be defined to meet patient needs. Moving from price-based approaches to value-based approaches is in the agenda to consider a broader range of criteria to achieve value for money and support patient access to innovations. Conclusion: Most of the countries have reorganized the mechanism of medical equipment procurement. The price of products is the important factor, and recently the value factor has become more important in procurement. Reinforcing the role of decision-making teams and hospital committees in the procurement of medical equipment is suggested. Further studies are needed on the application of value-based approaches to evaluate their effects in hospitals.

Cost-effectiveness of colorectal cancer screening strategies: A systematic review.

INTRODUCTION: Colorectal cancer (CRC) is the second leading cause of death worldwide and the use of CRC screening tests can reduce the incidence and mortality of the disease by early detection. This study aims to review cost-effectiveness strategies in different ages and countries, systematically. METHODS: We searched ProQuest, Web of Science, Scopus, Cochrane, PubMed and Embase for related studies between 2010 and 2020. Articles that reported costs per Quality-Adjusted Life Year or Life Year Gain and Incremental Cost-Effectiveness Ratios to compare the cost-effectiveness of CRC screening strategies in the average-risk population were included in our study. RESULTS: The search strategies identified 426 records and finally 48 articles were included in the systematic review based on included and excluded criteria. We identified seven strategies for CRC screening. Most of the strategies were performed in aged 50-75. These studies were reported by cost per Quality-Adjusted life year (QALY)/Life Year Gain (LYG) based on methods and perspectives and the ICER of comparison of two-by-two strategies. CONCLUSION: Most of the CRC screening strategies were cost-effective, but there was big heterogeneity between the cost-effectiveness analysis of CRC screening strategies because of different screening methods, perspectives and screening populations. So, it is important to consider this heterogeneity to compare the economic evaluation studies in this field.

Public-private partnership in Iranian hospitals: Challenges and opportunities.

BACKGROUND: Nowadays, various strategies are applied by governments to control costs and finance hospitals and the health sector. Public-private partnership (PPP) option is one of these strategies. Considering the growing importance of hospitals in different communities and their problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This study aimed to identify the challenges and opportunities of PPP in the country's hospitals and then offered an appropriate solution to overcome these challenges. MATERIALS AND METHODS: This is a qualitative study and content analysis approach is undertaken. The participants were selected through purposive sampling and data were collected using a semi-structured interview with experts in the public and private health sector until the saturation point achieved. Data analysis was performed through the thematic analysis of expert's statements using MAXQDA. 10 software in this sector. RESULTS: According to the study results, 3 main themes (challenges, opportunities, and solutions), 10 sub-themes, and 32 codes were identified in relation to the public and private partnership. 4 sub-themes on challenges of PPP, 3 sub-themes on partnership opportunities and 3 sub-themes on challenges solutions were identified. CONCLUSION: The results of this study revealed that given the discussed challenges the most important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated outsourcing backed with adequate supervision could solve many current hospitals' problems.

Economic impact of acute respiratory disease pandemics: A scoping review.

Background: The economic impact of acute respiratory disease pandemics has yet to be specifically systematically reviewed. The aim of this scoping review is to identify and classify the economic impacts and its values and ranges. Materials and Methods: We conducted a literature search across three key databases using an extensive list of keywords. Then, we included studies which explored direct and indirect costs as well as broader economic impact associated with different nine acute respiratory diseases, i.e., pandemic and seasonal influenza, avian influenza, equine influenza, swine influenza, severe acute respiratory syndrome, coronavirus disease 2019, Middle East respiratory syndrome, H1N1, and H7N9. Results: We included 62 studies in English language between 1987 and 2020, mostly from the countries of East Asia and Pacific pertinent. We classified the economic impact into 5 main categories and 18 subcategories. The main categories were macroeconomic impacts, impacts on health cost, industry, businesses and trade, and education. Conclusion: Respiratory disease pandemics have widely impacted different sectors of economy such as the direct cost on macroeconomic, providing and receiving health services, disease management, industries, business and trade, education, and indirect costs due to productivity losses. However, lots of the reviewed studies were unable to quantify the actual economic cost of these impacts. This made it challenging to conduct any kind of quantitative comparison of the results. A key priority for future research is to develop standard methods to quantify the broader economic costs of respiratory disease pandemics. Understanding the total economic impact of respiratory disease pandemics is a key step to inform national and international priority setting for disease prevention and pandemic control interventions.

Value-Based procurement for medical devices: A scoping review.

Background: Despite this seemingly simple definition of value in different perspectives, the definition of value-based procurement for medical devices is still unclear. This study aimed to delineate the definition of value-based procurement for medical devices and its characteristics. Methods: According to the systematic method for scoping review described by Arksey and O'Malley, we reviewed related literature through target databases (PUBMED, ProQuest, Web of Science, Scopus, and Science Direct) during 2004-2020. The publications that focused on the procurement of medical devices and address the issue of value in procurement were selected. The publications whose full-text was not available and were not in English were excluded. By using data charting tables, selected articles were reviewed and concepts and definitions were extracted. Results: According to the eligibility criteria and reference checking, 24 documents were selected. There are different definition and understanding for value-based procurement (VBP). Identified characteristics of VBP are information, actors Collaboration, patient experience, value analysis team, ability to evaluate alternatives, value proposition, competitive dialogue, and weighing evaluation criteria. Conclusion: VBP is a framework that guides the review and decision-making to procure medical devices. In this framework, all dimensions of the value equation (outcome/related costs) must be considered and weighted. Health systems need to work on identified aspects.

Use of a biosynthetic wound dressing to treat burns: a systematic review.

OBJECTIVE: Accelerating the process of wound healing, reducing infection risks, and decreasing pain and discomfort in the burn area are important goals of burn treatment. To achieve these goals, the use of biosynthetic wound dressings has increased in recent years. Suprathel (PolyMedics Innovations, Germany) is a biosynthetic wound dressing used to treat both partial-thickness burns and split-thickness skin graft (STSG) donor sites, full-thickness wounds, large-scale abrasions, and scar revisions. METHOD: This study is a systematic review of empirical evidence reported on the application of the biosynthetic wound dressing in burns up to 2017. Keywords such as 'Suprathel', 'effectiveness', 'safety', and 'cost' were searched in PubMed, Cochrane, Scopus and Embase databases. RESULTS: A total of 14 publications were identified, based on the inclusion and exclusion criteria. The findings reported in the literature reviewed were classified in terms of safety, effectiveness and cost-effectiveness of use of the biosynthetic wound dressing. Regarding safety and effectiveness, the dressing was found to yield desirable results, particularly for partial thickness burns and STSG donor sites. As of 2017 no health economics assessments have been carried out. CONCLUSION: Despite the desirable advantages of the biosynthetic wound dressing with respect to its effectiveness, safety and ease of use, its major limitation was found to be its cost. However, in the absence of comprehensive studies on the quantification of all factors, there is scant scientific evidence for making reliable conclusions from this systematic review.

A roadmap for implementing general policies of resistance economy in the Isfahan Universities of Medical Sciences.

CONTEXT AND AIMS: The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences. MATERIALS AND METHODS: This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively. RESULTS: Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people-centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health. CONCLUSION: The implementation of resistance economy policies entails planning in the long run, culture-building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

Risk Management in Executive Levels of Healthcare Organizations: Insights from a Scoping Review (2018).

BACKGROUND: This study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field. METHODS: A scoping review was conducted of all English language studies, from January 2000 to October 2018 in the main bibliographic databases. Review selection and characterization were performed by two independent reviewers using pretested forms. RESULTS: Following a keyword search and an assessment of fit for this review, 37 studies were analyzed. Based on the findings and considering the ISO31000 model, a comprehensive yet simple framework of risk management is developed for the executive levels of HCOs. It includes five main phases: establishing the context, risk assessment, risk treatment, monitoring and review, and communication and consultation. A set of tools and techniques were also suggested for use at each phase. Also, the status of risk management in the executive levels of HCOs was determined based on the proposed framework. CONCLUSION: The framework can be used as a training tool to guide in effective risk assessment as well as a tool to assess non-clinical risks of healthcare organizations. Managers of healthcare organizations who seek to ensure high quality should use a range of risk management methods and tools in their organizations, based on their need, and not assume that each tool is comprehensive.

Economic Evaluation of Using Pesticides to Control Cutaneous Leishmaniasis in Isfahan.

OBJECTIVE: Pesticides have been used as the main part of the national cutaneous leishmaniasis control program for serveral years in Iran. However, the cost-effectiveness of this strategy has not been yet analyzed. The aim of this study is to to analyze the cost-effectiveness and cost-utility of using pesticides as the main strategy to prevent rural CL in Isfahan. METHODS: This is an economic evaluation study performed from a health system perspective to estimate the cost-effectiveness and cost-utility of the control strategy with and without pesticides. The outcome measures are incidence rate of cutaneous leishmaniasis and the disability-adjusted life years (DALYs). The cost-effectiveness and cost-utility have been analyzed by calculating incremental cost-effectiveness ratio (ICER). Data of cost and incidence rate obtained from the health centers of Isfahan University of Medical Sciences and Vice-Chancellery for Health. The disability weight was obtained from the literature. A one-way sensitivity analysis was applied with a 20% increase and decrease in costs. FINDINGS: The total cost of control program in 2013 and 2014 were US$578,453 (ppp) and US$14,978.2 (ppp), respectively. The incidence rate of cutaneous leishmaniasis was estimated at 1396 and 1277 (per 100,000 population in hyperendemic areas where pesticides have been used) in 2013 and 2014, respectively. DALY lost due to disease was estimated to be 8.024 and 7.342 in 2013 and 2014, correspondingly. Both the cost-effectiveness and the cost-utility analyses resulted in negative ICERs, lying in the rejection area of the ICER plane. CONCLUSION: The use of pesticides to prevent cutaneous leishmaniasis (rural sicker) in Isfahan province has not proved to offer a reduction in the incidence rate of cutaneous leishmaniasis as well as reduction in DALYs lost. However, due to data availability limitation, the time frame for this study was limited. A prospective design with longitudinal data is recommended to be used by future research. Other alternatives to raise population awareness about different aspects of disease should be also considered for evaluation.

Smoking behaviour and health care costs coverage: a European cross-country comparison.

The empirical evidence about the effect of smoking on health care cost coverage is not consistent with the expectations based on the notion of adverse selection. This evidence is mostly based on correlational studies which cannot isolate the adverse selection effect from the moral hazard effect. Exploiting data from the Survey of Health, Aging, and Retirement in Europe, this study uses an instrumental variable strategy to identify the causal effect of daily smoking on perceived health care cost coverage of those at age 50 or above in 12 European countries. Daily smoking is instrumented by a variable indicating whether or not there is any other daily smoker in the household. A self-assessment of health care cost coverage is used as the outcome measure. Among those who live with a partner (72% of the sample), the result is not statistically significant which means we find no effect of smoking on perceived health care cost coverage. However, among those who live without a partner, the results show that daily smokers have lower self-assessed perceived health care cost coverage. This finding replicates the same counter-intuitive relationship between smoking and health insurance presented in previous studies, but in a language of causality. In addition to this, we contribute to previous studies by a cross-country comparison which brings in different institutional arrangements, and by using the self-assessed perceived health care cost coverage which is broader than health insurance coverage.

Patient Payment and Unhealthy Behavior: A Comparison across European Countries.

Introduction. Prior research has documented that unhealthy behaviors result in greater health care use and greater health care costs. However, there are few studies on out-of-pocket expenditure paid by those engaging in unhealthy behaviors. We provide cross-country evidence on the association of smoking, alcohol consumption, and obesity with health care use and health care cost as well as out-of-pocket payments among the elderly in Europe. Method. Using SHARE dataset for 13 European countries, the study uses a sequential logit model to analyze use and payments for outpatient and inpatient health care service in addition to a two-part model for the analysis of use and payments for prescribed drugs. Results. Former smoking is associated with a higher rate of health care use. However, current smoking is associated with lower health care use. Former smoking is also associated with paying higher amount of out-of-pocket payments. Alcohol consumption is associated with lower health care use. Conclusion. We do not find systematic evidence that unhealthy behaviors among elderly (50+) are associated with more utilization of health care and more out-of-pocket payments. The results can be of interest for policies that aim to make people more responsible toward their health behaviors.

Socio-economic Aspects of Health-Related Behaviors and Their Dynamics: A Case Study for the Netherlands.

BACKGROUND: Previous studies have mostly focused on socio-demographic and health-related determinants of health-related behaviors. Although comprehensive health insurance coverage could discourage individual lifestyle improvement due to the ex-ante moral hazard problem, few studies have examined such effects. This study examines the association of a comprehensive set of factors including socio-demographic, health status, health insurance, and perceived change in health insurance coverage with health-related behaviors and their dynamics (ie, changes in behavior). METHODS: Using Survey of Health, Aging, and Retirement in Europe (SHARE) data (a European aging survey among 50+ years old) for the Netherlands in 2004 and 2007 (sample size: 1745), binary and multinomial logit models are employed to study health-related behaviors (daily smoking, excessive alcohol use, and physical inactivity in 2004) and their corresponding changes (stopping or starting unhealthy behavior between 2004 and 2007). RESULTS: Our findings show that being older, being female, having higher education and living with a partner increase the likelihood not to be a daily smoker or to stop daily smoking. At the same time, being older (OR = 3.02 [1.31, 6.95]) and being female (OR = 1.77 [1.05, 2.96]) increases the likelihood to be or to become physically inactive. We also find that worse perceived health insurance coverage in 2007 is associated with a lower likelihood (OR = 0.19 [0.06, 0.57]) of stopping excessive alcohol use in that year. However, we do not find a strong association between the type of health insurance and health behavior. CONCLUSION: Our findings show that all above mentioned factors (ie, socio-demographic and health status factors) are associated with health-related behavior but not in a consistent way across all behaviors. Moreover, the dynamics of each behavior (positive or negative change) is not necessarily determined by the same factors that determine the state of that behavior. We also find that better perceived health insurance coverage is associated with a healthier lifestyle which is not compatible with an ex-ante moral hazard interpretation. Our results provide input to target policies towards elderly individuals in need of lifestyle change. However, further research should be done to identify the causal effect of health insurance on health-related behavior.

The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review.

BACKGROUND: Out-of-pocket payments can have a large impact on the demand for healthcare. They can be essential not only to decrease unnecessary service use, but also to encourage the use of particular preventive services provided free of charge or at a lower price. Moreover, out-of-pocket payments may increase the costs of unhealthy behaviour and provide incentives for a healthier lifestyle. METHOD: This study systematically reviews empirical evidence on the effects of out-of-pocket payments on the use of preventive services and health-related lifestyle. All possible combinations of three key words 'prevention', 'patient payment' and 'health-related behaviour' were searched in PUBMED, ECONLITH, ECONPAPER and EMBASE. In total, 47 relevant publications were identified. RESULTS: The results suggest that out-of-pocket payments can create a financial barrier and can decrease the use of preventive services and the uptake of preventive medications. A few studies (with contradicting empirical evidence) address the impact of cost sharing and reduced insurance coverage on a healthier lifestyle. CONCLUSION: Although the great diversity of study designs (various indicators of out-of-pocket payments and preventive/health-related behaviour) makes it difficult to offer robust policy recommendations, our findings support calls to reconsider how preventive services should be financed. More research is needed to explore the actual impact of cost sharing on different aspects of health-related lifestyles, as well as to explain the role of other relevant determinants that could impact this relationship.