Mohammad Arab

Determinants of health-related quality of life in elderly in Tehran, Iran

BackgroundAs Iran started to experience population ageing, it is important to consider and address the elderly peoples needs and concerns, which might have direct impacts on their well-being and quality of life. There have been only a few researches into different aspects of life of the elderly population in Iran including their health-related quality of life. The purpose of this study was to measure health-related quality of life (HRQoL) of elderly Iranians and to identify its some determinant factors.MethodsThis was a cross-sectional survey of a random sample of community residents of Tehran aged 65 years old and over. HRQoL was measured using the Short From Health Survey (SF-36). The study participants were interviewed at their homes. Uni-variate analysis was performed for group comparison and logistic regression analysis conducted to predict quality of life determinants.ResultsIn all, 400 elderly Iranian were interviewed. The majority of the participants were men (56.5%) and almost half of the participants were illiterate (n = 199, 49.8%). Eighty-five percent of the elderly were living with their family or relatives and about 70% were married. Only 12% of participants evaluated their economic status as being good and most of people had moderate or poor economic status. The mean scores for the SF-36 subscales ranged from 70.0 (SD = 25.9) for physical functioning to 53.5 (SD = 29.1) for bodily pain and in general, the respondents significantly showed better condition on mental component of the SF-36 than its physical component (mean scores 63.8 versus 55.0). Performing uni-variate analysis we found that women reported significantly poorer HRQoL. Multiple logistic regression analysis showed that for the physical component summary score of the SF-36, age, gender, education and economic status were significant determinants of poorer physical health-related quality of life; while for the mental component summary score only gender and economic status were significant determinants of poorer mental health-related quality of life. The analysis suggested that the elderly peoples economic status was the most significant predictor of their HRQoL.ConclusionThe study findings, although with a small number of participants, indicate that elderly people living in Tehran, Iran suffer from relatively poor HRQoL; particularly elderly women and those with lower education. Indeed to improve quality of life among elderly Iranians much more attention should be paid to all aspects of their life including their health, and economic status.

Space or no space for managing public hospitals; a qualitative study of hospital autonomy in Iran

Mehdi Jafari, Arash Rashidian, Farid Abolhasani, Kazem Mohammad, Shahram Yazdani, Patricia Parkerton, Masud Yunesian, Feizollah Akbari and Mohammad Arab* Department of Health Services Management, School of Health Services Management, Iran University of Medical Sciences, Tehran, Iran Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran Department of Epidemiology and Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran, Iran Educational Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Health Services Management, School of Public Health, University of California Los Angeles, California, USA Center for Environmental Research; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Developing evidence-based maternity care in Iran: A quality improvement study.

BackgroundCurrent Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified womens needs and preferences.MethodsThe major steps of the study were to (1) identify womens needs, values and preferences via interviews, (2) select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3) redesign care based on the selected evidence-based recommendations and womens views, and (4) implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model.ResultsTwenty womens needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, womens satisfaction levels improved significantly on 16 of 20 items (p < 0.0001) compared with baseline. Seventy-eight percent of studied women experienced care consistent with the new model and fewer women had a caesarean birth (30% compared with 42% previously).ConclusionThe introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in womens satisfaction levels and a reduction in rates of caesarean birth.

Using Data Mining to Detect Health Care Fraud and Abuse: A Review of Literature

Inappropriate payments by insurance organizations or third party payers occur because of errors, abuse and fraud. The scale of this problem is large enough to make it a priority issue for health systems. Traditional methods of detecting health care fraud and abuse are time-consuming and inefficient. Combining automated methods and statistical knowledge lead to the emergence of a new interdisciplinary branch of science that is named Knowledge Discovery from Databases (KDD). Data mining is a core of the KDD process. Data mining can help third-party payers such as health insurance organizations to extract useful information from thousands of claims and identify a smaller subset of the claims or claimants for further assessment. We reviewed studies that performed data mining techniques for detecting health care fraud and abuse, using supervised and unsupervised data mining approaches. Most available studies have focused on algorithmic data mining without an emphasis on or application to fraud detection efforts in the context of health service provision or health insurance policy. More studies are needed to connect sound and evidence-based diagnosis and treatment approaches toward fraudulent or abusive behaviors. Ultimately, based on available studies, we recommend seven general steps to data mining of health care claims.

Extent, consequences and economic burden of road traffic crashes in Iran

Abstract: Background: Road Traffic Injuries (RTIs) as a result of road traffic crashes (RTCs) rank as the leading cause of death, disability and property loss worldwide, especially in low and middle-income countries. This study aims to analyze the costs of RTCs in Iran. Methods: A standard human capital approach was used to estimate the costs. Costs included medical, administrative and funeral costs, property damage, production lost and intangible costs. Data about the number of deaths and injuries resulting from RTIs between 20 March 2009 and 20 March 2010 was obtained from two national databases designed at the Center for Disaster Management and Medical Emergencies (CDMME) and the Legal Medicine Organization (LMO), respectively. The severity and medical costs of injuries were identified by reviewing 400 medical records that were selected randomly from patients who were admitted to two large trauma centers in Shariati and Sina hospitals in Tehran province. Moreover, information about production lost, property damage, rehabilitation cost, intangible costs and administration costs were collected by review of current evidence and consulting with expert opinion. Results: In total 806,922 RTIs and 22,974 deaths resulted from the RTCs in the study period. The total cost of RTCs was about 72,465 billion Rials (7.2 billion US Dollars), which amounts to 2.19% of Iran’s Gross Domestic Production (GDP). Direct costs were 3,516 billion Rials (around 48.6 % of the total costs), following by 24,785 billion Rials (around 34.2 % of the total costs) for production lost and 12,513 billion Rials (around 17.2 % of the total costs) for intangible costs. Conclusions: This study indicated that the burden of both RTCs and RTIs in Iran is substantial. Moreover, RTCs have significant economic consequences and are a large drain on healthcare resources.

Report: The assessment of hospital waste management: a case study in Tehran

Hospital waste management is an important process that must be dealt with diligently. The management of hazardous waste material requires specific knowledge and regulations and it must be carried out by specialists in the field. In this cross-sectional study, we assessed the main stages of hospital waste management including separation, containment, removal and disposal of waste materials in public hospitals affiliated with Tehran University of Medical Sciences (TUMS). We selected 108 units of six hospitals (three general hospitals and three subspecialty hospitals) from those hospitals supervised by TUMS using the cluster sampling method. The measurement was conducted through a questionnaire and direct observation by researchers. Association analysis was done by statistical tests; Fisher exact test and chi-squared using SPSS software. According to the results obtained by the questionnaire, most of the studied wards scored moderately in terms of quality of their performance in all stages of waste management. About one-fifth of the wards were suffering from poor management of their medical waste and only a minority of wards obtained good scores for managing their waste materials. The findings also revealed significant associations between temporary waste storage and collection and the level of education of the managers (P = 0.040, P = 0.050, respectively). In summary, the study indicated a moderate management in all processes of separation, collection, containment, removal and disposal of waste materials in hospitals with several observed problems in the process.

Social support and health of older people in Middle Eastern countries: A systematic review.

The aim of this study is to systematically review quantitative studies exploring the association between social support (SS) and the health of older people in Middle Eastern countries. Sixteen electronic databases and other resources were searched to identify studies that met the inclusion criteria of the review. Abstracts of identified papers were screened for relevancy, following which the authors determined eligibility, applied quality criteria and extracted the data. Twenty‐two studies met the inclusion criteria. Even allowing for the diversity of the studies included, this review offered strong and consistent evidence for a positive relation between SS and mental health, while there was inconsistent evidence of an association between SS and other health outcomes. The limited evidence for the Middle Eastern region confirms findings from other settings on the importance of SS for mental health in later life. Current evidence is inadequate to assess whether SS is associated with physical health.

Evaluation of Quality of Life of the Elderly Population Covered by Healthcare Centers of Marivan and the Influencing Demographic and Background Factors in 2010

Dear Editor, World Health Organization reported there are more than 600 million elderly individuals in the world (1); a figure which will double by 2025 and will reach 2 billion people by 2050 (2, 3).The immense changes in cultural, socioeconomic and demographic aspects of Iranian society during the last few decades have given rise to an increase in the elderly population (2). A review on the age structure of Iranian population during the last half century reveals the increase in number and percentage of elderly individuals (2): the elderly population of Iran has almost doubled from 3.9% in 1956 to 7.3% (5121043 individuals) in 2006 (2). The rapid, unprecedented growth of elderly population in developing countries, which are still in fight with poverty and contagious diseases, is posing an obstacle for development, thus necessitating urgent measures and approaches for remedy (3). In many of these countries, poverty, deficits in social security programs, continuous urbanization and ever-growing recruitment of women as workforce all compromise the traditional forms of caring for the elderly people (3). It is said that an aging population is the consequence of development; however, if we are unprepared for this phenomenon in a developed world, it will lead to many complications (3-5).Therefore, the international community is paying greater attention to encountering the adverse outcomes of this phenomenon through adoption of appropriate policies in order to enhance the physical, mental and social status of the elderly population i.e. improve their quality of life (QOL) (5-7). This study evaluated QOL of the elderly population covered by healthcare centers in Marivan, Iran. The study population consisted of all the elderly covered by 5 healthcare centers and 2 healthcare bases in Marivan, summing up to 2,433 individuals. A total of 400 these elderly were studied. A simple stratified random sampling proportional to the size of healthcare centers was performed. Data were collected using a standardized QOL questionnaire (Short Form Health Survey (SF-36) – Iranian Version) (8) and questions on demographic and background factors which were completed through face-to-face interviews. The SF-36 questionnaire has been translated and used in over 50 countries all over the world including Iran. The questionnaire consists of two major scales: the physical component and the mental component. The SF-36 also consisting 8 subscales (domains): physical functioning, role physical, bodily pain, general health, vitality, social functioning, and role emotional and mental health. Each of these 8 dimensions may be scored from 0 through 100. Scoring is performed according to criteria of SF-36 standards, with higher scores indicating better function (8). Data were entered and analyzed in SPSS (16.0), using non-parametric Mann-Whitney U test and Kruskal-Wallis test. Then multiple regressions were performed. 240 (60%) of the elderly were men and 160 (40%) were women. 76.3% of the elderly were 60-69 years old and 87.2% of them illiterate. 18% of the elderly stated they have financial problems however 19.5% did not express any financial problems. Most of them (72.7%) were living with their spouse and/ children and 74.8% were married. The mean in eight domains of QOL were as follows: Physical Functioning: 53.2; Role-Physical: 31.6; Bodily Pain: 51; General Health: 47.1; Vitality: 52.4; Social Functioning: 60; Role Emotional: 40.9; Mental Health: 61.4. In general, the physical and mental components scored 45.7±21.8 and 53.7±23.7, respectively, yielding an overall score of 49.7±20.6 for the couplet indices of quality of life ( Table 1 ). Table 1 Mean score of QOL of the elderly population covered by healthcare centers in Marivan, Iran - 2010 The impacts of gender, age, education, financial and marital status, status of living on the mean scores of 8 subscales of QOL were studied using the Mann-Whitney U test and Kruskal-Wallis test. The mean of all 8 subscales of QOL were significantly lower for women compared to men (P < 0.001; Mann-Whitney U test) except in the case of role physical (P = 0.62). Also, the mean of all 8 subscales of QOL decreased significantly (P < 0.001) with increase in age, except for the case of vitality (P = 0.28). The analysis of the relationship between financial status with subscales of QOL showed that for all subscale the corresponding mean scores are significantly higher (P ≤ 0.032) for those who financially doing better. Moreover, the mean of 8 QOL subscale scores are significantly (P < 0.005) higher for the diploma and higher educated elderly. The mean of all subscales are also significantly (P < 0.003) higher for the elderly living with their spouse and or children and are worse for whom were widowed. Multiple regression for all 8 subscales of the QOL were carried out to identify which of the gender, age, education, financial and marital status, status of living were the most important independent factors after adjusting for the effect of possible confounders we found that education, financial and marital status were the most common important independent factors on each of the 8 subscales of QOL. Our findings support previously described beneficial effects of the counseling model on the elderly QOL in the cities of Masjed solaiman (5), Zahedan (9) and Shahinshar (10), Bandar Abbas (11), Iran. The mean QOL scores measured in the elderly population, in other countries were much higher than the results obtained in Iran (12). The QOL subscales were influenced by different factors including age, gender, financial status and more importantly by education, financial and marital status as other studies showed (5, 13, 14). Therefore, it is important to inform the elderly population of the behavioral modifications benefits of the QOL.

An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran.

Objective: Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran. Method: This cross-sectional study was conducted in the year 2010. The study’s sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression. Result: this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction. Conclusions: Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers.

Indications and Overuse of Computed Tomography in Minor Head Trauma

Background: Computed Tomography (CT) is a useful diagnostic technology, particularly in accident and emergency departments. Objectives: To identify a comprehensive list of indications for application of CT in patients with minor head trauma (MHT) and to determine appropriateness of its use on the basis of this list. Materials and Methods: A cross-sectional study was conducted in three Imaging centers in Tehran. A panel of experts developed a list of CT indications for MHT by reviewing documents. A pre-structured checklist was designed and incorporated into a structured form. Four hundred consecutive patients referring to three imaging centers for performing CT due to MHT completed the questionnaire. Results: Of 400 patients who underwent CT after MHT, 187 (46.8%) patients had Glasgow coma scale (GCS) score of 13 or 14 at two hours post-trauma and 37 (19.8%) of these patients did not have any indication of imaging. In addition, 213 (53.2%) patients had GCS score of 15 out of which 110 (51.6%) patients did not have any indication of imaging. Patients with a GCS score of 15 had a noticeably lower proportion of abnormal CT results in comparison to patients with a GCS score of 13 or 14, (odds ratio, 19.07; 95% confidence interval, 6.74-54.00; and P < 0.001). There was a statistically significant association between abnormal CT results and the presence of indications including vomiting, dangerous mechanism of injury, visible signs of trauma above the clavicles, signs of skull base fracture, and suspected skull fracture (P < 0.001). Conclusions: On average, about 37% of the patients with MHT referring to the emergency departments had no indication of CT and approximately 86.5% of CT results were normal. Improving this situation can result in a significant saving in health care costs.