تاثیر طرح تحول نظام سلامت بر زمان ارائه خدمات اورژانس با استفاده از تحلیل سری زمانی منقطع (مطالعه موردی: بیمارستان حضرت رسول اکرم تهران)
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانی
مائده اله وردی
1
,
انیسه نیک روان
2
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کامران حاجی نبی
3
1 - دانش آموخته کارشناسی ارشد مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - استادیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
3 - استادیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: تحلیل سری زمانی منقطع, استاندارد زمان انتظار بیمار, طرح تحول سلامت, اورژانس,
چکیده مقاله :
مقدمه: در سال‌های اخیر نظام سلامت کشور با مشکلات متعددی مواجه بود که نارضایتی مردم را به همراه داشت. وزارت بهداشت، طرح تحول نظام سلامت را با هدف محافظت مالی مردم در قبال هزینه‌های سلامت، ارتقای کیفیت و افزایش دسترسی به خدمات درمانی تدوین کرد. روش پژوهش: پژوهش حاضر با هدف تعیین تاثیر طرح تحول نظام سلامت بر زمان ارائه خدمات اورژانس در بیمارستان حضرت رسول اکرم تهران انجام شده است. جامعه آماری این پژوهش شامل تمام بیماران مراجعه کننده به اورژانس بیمارستان حضرت رسول طی سال‌های 1391 تا 1395 بوده است. به‌منظور بررسی تاثیر طرح بر زمان رسیدگی در اورژانس از تحلیل رگرسیون سری زمانی منقطع و نرم افزار Stata استفاده شده است. این روش این امکان را فراهم می‌کند تا بتوانیم اثرات آنی و بلندمدت طرح بر مدت زمان دریافت خدمت را نشان دهیم. یافته‌ها: یافته‌های این پژوهش نشان داد که اجرای طرح تحول در کوتاه مدت، روی زمان انتظار بیماران تاثیری نداشته اما در بلند مدت به طور معنی داری (0/01>P) باعث کاهش مدت زمان انتظار ویزیت، اولین اقدام درمانی، آماده شدن نتیجه آزمایش، دریافت نتیجه آزمایش توسط پزشک، دریافت نتیجه نهایی آزمایش، دریافت نتیجه نوارقلبی، دریافت نتیجه نوار قلبی توسط پزشک و دریافت نتیجه نهایی نوار قلبی در بیمارستان حضرت رسول اکرم شده است. نتیجه‌گیری: یافته های این پژوهش می تواند در راستای مدیریت زمان انتظار بیماران برای دریافت خدمات پس از اجرای طرح تحول نظام سلامت مفید باشد.
Introduction: In recent years, the country's health system has faced numerous problems that have caused dissatisfaction among the people. The Ministry of Health launched the Health System Transformation Plan with the aim of protecting people from health costs, improving quality, and increasing access to health care. The aim of this study is to investigate the effect of health system transformation plan on the time of providing emergency services in Hazrat Rasoul Hospital. Methods: The statistical population of this study included all patients referred to the emergency department during the years 1391 to 1395. In order to investigate the effect of the design on the time of emergency treatment, interrupted time series analysis and Stata software have been used has been used. This method allows us to show the short and long-term plan for the duration of service. Results: The research of this study showed that the implementation of the transformation plan in the short-term does not have any impact on the waiting time but in the long-term significantly (P<0.01) has reduced the waiting time for the visit, the first treatment, preparation of the test result, receiving the test result by the doctor, receiving the final test result, receiving the ECG result, receiving the ECG result by the doctor and Receiving the final result of the ECG in Hazrat Rasool Akram Hospital. Conclusion: Findings of this study can be useful in managing the waiting time of patients to receive services after the implementation of the health system transformation plan.
1- Cheshmekaboodi, M., Ahmadi, T., Nikbazm, R., Mohammadi, R., Zarduee golanbari, S., Mohammadi, A. Analysis of Performance Indices of emergency Departments in Educational Hospitals of Kermanshah University of Medical Sciences Before and After Implementation of Health Sector Evolution Plan. Journal of healthcare management, 2020; 10 (34): 55-66.
2- The Ministry of Health, Treatment and Medical Education. Office of evaluation, treatment standard and principles, Hospital emergency management council, management guideline for emergency ward of teaching and treatment hospitals in Iran; 2000:1, 3, 4, 18, 25, 26.
3- Peikanpour M, Esmaeli S, Yousefi N, Aryaeinezhad A, Rasekh H. A review of achievements and challenges of Iran’s health transformation plan. Payesh, 2018; 17(5): 481-494.
4- Dolan Sh, Shuler R. Personnel and human resource management. Translated by: Tosi MA, Saebi M. 1st ed, Higher education research centers of management and planning organization; 2005: 246-263.
5- Janati, A., Hasanpoor, E., Aslani, F., HaghGoshayie, E. and Hassanzadeh, E. Evaluating visit quality in plan of health sector evolution in Iran: A local survey from Tabriz. International Journal of Epidemiologic Research, 2017, 4(1): 69-77.
6- Huitema, B. E., and J. W. McKean. Design specification issues in time-series intervention models. Educational and Psychological Measurement, 2000a; 60: 38–58.
7- Linden, A., and J. L. Adams. Applying a propensity-score based weighting model to interrupted time series data: Improving causal inference in program evaluation. Journal of Evaluation in Clinical Practice, 2011; 17: 1231–1238.
8- Simonton, D. K. Cross-sectional time-series experiments: Some suggested statistical analyses. Psychological Bulletin, 1977a; 84: 489–502.
9- Salluzzo Mayer., Strauss, Kidd. Emergency Department Management: Principles and Applications, Elsevier Canada; 2008.
10- Linden, A., and J. L. Adams. Pplying a propensity-score based weighting model to interrupted time series data: Improving causal inference in program evaluation. Journal of Evaluation in Clinical Practice, 2011a; 17: 1231–1238.
11- Bernal, J., Cummins, S., Gasparrini, A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. International Journal of Epidemiology, 2017; 46(1), 348-355.
12- Staples JA, Liu G, Brubacher JR, Karimuddin A, Sutherland JM. Physician Financial Incentives to Reduce Unplanned Hospital Readmissions: an Interrupted Time Series Analysis. J Gen Intern Med, 2021 Nov; 36(11): 3431-3440. Doi: 10.1007/s11606-021-06803-8. Epub 2021 May 4. PMID: 33948803; PMCID: PMC8606373.
13- Kirkwood G, Pollock AM. Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies. J R Soc Med, 2022 Apr 12:1410768221090672. Doi: 10.1177/01410768221090672. Epub ahead of print. PMID: 35413211.
14- Yun CC, Huang SJ, Kuo T, Li YC, Juang WC. Impact of New Bed Assignment Information System on Emergency Department Length of Stay: An Effect Evaluation for Lean Intervention by Using Interrupted Time Series and Propensity Score Matching Analysis. Int J Environ Res Public Health, 2022 Apr 28; 19(9): 5364. Doi: 10.3390/ijerph19095364. PMID: 35564761; PMCID: PMC9102768.
16- Mankiw N.G. Principles of Economics. USA; Harvard University press; 2014.
18- Jafari Sirizi M, Seyedin S, Aghlmand S, Seyed Mahmodi M. Performance Indicators of Emergency Departments Following the Implementation of Specialist Residency Program under the Health Sector Evolution Plan in Public Hospitals of West Azerbaijan Province. Jha, 2017; 20 (67): 50-63. [In Persian]
19- Karami Matin, B., Hajizadeh, M., Najafi, F., Homaie Rad, E., Piroozi, B. and Rezaei, S. The impact of health sector evolution plan on hospitalization and cesarean section rates in Iran: an interrupted time series analysis. International Journal for Quality in Health Care, 2018; 30(1): 75-79.
20- Hasanpoor E, Janati A, HaghGoshayie E, Arab Zozani M, Aslani F. Surveying waiting time and visit time in plan of health sector evolution in Iran: A case study in Tabriz. Int J Epidemiol Res, 2016; 3(3): 239-245.
21- Janati, A., Hasanpoor, E., Aslani, F., HaghGoshayie, E. and Hassanzadeh, E. Evaluating visit quality in plan of health sector evolution in Iran: A local survey from Tabriz. International Journal of Epidemiologic Research, 2017; 4(1): 69-77.
22- Ferdosi, M., Raeisi, A., Ganji, H., Vesal, S., Jannesari, A., Yazdi, H. Investigating the Effects of Quality Improvement Package of Outpatient Visit from Iran Health Transformation Plan in Alzahra University Hospital, Isfahan, Iran (2014-2015). Health Information Management, 2016; 13(4): 292-296. [In Persian]
_||_1- Cheshmekaboodi, M., Ahmadi, T., Nikbazm, R., Mohammadi, R., Zarduee golanbari, S., Mohammadi, A. Analysis of Performance Indices of emergency Departments in Educational Hospitals of Kermanshah University of Medical Sciences Before and After Implementation of Health Sector Evolution Plan. Journal of healthcare management, 2020; 10 (34): 55-66.
2- The Ministry of Health, Treatment and Medical Education. Office of evaluation, treatment standard and principles, Hospital emergency management council, management guideline for emergency ward of teaching and treatment hospitals in Iran; 2000:1, 3, 4, 18, 25, 26.
3- Peikanpour M, Esmaeli S, Yousefi N, Aryaeinezhad A, Rasekh H. A review of achievements and challenges of Iran’s health transformation plan. Payesh, 2018; 17(5): 481-494.
4- Dolan Sh, Shuler R. Personnel and human resource management. Translated by: Tosi MA, Saebi M. 1st ed, Higher education research centers of management and planning organization; 2005: 246-263.
5- Janati, A., Hasanpoor, E., Aslani, F., HaghGoshayie, E. and Hassanzadeh, E. Evaluating visit quality in plan of health sector evolution in Iran: A local survey from Tabriz. International Journal of Epidemiologic Research, 2017, 4(1): 69-77.
6- Huitema, B. E., and J. W. McKean. Design specification issues in time-series intervention models. Educational and Psychological Measurement, 2000a; 60: 38–58.
7- Linden, A., and J. L. Adams. Applying a propensity-score based weighting model to interrupted time series data: Improving causal inference in program evaluation. Journal of Evaluation in Clinical Practice, 2011; 17: 1231–1238.
8- Simonton, D. K. Cross-sectional time-series experiments: Some suggested statistical analyses. Psychological Bulletin, 1977a; 84: 489–502.
9- Salluzzo Mayer., Strauss, Kidd. Emergency Department Management: Principles and Applications, Elsevier Canada; 2008.
10- Linden, A., and J. L. Adams. Pplying a propensity-score based weighting model to interrupted time series data: Improving causal inference in program evaluation. Journal of Evaluation in Clinical Practice, 2011a; 17: 1231–1238.
11- Bernal, J., Cummins, S., Gasparrini, A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. International Journal of Epidemiology, 2017; 46(1), 348-355.
12- Staples JA, Liu G, Brubacher JR, Karimuddin A, Sutherland JM. Physician Financial Incentives to Reduce Unplanned Hospital Readmissions: an Interrupted Time Series Analysis. J Gen Intern Med, 2021 Nov; 36(11): 3431-3440. Doi: 10.1007/s11606-021-06803-8. Epub 2021 May 4. PMID: 33948803; PMCID: PMC8606373.
13- Kirkwood G, Pollock AM. Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies. J R Soc Med, 2022 Apr 12:1410768221090672. Doi: 10.1177/01410768221090672. Epub ahead of print. PMID: 35413211.
14- Yun CC, Huang SJ, Kuo T, Li YC, Juang WC. Impact of New Bed Assignment Information System on Emergency Department Length of Stay: An Effect Evaluation for Lean Intervention by Using Interrupted Time Series and Propensity Score Matching Analysis. Int J Environ Res Public Health, 2022 Apr 28; 19(9): 5364. Doi: 10.3390/ijerph19095364. PMID: 35564761; PMCID: PMC9102768.
16- Mankiw N.G. Principles of Economics. USA; Harvard University press; 2014.
18- Jafari Sirizi M, Seyedin S, Aghlmand S, Seyed Mahmodi M. Performance Indicators of Emergency Departments Following the Implementation of Specialist Residency Program under the Health Sector Evolution Plan in Public Hospitals of West Azerbaijan Province. Jha, 2017; 20 (67): 50-63. [In Persian]
19- Karami Matin, B., Hajizadeh, M., Najafi, F., Homaie Rad, E., Piroozi, B. and Rezaei, S. The impact of health sector evolution plan on hospitalization and cesarean section rates in Iran: an interrupted time series analysis. International Journal for Quality in Health Care, 2018; 30(1): 75-79.
20- Hasanpoor E, Janati A, HaghGoshayie E, Arab Zozani M, Aslani F. Surveying waiting time and visit time in plan of health sector evolution in Iran: A case study in Tabriz. Int J Epidemiol Res, 2016; 3(3): 239-245.
21- Janati, A., Hasanpoor, E., Aslani, F., HaghGoshayie, E. and Hassanzadeh, E. Evaluating visit quality in plan of health sector evolution in Iran: A local survey from Tabriz. International Journal of Epidemiologic Research, 2017; 4(1): 69-77.
22- Ferdosi, M., Raeisi, A., Ganji, H., Vesal, S., Jannesari, A., Yazdi, H. Investigating the Effects of Quality Improvement Package of Outpatient Visit from Iran Health Transformation Plan in Alzahra University Hospital, Isfahan, Iran (2014-2015). Health Information Management, 2016; 13(4): 292-296. [In Persian]
