Journal of Education and Health Promotion

Abstract Pregnancy termination and abortion‑related complications are well‑established problems among
women at reproductive age and resulted in significant morbidity and mortality. Accordingly, a
systematic study was performed to investigate the economic evaluation studies results on costs
and benefits of medical and surgical abortion methods. PubMed, Web of Science, Scopus, Embase,
Cochrane library, ProQuest, and ScienceDirect databases as well as Google scholar were searched
through June 2021. Original full‑text English language studies that performed an economic evaluation
analysis comparing medical and surgical methods of pregnancy termination were included in this
review. A critical quality assessment was conducted utilizing the Consolidated Health Economic
Evaluation Standards checklist. The latest web‑based tool adjusted the estimates of costs expressed
in one specific currency and price year into a specific target currency (the year 2020 $US). Overall,
538 records were retrieved, and 20 studies were deemed eligible for qualitative synthesis. Among
the reviewed studies, three studies investigated cost‑minimization analysis, three studies investigated
cost‑utility analysis, and 14 studies investigated cost‑effectiveness analysis. The directly comparison
of medical with surgical abortion was most frequently studied. Medical abortion saved US$ 6 to US$
2373 per patient’s costs. Medical abortion was cost‑effective and cost‑saving option in compare to
the surgical abortion across all perspectives (the incremental cost effectiveness ratio ranged from
US$ 419 to US$ 4,044). Quality scores of included studies ranged from 54% to 100%, and 70% of
studies received a score of above 85% and had “excellent” quality. According to the results, based on
various economic and clinical effectiveness decision‑making criteria used in different studies of health
economic evaluation, the majority of research provided evidence on the advantage of pharmaceutical
methods compared to surgical methods, as well as the advantages of using combinations therapy
compared to single therapeutic interventions.

Abstract Population aging has increased the need for long‑term care of older persons who suffer from
multi‑morbidity and chronic conditions. Today, the majority of older people are living alone in their
home in which they try to cope with highly risky conditions such as sensory impairment, diminished
mobility, and medication management. Recent developments in information technologies could
improve the access to care for older people as well as reducing the need for full‑time caregivers
both in homes and institutions such as nursery homes and hospitals. This study aimed to review
the economic evaluation of such technological advancements in the care of older people. Through
a systematic approach, electronic databases were searched and of 2732 records retrieved, three
papers were included in the final review. Three different models of economic evaluation including
cost analysis, cost–benefit analysis and cost‑effectiveness analysis were applied in these studies
in the context of telemedicine and older persons’ care. Since the methodological approaches were
quite different and the outcomes reported were not consistent between studies, no meta‑analysis
was applicable and we qualitatively reviewed the papers. All studies have reported cost savings
associated with the use of telemedicine technologies such as video visits and smart homes in the
care of older persons.

Abstract BACKGROUND: One of the main goals of hospital management is to attract, maintain, and increase
the number of qualified and efficient human resources, and one of the key and most important factors
in achieving this goal is to design and implement a fair and efficient payment system. The purpose
of this project is to determine the challenges of the performance‑based payment system and provide
solutions to overcome its obstacles in the city of Tehran.
MATERIALS AND METHODS: This qualitative research sought to perform content analysis so as
to explore the experiences and perceptions of a purposeful group of specialists and managers of
Tehran’s educational and medical centers (n = 10). Data were collected using in‑depth semi‑structured
interviews and were ongoing until the point of saturation.
RESULTS: On analysis of data by Specialists and managers of Tehran’s educational and medical
centers, three main themes including behavior, organization, rules and regulation were defined
alongside seven subthemes includes scheduling, platform, education, quantity‑oriented, motivation,
implementation, and payment system.
CONCLUSION: In general, it can be concluded that for the successful implementation of any project,
the necessary infrastructure must be provided for implementation. In this plan, despite the challenges
in the field of behavior, organization, and rules and regulations, the need for necessary training
before implementing the plan, special attention to quality instead of quantity, motivating employees
to cooperate in implementing the plan as successfully as possible, creating a platform Appropriate
before the implementation of the plan and most importantly, the pilot implementation of the plan
before its widespread implementation seems necessary.

Abstract BACKGROUND: Evidence‑based medicine (EBM) plays an important and dominant role in
promoting effective decision‑making in the health system. This study was aimed to evaluate the
EBM performance among health‑care workers (HCWs) in hospitals in Iran.
METHODS: In this study (a cross‑sectional study), participants were 2800 HCWs in hospitals.
A researcher‑made questionnaire was designed, and judgments of 10 experts were used for the
improvement of content validity. The reliability of the questionnaire was assessed by the test‑retest
method (α = 0.85). Data were analyzed using the descriptive statistics, t‑test, and one‑way ANOVA,
in SPSS.16 software.
RESULTS: Eventually, 1524 questionnaires were completed (response rate: 54.4%). The results
of the study show that 62%of participants have not accessed scientific journals, 52% of them have
difficulties using the Internet at work, guidelines were not reachable for 76% of them, and about 80%
have not access to databases. About 39% of participants were not well informed about databases
of EBM, and 15.8% of them were immensely knowledgeable about EBM terminology. The most
important problems to increase HCWs information about EBM include research methodology‑ related
problems, lack of resources and motivation, and coordination problems. The most prominent facilitators
include: providing training courses in EBM and increased facilities. Only work experience showed
a significant correlation with barriers and facilitators, and gender revealed a significant correlation
with barriers (P < 0.05).
CONCLUSION: It seems that prioritizing the increased access to information resources and
databases, considering the research skills of the HCWs, extending the opportunities and increasing
the facilities such as workforce, equipment, physical environment, and accessibility can have a great
impact on the improvement of the activities associated with EBM.

Abstract INTRODUCTION: Hospitals are the main axis of health‑care reforms or national health plans;
therefore, accurate recognition of hospital costs based on operational indexes to these plans is
necessary. The impact of implementing national health plans on the performance of health systems
is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare
Reform Plan (HRP) on the micro level (e.g., educational or university hospitals).
METHODS: This study was a descriptive retrospective study that research variables are checked
in 1 year before and mean of 3 years after implementation of HRP by self‑administrated checklist in
selected public‑educational hospitals covered by the medical universities in Tehran. The final analysis
of the data was performed using cost–performance ratio and independent t‑test for comparing the
variables’ changes before and after HRP.
RESULTS: Unlike adjusted hospitalization costs, most operational indexes were not significant.
The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased
49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48%
and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared
to before HRP (P < 0.001).
CONCLUSION: Given the lack of alignment in adjusted cost changes in exchange for functional
indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the
hospitals.

Abstract CONTEXT: Selecting variables is a fundamental step in evaluating comparative efficiency because
the results of measuring efficiency depend on the used variables.
AIMS: The aim of this study is to provide a comprehensive set of input and output variables for
measuring efficiency with an emphasis on application in general hospitals in Iran.
MATERIALS AND METHODS: This study comprised a literature review followed by a Delphi survey
process. After extracting the variables from the literature review in order to reach consensus on them
and identify the native variables, the researchers used the Delphi technique in three rounds. Thirty
Iranian hospital managers, in Alborz, Saveh, Qazvin, Qom, and Hamadan universities, participated
in this study. For analysis, the interquartile range (IQR) and median were used. IQR was used to
assess the agreement of Delphi panel members.
RESULTS: After literature review, nine indicators were identified as input variables and 11 indicators
were identified as output variables. After the proposed changes by Delphi members, 24 input variables
and 24 output variables were identified to measure hospital efficacy. Finally, ten variables were
selected as inputs and ten variables were selected as outputs to measure the performance of public
hospitals in Iran by using the consensus of the members in the Delphi panel.
CONCLUSIONS: This study proposes a framework for selecting the most appropriate variables for
measuring the hospital efficiency with an emphasis on nonparametric methods. Choosing variables
to measure hospital efficiency requires infrastructure such as an intelligent information system.