Document Type : Original Article
Authors
- . Niusha Shahidi Sadeghi
- . Mohammadreza Maleki
- . Hassan Abolghasem Gorji
- . Soudabeh Vatankhah
- . Bahram Mohaghegh
Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran
Abstract
BACKGROUND: In terms of missions, hospitals are divided into teaching and nonteaching. In addition,
differences in health‑care systems in countries will lead to differences in hospitals’ operation. Iran, as
a specific health‑care system, is different from other countries. Hence, the present study investigated
differences between teaching and nonteaching hospitals and their differences in Iran and the world.
MATERIALS AND METHODS: A concurrent mixed‑methods study was conducted in two stages.
The first stage was a narrative review of studies (2000–2020). Using narrative inquiry and reflective
analysis, the content was analyzed and the categories were extracted. The second stage was a
qualitative study conducted using semi‑structured interviews with forty Iranian hospital managers and
policymakers through a purposive sampling in 2020. Content analysis was made using deductive
approach, and MAXQDA 12 was used for data analysis.
RESULTS: According to the first stage, categories were extracted as follows: service quality, type
of cases, patient satisfaction, efficiency, performance indicators, patient safety, personnel, use of
drugs, access to services, technologies, justice in the type of services received, using guidelines,
processes, and number of services. In the second stage, 8 main categories, 17 categories, and 45
subcategories were extracted. The extracted main categories were as follows: mission and target,
management and behavioral organizations, supply chain and chain of results, human resources,
costs and budget, policy demands, clients’ satisfaction and patients’ right, and integration of medical
education.
CONCLUSION: Unlike other countries, in Iran, the combination of missions and the complete
dependence of teaching hospitals on the government has caused differences. Reducing the treatment
mission of teaching hospitals; differences in the budget and development of its indicators; lower tariffs
for teaching hospitals; developing a cost–income management model and supply chain; preventing
uncertainty other than medical students except medicine; considering the clients’ right to choose
hospital; and organizing research missions in hospitals were the solutions for decrease differences.
Keywords
1. Coid DR, Davies H. Structural change in health care: What’s the
attraction? J R Soc Med 2008;101:278‑81.
2. Marandi SA. The integration of medical education and health
care services in the IR of Iran and its health impacts. Iran J Public
Health 2009;38 Suppl 1:4‑12.
3. Safarani S. Presenting a Management Pattern for Iranian Teaching
Hospitals. Tehran: Iran University of Medical Sciences; 2019.
4. Ministry of Health Tame. Center for Hospital Management and
Clinical Services Excellence Statistical Report From Hospital
Statistics and Information System (Avab). June 2018 ed. Tehran:
Ministry of Health, Treatment and Medical Education; 2018.
Available from: http://Td.Lums.Ac.Ir.[Last accessed on June
2020;Last updated on 2018 June 2].
5. Memtsoudis SG, Poeran J, Zubizarreta N, Rasul R, Opperer M,
Mazumdar M. Anesthetic care for orthopedic patients: Is there a
potential for differences in care? Anesthesiology 2016;124:608‑23.
6. Stephenson‑Laws JF. Navigating Hospitals: Teaching Hospital vs.
Non‑Teaching, Does It Matter? Available from: https://Phlabs.
com. [Last accessed on 2020 Oct 18; Last updated on 2018 Oct 18].
7. Nuti S, Grillo Ruggieri T, Podetti S. Do university hospitals
perform better than general hospitals? A comparative analysis
among Italian regions. BMJ Open 2016;6:e011426.
8. Castro Lobo MS, Lins MP, Silva AC, Fiszman R. Assessment of
teaching‑health care integration and performance in university
hospitals. Rev Saude Publica 2010;44:581‑90.
9. Shahian DM, Liu X, Meyer GS, Normand SL. Comparing
teaching versus nonteaching hospitals: The association of patient
characteristics with teaching intensity for three common medical
conditions. Acad Med 2014;89:94‑106.
10. Silber JH, Rosenbaum PR, Niknam BA, Ross RN, Reiter JG,
Hill AS, et al. Comparing outcomes and costs of medical patients
treated at major teaching and non‑teaching hospitals: A national
matched analysis. J Gen Intern Med 2020;35:743‑52.
11. Czarnecki A, Qiu F, Koh M, Cheskes S, Dorian P, Scales DC, et al.
Association between hospital teaching status and outcomes after
out‑of‑hospital cardiac arrest. Circ Cardiovasc Qual Outcomes
2019;12:e005349.
12. Kotwal S, Abougergi MS, Wright S. Differences in healthcare
outcomes between teaching and non teaching hospitals for
patients with delirium: A retrospective cohort study. Int J Qual
Health Care 2019;31:378‑84.
13. Burke LG, Khullar D, Zheng J, Frakt AB, Orav EJ, Jha AK.
Comparison of costs of care for Medicare patients hospitalized
in teaching and nonteaching hospitals. JAMA Netw Open
2019;2:e195229.
14. Valencia V, Arora VM, Ranji SR, Meza C, Moriates C.
A comparison of laboratory testing in teaching vs nonteaching
hospitals for 2 common medical conditions. JAMA Intern Med
2018;178:39‑47.
15. Cron DC, Hwang C, Hu HM, Lee JS, Dupree JM, Syrjamaki JD,
et al. A statewide comparison of opioid prescribing in teaching
versus nonteaching hospitals. Surgery 2019;165:825‑31.
16. Naghizadeh S, Sehhati F, Atri BS, Ebrahimi H, Egdampour F.
Assessment and comparison of mothers’ satisfaction with physical
care during labor, delivery and postpartum care in teaching and
non‑teaching maternity hospitals of Tabriz. WOMAN and STUDY
OF FAMILY 2011;4:129‑41.
17. Khoeiniha F, Sheikhi M, Aam S, Aa M. Nurses’ clinical
performance assessment in critical care units in teaching and
non‑teaching hospitals in Qazvin city: Based on synergy model.
Journal of Health promotion Manangement 2016;5:28‑36.
18. Naderi Manesh K, Nasiripour A, Masoudi Asl S, Babouei A,
Ostovar R, Rezanjad M. The study of the status of performance
indicators in selected educational and non‑educational hospitals
of Tehran Province. Armaghane Danesh 2021;25:104‑17.
19. Association Ah. Teaching Hospitals: Their Impact on Patients and
the Future Health Care Workforce. Washington, USA: Association
of American Medical Colleges, Report No.: 202.638.1100; 2009.
20. Souba W, Notestine M, Way D, Lucey C, Yu L, Sedmak D. Do
deans and teaching hospital CEOs agree on what it takes to be a
successful clinical department chair? Acad Med 2011;86:974‑81.
21. Ellis MC, Diggs BS, Vetto JT, Herzig DO. Trends in the surgical
treatment of ulcerative colitis over time: Increased mortality and
centralization of care. World J Surg 2011;35:671‑6.
22. Zelle BA, Morton‑Gonzaba NA, Adcock CF, Lacci JV, Dang KH,
Seifi A. Healthcare disparities among orthopedic trauma patients
in the USA: Socio‑demographic factors influence the management
of calcaneus fractures. J Orthop Surg Res 2019;14:359 23. Gopaldas RR, Overbey DM, Dao TK, Markley JG. The
impact of academic calendar cycle on coronary artery bypass
outcomes: A comparison of teaching and non‑teaching hospitals.
J Cardiothorac Surg 2013;8:191.
24. Patel DB, Shah RM, Bhatt DL, Liang L, Schulte PJ, Devore AD,
et al. Guideline‑appropriate care and in‑hospital outcomes in
patients with heart failure in teaching and nonteaching hospitals:
Findings from get with the guidelines–heart failure. Circulation
2016;9:757‑66.
25. Gopaldas RR, Bakaeen FG, Dao TK, Coselli JS, LeMaire SA,
Huh J, et al. Outcomes of concomitant aortic valve replacement
and coronary artery bypass grafting at teaching hospitals versus
nonteaching hospitals. J Thorac Cardiovasc Surg 2012;143:648‑55.
26. Greving JP, Denig P, de Zeeuw D, Haaijer‑Ruskamp FM.
Physicians’ attitudes towards treatment guidelines: Differences
between teaching and nonteaching hospitals. Eur J Clin Pharmacol
2006;62:129‑33.
27. Holena DN, Hadler R, Wirtalla C, Carr B, Morris JB, Kelz RR.
Teaching status: The impact on emergency and elective surgical
care in the US. Ann Surg 2011;253:1017‑23.
28. Holscher CM, Aridi HD, Locham SS, Hicks CW, Canner JK,
Malas M, et al. Aortic surgery outcomes of Marfan syndrome and
Ehlers–Danlos syndrome patients at teaching and nonteaching
hospitals. Ann Vasc Surg 2019;55:175‑81.e3.
29. Masoomi H, Wirth GA, Paydar KZ, Richland BK, Evans GR.
Perioperative outcomes of autologous breast reconstruction
surgery in teaching versus nonteaching hospitals. Plast Reconstr
Surg 2014;134:514e‑520e.
30. Murata A, Matsuda S, Kuwabara K, Ichimiya Y, Fujino Y,
Kubo T,et al. Equivalent clinical outcomes of bleeding peptic
ulcers in teaching and non‑teaching hospitals: Evidence for
standardization of medical care in Japan. Tohoku J Exp Med
2011;223:1‑7.
31. Sandhu A, Moscucci M, Dixon S, Wohns DH, Share D, LaLonde T,
et al. Differences in the outcome of patients undergoing
percutaneous coronary interventions at teaching versus
non‑teaching hospitals. Am Heart J 2013;166:401‑8.
32. Zafar SN, Shah AA, HashmiZG, Efron DT, Haut ER, Schneider EB,
et al. Outcomes after emergency general surgery at teaching
versus nonteaching hospitals. J Trauma Acute Care Surg
2015;78:69‑76.
33. Sharma M, Eriksson B, Marrone G, Dhaneria S, Lundborg CS.
Antibiotic prescribing in two private sector hospitals; one teaching
and one non‑teaching: A cross‑sectional study in Ujjain, India.
BMC Infect Dis 2012;12:155.
34. Dumont TM, Tranmer BI, Horgan MA, Rughani AI. Trends in
neurosurgical complication rates at teaching vs nonteaching
hospitals following duty‑hour restrictions. Neurosurgery
2012;71:1041‑6.
35. Abusaada K, Alsaleh L, Herrera V, Du Y, Baig H, Everett G.
Comparison of hospital outcomes and resource use in acute COPD
exacerbation patients managed by teaching versus nonteaching
services in a community hospital. J Eval Clin Pract 2017;23:625‑30.
36. Amarneh BH. Social support behaviors and work stressors among
nurses: A comparative study between teaching and non‑teaching
hospitals. Behav Sci 2017;7:5.
37. De La Garza‑Ramos R, Jain A, Kebaish KM, Bydon A, Passias PG,
Sciubba DM. Inpatient morbidity and mortality after adult spinal
deformity surgery in teaching versus nonteaching hospitals.
J Neurosurg Spine 2016;25:15‑20.
38. Grosskopf S, Margaritis D, Valdmanis V. Comparing teaching
and non‑teaching hospitals: A frontier approach (teaching vs.
non‑teaching hospitals). Health Care Manag Sci 2001;4:83‑90.
39. Nandyala SV, Marquez‑Lara A, Fineberg SJ, Hassanzadeh H,
Singh K. Complications after lumbar spine surgery between
teaching and nonteaching hospitals. Spine (Phila Pa 1976)
2014;39:417‑23.
40. Lichtman JH, Jones SB, WangY, Leifheit‑Limson EC, Goldstein LB.
Seasonal variation in 30‑day mortality after stroke: Teaching
versus nonteaching hospitals. Stroke 2013;44:531‑3.
41. Perez JA Jr., Awar M, Nezamabadi A, Ogunti R, Puppala M,
Colton L, et al. Comparison of direct patient care costs and quality
outcomes of the teaching and nonteaching hospitalist services at
a Large Academic Medical Center. Acad Med 2018;93:491‑7.
42. Shahian DM, Nordberg P, Meyer GS, Blanchfield BB, Mort EA,
Torchiana DF, et al. Contemporary performance of us teaching
and nonteaching hospitals. Acad Med 2012;87:701‑8.
43. Messina DJ, Scotti DJ, Ganey R, Zipp GP. The relationship between
patient satisfaction and inpatient admissions across teaching and
nonteaching hospitals. J Healthc Manag 2009;54:177‑89.
44. Moosavisadat SM, LamyianM, ParsapS, HajizadehE. Comparison
of maternity care quality in teaching and non‑teaching hospitals
in Khorram Abad, Islamic Republic of Iran. East Mediterr Health
J 2011;17:638‑45.
45. Aghaei Hashjin A, Kringos DS, Manoochehri J, Aryankhesal A,
Klazinga NS. Development and impact of the Iranian hospital
performance measurement program. BMC Health Serv Res
2014;14:448.
46. Bastani P, Vatankhah S, Salehi M. Performance ratio analysis:
A national study on Iranian hospitals affiliated to ministry of
health and medical education. Iran J Public Health 2013;42:876‑82.
47. Keyvanara M, Zardoeigolanbar S, Karimi S, Saghaeiannejad IS.
The quality of death certificates record in the educational and
non‑educational hospitals in Kermanshah. Health Information
Management 2011;8:32.
48. Askarian M, Vakili M, Kabir G. Hospital waste management status
in university hospitals of the Fars province, Iran. Int J Environ
Health Res 2004;14:295‑305.
49. Dehghani M, Hayavi Haghighi MH, Tavassoli‑Farahi M.
A comparison of teaching and non‑teaching hospitals emergency
centers information management systems of Hormozgan
University of Medical Sciences. J Mod Med Inf Sci 2015;1:70‑9.
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attraction? J R Soc Med 2008;101:278‑81.
2. Marandi SA. The integration of medical education and health
care services in the IR of Iran and its health impacts. Iran J Public
Health 2009;38 Suppl 1:4‑12.
3. Safarani S. Presenting a Management Pattern for Iranian Teaching
Hospitals. Tehran: Iran University of Medical Sciences; 2019.
4. Ministry of Health Tame. Center for Hospital Management and
Clinical Services Excellence Statistical Report From Hospital
Statistics and Information System (Avab). June 2018 ed. Tehran:
Ministry of Health, Treatment and Medical Education; 2018.
Available from: http://Td.Lums.Ac.Ir.[Last accessed on June
2020;Last updated on 2018 June 2].
5. Memtsoudis SG, Poeran J, Zubizarreta N, Rasul R, Opperer M,
Mazumdar M. Anesthetic care for orthopedic patients: Is there a
potential for differences in care? Anesthesiology 2016;124:608‑23.
6. Stephenson‑Laws JF. Navigating Hospitals: Teaching Hospital vs.
Non‑Teaching, Does It Matter? Available from: https://Phlabs.
com. [Last accessed on 2020 Oct 18; Last updated on 2018 Oct 18].
7. Nuti S, Grillo Ruggieri T, Podetti S. Do university hospitals
perform better than general hospitals? A comparative analysis
among Italian regions. BMJ Open 2016;6:e011426.
8. Castro Lobo MS, Lins MP, Silva AC, Fiszman R. Assessment of
teaching‑health care integration and performance in university
hospitals. Rev Saude Publica 2010;44:581‑90.
9. Shahian DM, Liu X, Meyer GS, Normand SL. Comparing
teaching versus nonteaching hospitals: The association of patient
characteristics with teaching intensity for three common medical
conditions. Acad Med 2014;89:94‑106.
10. Silber JH, Rosenbaum PR, Niknam BA, Ross RN, Reiter JG,
Hill AS, et al. Comparing outcomes and costs of medical patients
treated at major teaching and non‑teaching hospitals: A national
matched analysis. J Gen Intern Med 2020;35:743‑52.
11. Czarnecki A, Qiu F, Koh M, Cheskes S, Dorian P, Scales DC, et al.
Association between hospital teaching status and outcomes after
out‑of‑hospital cardiac arrest. Circ Cardiovasc Qual Outcomes
2019;12:e005349.
12. Kotwal S, Abougergi MS, Wright S. Differences in healthcare
outcomes between teaching and non teaching hospitals for
patients with delirium: A retrospective cohort study. Int J Qual
Health Care 2019;31:378‑84.
13. Burke LG, Khullar D, Zheng J, Frakt AB, Orav EJ, Jha AK.
Comparison of costs of care for Medicare patients hospitalized
in teaching and nonteaching hospitals. JAMA Netw Open
2019;2:e195229.
14. Valencia V, Arora VM, Ranji SR, Meza C, Moriates C.
A comparison of laboratory testing in teaching vs nonteaching
hospitals for 2 common medical conditions. JAMA Intern Med
2018;178:39‑47.
15. Cron DC, Hwang C, Hu HM, Lee JS, Dupree JM, Syrjamaki JD,
et al. A statewide comparison of opioid prescribing in teaching
versus nonteaching hospitals. Surgery 2019;165:825‑31.
16. Naghizadeh S, Sehhati F, Atri BS, Ebrahimi H, Egdampour F.
Assessment and comparison of mothers’ satisfaction with physical
care during labor, delivery and postpartum care in teaching and
non‑teaching maternity hospitals of Tabriz. WOMAN and STUDY
OF FAMILY 2011;4:129‑41.
17. Khoeiniha F, Sheikhi M, Aam S, Aa M. Nurses’ clinical
performance assessment in critical care units in teaching and
non‑teaching hospitals in Qazvin city: Based on synergy model.
Journal of Health promotion Manangement 2016;5:28‑36.
18. Naderi Manesh K, Nasiripour A, Masoudi Asl S, Babouei A,
Ostovar R, Rezanjad M. The study of the status of performance
indicators in selected educational and non‑educational hospitals
of Tehran Province. Armaghane Danesh 2021;25:104‑17.
19. Association Ah. Teaching Hospitals: Their Impact on Patients and
the Future Health Care Workforce. Washington, USA: Association
of American Medical Colleges, Report No.: 202.638.1100; 2009.
20. Souba W, Notestine M, Way D, Lucey C, Yu L, Sedmak D. Do
deans and teaching hospital CEOs agree on what it takes to be a
successful clinical department chair? Acad Med 2011;86:974‑81.
21. Ellis MC, Diggs BS, Vetto JT, Herzig DO. Trends in the surgical
treatment of ulcerative colitis over time: Increased mortality and
centralization of care. World J Surg 2011;35:671‑6.
22. Zelle BA, Morton‑Gonzaba NA, Adcock CF, Lacci JV, Dang KH,
Seifi A. Healthcare disparities among orthopedic trauma patients
in the USA: Socio‑demographic factors influence the management
of calcaneus fractures. J Orthop Surg Res 2019;14:359 23. Gopaldas RR, Overbey DM, Dao TK, Markley JG. The
impact of academic calendar cycle on coronary artery bypass
outcomes: A comparison of teaching and non‑teaching hospitals.
J Cardiothorac Surg 2013;8:191.
24. Patel DB, Shah RM, Bhatt DL, Liang L, Schulte PJ, Devore AD,
et al. Guideline‑appropriate care and in‑hospital outcomes in
patients with heart failure in teaching and nonteaching hospitals:
Findings from get with the guidelines–heart failure. Circulation
2016;9:757‑66.
25. Gopaldas RR, Bakaeen FG, Dao TK, Coselli JS, LeMaire SA,
Huh J, et al. Outcomes of concomitant aortic valve replacement
and coronary artery bypass grafting at teaching hospitals versus
nonteaching hospitals. J Thorac Cardiovasc Surg 2012;143:648‑55.
26. Greving JP, Denig P, de Zeeuw D, Haaijer‑Ruskamp FM.
Physicians’ attitudes towards treatment guidelines: Differences
between teaching and nonteaching hospitals. Eur J Clin Pharmacol
2006;62:129‑33.
27. Holena DN, Hadler R, Wirtalla C, Carr B, Morris JB, Kelz RR.
Teaching status: The impact on emergency and elective surgical
care in the US. Ann Surg 2011;253:1017‑23.
28. Holscher CM, Aridi HD, Locham SS, Hicks CW, Canner JK,
Malas M, et al. Aortic surgery outcomes of Marfan syndrome and
Ehlers–Danlos syndrome patients at teaching and nonteaching
hospitals. Ann Vasc Surg 2019;55:175‑81.e3.
29. Masoomi H, Wirth GA, Paydar KZ, Richland BK, Evans GR.
Perioperative outcomes of autologous breast reconstruction
surgery in teaching versus nonteaching hospitals. Plast Reconstr
Surg 2014;134:514e‑520e.
30. Murata A, Matsuda S, Kuwabara K, Ichimiya Y, Fujino Y,
Kubo T,et al. Equivalent clinical outcomes of bleeding peptic
ulcers in teaching and non‑teaching hospitals: Evidence for
standardization of medical care in Japan. Tohoku J Exp Med
2011;223:1‑7.
31. Sandhu A, Moscucci M, Dixon S, Wohns DH, Share D, LaLonde T,
et al. Differences in the outcome of patients undergoing
percutaneous coronary interventions at teaching versus
non‑teaching hospitals. Am Heart J 2013;166:401‑8.
32. Zafar SN, Shah AA, HashmiZG, Efron DT, Haut ER, Schneider EB,
et al. Outcomes after emergency general surgery at teaching
versus nonteaching hospitals. J Trauma Acute Care Surg
2015;78:69‑76.
33. Sharma M, Eriksson B, Marrone G, Dhaneria S, Lundborg CS.
Antibiotic prescribing in two private sector hospitals; one teaching
and one non‑teaching: A cross‑sectional study in Ujjain, India.
BMC Infect Dis 2012;12:155.
34. Dumont TM, Tranmer BI, Horgan MA, Rughani AI. Trends in
neurosurgical complication rates at teaching vs nonteaching
hospitals following duty‑hour restrictions. Neurosurgery
2012;71:1041‑6.
35. Abusaada K, Alsaleh L, Herrera V, Du Y, Baig H, Everett G.
Comparison of hospital outcomes and resource use in acute COPD
exacerbation patients managed by teaching versus nonteaching
services in a community hospital. J Eval Clin Pract 2017;23:625‑30.
36. Amarneh BH. Social support behaviors and work stressors among
nurses: A comparative study between teaching and non‑teaching
hospitals. Behav Sci 2017;7:5.
37. De La Garza‑Ramos R, Jain A, Kebaish KM, Bydon A, Passias PG,
Sciubba DM. Inpatient morbidity and mortality after adult spinal
deformity surgery in teaching versus nonteaching hospitals.
J Neurosurg Spine 2016;25:15‑20.
38. Grosskopf S, Margaritis D, Valdmanis V. Comparing teaching
and non‑teaching hospitals: A frontier approach (teaching vs.
non‑teaching hospitals). Health Care Manag Sci 2001;4:83‑90.
39. Nandyala SV, Marquez‑Lara A, Fineberg SJ, Hassanzadeh H,
Singh K. Complications after lumbar spine surgery between
teaching and nonteaching hospitals. Spine (Phila Pa 1976)
2014;39:417‑23.
40. Lichtman JH, Jones SB, WangY, Leifheit‑Limson EC, Goldstein LB.
Seasonal variation in 30‑day mortality after stroke: Teaching
versus nonteaching hospitals. Stroke 2013;44:531‑3.
41. Perez JA Jr., Awar M, Nezamabadi A, Ogunti R, Puppala M,
Colton L, et al. Comparison of direct patient care costs and quality
outcomes of the teaching and nonteaching hospitalist services at
a Large Academic Medical Center. Acad Med 2018;93:491‑7.
42. Shahian DM, Nordberg P, Meyer GS, Blanchfield BB, Mort EA,
Torchiana DF, et al. Contemporary performance of us teaching
and nonteaching hospitals. Acad Med 2012;87:701‑8.
43. Messina DJ, Scotti DJ, Ganey R, Zipp GP. The relationship between
patient satisfaction and inpatient admissions across teaching and
nonteaching hospitals. J Healthc Manag 2009;54:177‑89.
44. Moosavisadat SM, LamyianM, ParsapS, HajizadehE. Comparison
of maternity care quality in teaching and non‑teaching hospitals
in Khorram Abad, Islamic Republic of Iran. East Mediterr Health
J 2011;17:638‑45.
45. Aghaei Hashjin A, Kringos DS, Manoochehri J, Aryankhesal A,
Klazinga NS. Development and impact of the Iranian hospital
performance measurement program. BMC Health Serv Res
2014;14:448.
46. Bastani P, Vatankhah S, Salehi M. Performance ratio analysis:
A national study on Iranian hospitals affiliated to ministry of
health and medical education. Iran J Public Health 2013;42:876‑82.
47. Keyvanara M, Zardoeigolanbar S, Karimi S, Saghaeiannejad IS.
The quality of death certificates record in the educational and
non‑educational hospitals in Kermanshah. Health Information
Management 2011;8:32.
48. Askarian M, Vakili M, Kabir G. Hospital waste management status
in university hospitals of the Fars province, Iran. Int J Environ
Health Res 2004;14:295‑305.
49. Dehghani M, Hayavi Haghighi MH, Tavassoli‑Farahi M.
A comparison of teaching and non‑teaching hospitals emergency
centers information management systems of Hormozgan
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