Aghaei Hashjin Asgar, Kringos Dionne S, Manoochehri Jila, Aryankhesal Aidin, Klazinga Niek S
Department of Public Health, Academic Medical Center (AMC)/University of Amsterdam, Postbox: 22660, 1100 DD Amsterdam, The Netherlands.
BMC Health Serv Res. 2014 Oct 1;14:448. doi: 10.1186/1472-6963-14-448.
Iran developed a national hospital performance measurement program (HPMP) which has been implemented annually throughout its hospitals since 1997. However, little is known yet about its development and the impact of the program on hospital performance.This study aims to describe the development and process of implementation of the HPMP, and to explore the impact on hospital performance by looking at the trends of performance scores of all different types of Iranian hospitals.
This was a mixed method study consisting of longitudinal data and qualitative document analysis. Hospital performance data over the period of 2002 to 2008 was analysed.
Iran instituted a comprehensive HPMP and implemented it in all hospitals since 1997. The program followed a phased development to stimulate performance and quality improvement in hospitals. Overall, the program has had a positive impact on the performance of general and specialized hospitals. The performance of general hospitals did not appear to be associated with their size or affiliated university ranking. However, the rate of performance improvement of general teaching and private hospitals was significantly lower than the average improvement rate of all general hospitals. There was no relationship between teaching status of the specialized hospitals and their level of performance. However, the performance of the governmental specialized hospitals showed a substantial decline over time. Moreover, among specialized hospitals, the bigger sized and those affiliated with higher ranked universities, reported better performance.
Overall, the development and implementation of an obligatory HPMP in Iran has improved the level of performance in general and specialized hospitals. However, there is room for further performance improvement especially in the general teaching, private, and governmental specialized hospitals. Reconsidering the ownership type, funding mechanisms and responsibility for the HPMP may have an impact on the absolute level of performance and improvement capacity of hospitals. In addition, the role and composition of survey teams, mechanism of implementation according to the characteristics of hospitals, and updating standards are important factors to promote performance improvement and hospital accreditation requirements.
伊朗制定了一项全国医院绩效评估计划（HPMP），自1997年起每年在其所有医院实施。然而，关于该计划的发展情况及其对医院绩效的影响，目前所知甚少。本研究旨在描述HPMP的发展及实施过程，并通过观察伊朗各类医院绩效得分的趋势，探讨其对医院绩效的影响。
这是一项混合方法研究，包括纵向数据和定性文献分析。分析了2002年至2008年期间的医院绩效数据。
伊朗自1997年起制定并在所有医院实施了全面的HPMP。该计划分阶段发展，以促进医院绩效和质量提升。总体而言，该计划对综合医院和专科医院的绩效产生了积极影响。综合医院的绩效似乎与其规模或附属大学排名无关。然而，综合教学医院和私立医院的绩效改善率明显低于所有综合医院的平均改善率。专科医院的教学状况与其绩效水平之间没有关系。然而，政府专科医院的绩效随时间大幅下降。此外，在专科医院中，规模较大且附属大学排名较高的医院，绩效表现更好。
总体而言，伊朗强制性HPMP的发展和实施提高了综合医院和专科医院的绩效水平。然而，仍有进一步提升绩效的空间，特别是在综合教学医院、私立医院和政府专科医院。重新考虑HPMP的所有制类型、资金机制和责任，可能会对医院的绝对绩效水平和改善能力产生影响。此外，调查团队的角色和构成、根据医院特点的实施机制以及标准更新，是促进绩效提升和医院认证要求的重要因素。
