Toofan Firooz, Hosseini Seyed Mojtaba, Alimohammadzadeh Khalil, Jafari Mehrnoosh, Bahadori Mohammadkarim
Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran.
Health Economics Policy Research Center, Tehran Medical Sciences Islamic Azad University, Tehran, Iran.
Med J Islam Repub Iran. 2022 Apr 14;36:35. doi: 10.47176/mjiri.36.35. eCollection 2022.
Today, multi-morbidity (MM), the presence of more than one disease in the same person at the same time, has been prevalent. This is while the healthcare delivery systems are formed based on a single-disease-oriented approach. Hence, this study intended to address presenting a model for the management of patients with multi-morbidity in Iranian hospitals. This was a mixed-method study. The data was gathered from 54 semi-structured interviews with the participation of experts in inpatient care management who were purposefully selected. The qualitative data were analyzed using content analysis. The Interpretive Structural Modeling (ISM) via STATA and Excel software was exploited in the quantitative phase. The factors affecting the management of patients with multi-morbidity were identified in 26 main themes and 142 sub-themes, and ultimately, a model for improving the management of patients with multi-morbidity in Iranian hospitals at six different levels was offered. The "Comprehensive Health Care Information System (CHIS) and Electronic Health Record (EHR)" had the greatest influence and the lowest dependency. "Efforts to remove patients' confusion" had the highest dependency and the lowest influence. The results of employing the Cross Impact Matrix Multiplication Applied to Classification (MICMAC) analysis demonstrated that most of the variables are placed in the third group of linkage variables that have high driving power and dependence power. Concerning the sophisticated needs of patients with multi-morbidity for the management of their clinical conditions, the presented model could be provided to policymakers and health care managers as a beneficial performance guideline for improving the quality of care.
如今，多重疾病（MM），即同一人在同一时间患有不止一种疾病的情况，已普遍存在。然而，医疗服务提供系统是基于单一疾病导向的方法构建的。因此，本研究旨在提出一种伊朗医院多重疾病患者管理模型。这是一项混合方法研究。数据来自对54名经过目的抽样选取的住院护理管理专家进行的半结构化访谈。定性数据采用内容分析法进行分析。定量阶段利用STATA和Excel软件进行解释性结构建模（ISM）。确定了影响多重疾病患者管理的26个主要主题和142个子主题中的因素，最终提供了一个在六个不同层面改善伊朗医院多重疾病患者管理的模型。“综合医疗保健信息系统（CHIS）和电子健康记录（EHR）”影响最大且依赖性最低。“消除患者困惑的努力”依赖性最高且影响最低。应用交叉影响矩阵乘法分类法（MICMAC）分析的结果表明，大多数变量属于具有高驱动力和依赖力的第三组联动变量。鉴于多重疾病患者对其临床状况管理的复杂需求，所提出的模型可作为提高护理质量的有益绩效指南提供给政策制定者和医疗保健管理者。
