Introduction The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. Method For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. Results After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. Discussion This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system’s resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

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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.

Background Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Background: Close contact tracing is an essential measure that countries are applying to combat the epidemic of COVID-19. The purpose of contact tracing is to rapidly identify potentially infected individuals and prevent further spread of the disease. In this study, based on the factors affecting the COVID-19 transmission, a scoring protocol is provided for close contact tracing. Methods: First, the factors affecting the COVID-19 transmission in close contacts were identified by a rapid review of the literature. Data were gathered by searching the Embase, PubMed, Google Scholar, and Scopus databases. Then, by formulating and scoring the identified factors with two sessions of the expert panel, close contact transmission risk score determined, and a protocol for contacts tracing was designed. Results: Close contact transmission risk depends on the contact environment characteristics, the infectivity (virus shedding) of the sentinel case, and contact characteristics. Based on these factors, the close contact transmission risk score and contact tracing protocol were prepared.   Conclusion: The close contact transmission risk scores will provide the ability to contact classifications and developing specific tracing strategies for them. Given that there are not any specific treatments for COVID-19 and lack of universal vaccination, applying nonpharmaceutical measures such as contact tracing along with physical distancing is very crucial. Therefore, we recommended this model to the evaluation of exposure risk and contact tracing.

Background Since December 2019, the novel coronavirus disease (COVID-19) has rapidly spread around the world leading to a pandemic with more than 3,000,000 infected people and more than 200,000 death. Several case definitions have been released and revised by countries and organizations. However, collectivization of case definitions has not been fully investigated.Methods In this study, we rapidly reviewed existing COVID-19 case definitions, finally a dynamic case definition algorithm was provided by using Bayesian theorem models of diagnosis.Results Our results showed categorization as suspected, probable, and confirmed cases, is used in majority of case definitions. Furthermore, the criteria for suspected cases and laboratory testing priority was a point of argument. Due to pandemic situation and resource limitation, diagnostic tests were rationed and mainly administered to a selected population, thus it was shown that the fraction of positive test results does not reflect the total infection rate of the population. Case definitions for COVID-19 is changing as we learn more about the disease. RT-PCR and CT Scan of lung seem to be beneficial in COVID-19 diagnosis and combing them with epidemiological criteria helps us in better understanding of the disease.Conclusion Based on our results, in the current case definitions, only symptomatic patients categorized and tested as a susceptible case. While the majority of COVID-19 cases are asymptomatic carriers of the disease, thus making the prevention more challenging. Dynamic statistical models can provide new insights into surveillance systems.

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (MRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.