Developing criteria for Cesarean Section using the RAND appropriateness method

Ostovar, Rahim; Rashidian, Arash; Pourreza, Abolghasem; Rashidi, Batool Hossein; Hantooshzadeh, Sedigheh; Ardebili, Hassan Eftekhar; Mahmoudi, Mahmood

doi:10.1186/1471-2393-10-52

Cited by 32 publications

(42 citation statements)

References 32 publications

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“…Since low back pain (LBP) is one of the most prevalent disorders (19, 20) and there is little consensus among the specialists about appropriate LBP procedures (21, 22), we aimed to identify the appropriate criteria for utilization of MRI in LBP patients based on the viewpoints of the experts in the country. The result of this study may be useful for policymakers as well as clinicians in Iran and in other low and middle income countries.…”

Section: Objectivesmentioning

confidence: 99%

Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM)

et al. 2012

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BackgroundStudies show that a large proportion of healthcare offered may be inappropriate or unnecessary. Magnetic resonance imaging (MRI) is a new and expensive diagnostic technology which has been increasingly used all over the world. Moreover, this trend has been more rapidly increasing in Iran. Low back pain is a common disorder all over the world and MRI technique is one of the several ways to assess its cause.ObjectivesThe present study aims to develop scenarios for lumbar spine MRI.Materials and MethodsIn the present study, the RAND Appropriateness Method (RAM) was used in order to reach consensus regarding developing scenarios for lumbar spine MRI. We generated scenarios from valid clinical guidelines as well as the experts’ opinion. The panel members included nine specialists from various medical specialties that had scored scenarios in two rounds, the first of which was without interaction, while the second one was with interaction.ResultsWe extracted 97 scenarios for the lumbar spine MRI in the scenario extracting phase of the study and the panel members added 18 scenarios. After implementation of two rounds, the scenarios were categorized into three ranges. Sixty seven (58%) of the scenarios were considered as appropriate, 45 (39%) as uncertain, and three (2.6%) as inappropriate.ConclusionsRAM is useful for identifying stakeholder views in settings with limited resources. Since RAM has precise instructions for consensus developing, a large number of scenarios were considered as uncertain. Therefore, more research has to be conducted on the issue.

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Section: Objectivesmentioning

confidence: 99%

Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM)

et al. 2012

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“…Special attention should be paid to evaluating the efficiency and appropriate application of the facilities in health care systems to achieve the highest efficiency (2,3).…”

Section: Introductionmentioning

confidence: 99%

The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014

et al. 2016

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Background: Investigating the conditions and the appropriateness of admission of patients in hospitals is an important issue which can improve the efficiency of health care delivery. Intensive care unit (ICU) is important due to applying expensive financial sources; therefore, its efficient application is of great priority. In this regard, the current study aimed to determine the financial burden of inappropriate admissions in internal intensive care units (IICUs). Methods: It was a cross-sectional study conducted in 2014. A total of 294 patients admitted to IICUs of Shahid Faghihi and Nemazee hospitals of Shiraz, Iran, in 2012 were enrolled into this retrospective study. The study was conducted in two phases, using the guidelines of American critical care association (ACCA) and experts' opinion to investigate the financial burden of inappropriate admissions in IICUs of the above-mentioned hospitals. Results:The results showed no statistically significant relationships among insurance status, insurance type, age, gender and inappropriate admission by applying Chi-square. Among 294 admitted patients under the study, the inappropriate admissions were 11.2% based on the guidelines and 13.6% based on the experts' opinion. The level of agreement of the guidelines and experts' opinion for the inappropriate admissions was 0.076 based on Kappa coefficient. The total financial burden imposed on the insurance agencies and the patients by inappropriate admissions was US$ 47867.78 based on the guidelines and US$ 83241.68 based on the experts' opinion. Conclusions: Inappropriate admissions to ICUs may impose additional costs to the health system and the patients on one hand, and deprives other patients from receiving health services. Therefore, it is crucial to effectively plan for the application of ICU beds.

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“…One of the important factors is the choice of hospital. In our previous studies, CS rate was much higher in private than public hospitals and inappropriate CS comprises around 47% of all CS [24,25]. The difference in CS rate in public and private hospitals is mainly related to factors such as management and supervision, large differences between the costs of public and private hospitals, much higher costs of CS as compared to NVD, especially in the private sector and the therapeutic insurance coverage.…”

Section: Discussionmentioning

confidence: 95%

Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences

Ostovar¹,

Rashidi²,

Haghallahi³

et al. 2013

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Background: Kind of delivery affect many aspects of individuals, families and health systems situations. The aim of this study was to identify the Role of nonmedical factors on choice of delivery (CS/NVD) in hospitals affiliated to Tehran University of Medical Sciences. Materials and Method: This cross-sectional study was performed to identify the factors involved in the choice of delivery (CS/NVD) among women attending hospitals affiliated to Tehran University of Medical Sciences. Data was derived from the medical records of women who gave birth in the hospitals. Results: A significant statistical relationship was found between factors such as age of mother, level of education, occupational status, type of previous delivery, person supervising the pregnancy and dissatisfaction about delivery were more frequent in women who underwent CS than those who gave birth by NVD. Conclusion: The highly increasing rise in the rate of unnecessary CS during throughout the world, and its adverse effect on maternal and child health, the financial burden imposed on families and health systems, has highlighted the importance of studies to identify the non-medical factors that affect decisionmaking concerning type of delivery as well as to determine the appropriate medical indications of CS.

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Developing criteria for Cesarean Section using the RAND appropriateness method

Cited by 32 publications

References 32 publications

Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM)

Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM)

The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014

Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences

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