The healthcare sector in general and hospitals in particular represent a main application area for Data Envelopment Analysis (DEA). This paper reviews 262 papers of DEA applications in healthcare with special focus on hospitals and therefore closes a gap of over ten years that were not covered by existing review articles. Apart from providing descriptive statistics of the papers, we are the first to examine the research purposes of the publications. These research goals can be grouped into four distinct clusters according to our proposed framework. The four clusters are (1) "Pure DEA efficiency analysis", i.e. performing a DEA on hospital data, (2) "Developments or applications of new methodologies", i.e. applying new DEAy approaches on hospital data, (3) "Specific management question", i.e. analyzing the effects of managerial specification, such as ownership, on hospital efficiency, and (4) "Surveys on the effects of reforms", i.e. researching the impact of policy making, such as reforms of health systems, on hospital efficiency. Furthermore, we analyze the methodological settings of the studies and describe the applied models. We analyze the chosen inputs and outputs as well as all relevant downstream techniques. A further contribution of this paper is its function as a roadmap to important methodological literature and publications, which provide crucial information on the setup of DEA studies. Thus, this paper should be of assistance to researchers planning to apply DEA in a hospital setting by providing information on a) what has been published between 2005 and 2016, b) possible pitfalls when setting up a DEA analysis, and c) possible ways to apply the DEA analysis in practice. Finally, we discuss what could be done to advance DEA from a scientific tool to an instrument that is actually utilized by managers and policymakers.

The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals.

China had proposed the unification of equity and efficiency since the launch of the new round of health system reform in 2009 And the central government gave priority to the development of primary health care (PHC) whilst ensuring its availability and improving its efficiency This study aimed to evaluate the changes of equity and efficiency in PHC resource allocation (PHCRA) and explored ways to improve the current situation The data of this study came from the China Health Statistical Yearbook (2013–2017) and China Statistical Yearbook (2017) Three and five indicators were used to measure equity and efficiency, respectively The Lorenz curve, Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were used to assess equity in demographic and geographical dimensions Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were chosen to measure the efficiency and productivity of PHCRA From 2012 to 2016, the total amount of PHCR had increased year by year The Gs by population size were below 02 and that by geographical area were between 06 and 07 T had the same trend with G, and intra-regional contribution rates were higher than inter-regional contribution rates, which were all beyond 60% From 2012 to 2016, the numbers of provinces that achieved an effective DEA were 4, 3, 4, 5 and 5, respectively The mean of the total factor productivity index was 0994 The equity of PHCRA in terms of population size is superior in the geographical area Intra-regional differences are the main source of inequality The eastern region has the highest density of PHCR, whereas the western region has the lowest In addition, PHC institutions in more than 80% of the provinces are inefficient, and the productivity of the institutions decline by 06% from 2012 to 2016 because of technological retrogression

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Equity and efficiency of primary health care resource allocation in mainland China

Purpose The five-dimension service quality (SERVQUAL) scale is one of the most common tools for evaluating gaps between clients' perceptions and expectations. This study aimed to assess the quality of health services in Iran through a meta-analysis of all Iranian studies which used the SERVQUAL tool. Data sources A systematic literature review has been performed in Web of Science, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and Scientific Information Database. Study selection All relevant English or Persian studies published between January 2009 and April 2016 were have been selected. Papers were considered if they regarded all five dimensions of the SERVQUAL tool for assessing the quality of health care services. Data extraction Two reviewer independently extracted mean and standard deviation of five dimensions and characteristics of studies. The quality of studies included in meta-analysis using STROBE checklist. Results of data synthesis Of 315 studies initially identified, 12 were included in our meta-analysis. All analyses were performed in Stata MP v. 14. Patients' perceptions were lower than their expectations (gap = -1.64). Responsibility (-1.22) and reliability (-1.15) had the lowest gaps, and tangibility and empathy (-1.03) had the largest gaps. Except gender, other variables had no significant associations with gaps. Patients in the cities of Arak (-3.47) and Shiraz (-3.02) had the largest gaps. Conclusions All dimensions of service quality were negative, which implies that the quality of health services in Iran has not been satisfying to patients and needs to be improved.

Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis.

Colorectal cancer screening saves lives and is cost-effective. It allows early detection of the pathology, and enables earlier medical intervention. Despite clinical practice guidelines promoting screening for average risk individuals, uptake remains suboptimal in many populations. Few studies have examined how sociobehavioural factors influence screening uptake in the context of behaviour change theories such as the health belief model. This systematic review therefore examines how the health belief model's constructs are associated with colorectal cancer screening. Four databases were systematically searched from inception to September 2019. Quantitative observational studies that used the health belief model to examine colorectal screening history, intention or behaviour were included. A total of 30 studies met the criteria for review; all were of cross-sectional design. Perceived susceptibility, benefits and cues to action were directly associated with screening history or intention. Perceived barriers inversely associated with screening history or intention. The studies included also found other modifying factors including sociodemographic and cultural norms. Self-report of screening history, intention or behaviour, convenience sampling and lack of temporality among factors were common limitations across studies. The health belief model's associations with colorectal cancer screening uptake was consistent with preventive health behaviours in general. Future studies should examine how theory-based behavioural interventions can be tailored to account for the influence of socioecological factors.

The health belief model and colorectal cancer screening in the general population: A systematic review.

COVID-19 has become a global pandemic, with over 81 million cases worldwide. To assess changes in tobacco use as a result of the pandemic, we surveyed a convenience sample of current tobacco users between April and June 2020. The sample was taken from a tobacco user research registry (n = 3396) from the Penn State College of Medicine in Hershey, Pennsylvania, USA. Participants who responded to the survey and were eligible for this study (n = 291) were 25.6% male, 93% white, and had a mean age of 47.3 (SD = 11.6) years. There were no reports of participants testing positive for COVID-19, but 21.7% reported experiencing symptoms associated with the virus. Most participants (67%) believed that their risk of contracting COVID-19 was the same as non-tobacco users, but 57.7% believed that their risk of serious complications, if infected, was greater compared to non-tobacco users. A total of 28% reported increasing their cigarette use during the pandemic. The most common reasons for increased use were increased stress, more time at home, and boredom while quarantined. Nearly 15% reported decreasing their tobacco use. The most common reasons for reduced use were health concerns and more time around non-smokers (including children). A total of 71 (24.5%) users reported making a quit attempt. Characterizing these pandemic-related changes in tobacco use may be important to understanding the full scope of subsequent health outcomes resulting from the pandemic. Tobacco cessation resources should be tailored to allow for safe, appropriate access for those interested in quitting.

https://www.mdpi.com/1660-4601/18/4/1795/pdf

Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic.

Breast cancer is a life-threatening condition affecting women around the world. The early detection of breast lumps using a breast self-examination (BSE) is important for the prevention and control of this disease. The aim of this study was to examine BSE behavior and its predictive factors among female university students using the Health Belief Model (HBM). This investigation was a cross-sectional survey carried out with 334 female students at Urmia University of Medical Sciences in the northwest of Iran. To collect the necessary data, researchers applied a valid and reliable three-part questionnaire. The data were analyzed using descriptive statistics and a chi-square test, in addition to multivariate logistic regression statistics in SPSS software version 16.0 (SPSS Inc., Chicago, IL, USA). The results indicated that 82 of the 334 participants (24.6%) reported practicing BSEs. Multivariate logistic regression analyses showed that high perceived severity [OR = 2.38, 95% CI = (1.02–5.54)], high perceived benefits [OR = 1.94, 95% CI = (1.09–3.46)], and high perceived self-efficacy [OR = 13.15, 95% CI = (3.64–47.51)] were better predictors of BSE behavior (P < 0.05) than low perceived severity, benefits, and self-efficacy. The findings also showed that a high level of knowledge compared to a low level of knowledge [OR = 5.51, 95% CI = (1.79–16.86)] and academic undergraduate and graduate degrees compared to doctoral degrees [OR = 2.90, 95% CI = (1.42–5.92)] of the participants were predictors of BSE performance (P < 0.05). The study revealed that the HBM constructs are able to predict BSE behavior. Among these constructs, self-efficacy was the most important predictor of the behavior. Interventions based on the constructs of perceived self-efficacy, benefits, and severity are recommended for increasing women’s regular screening for breast cancer.

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Psychosocial predictors of breast self-examination behavior among female students: an application of the health belief model using logistic regression

Patient safety is a new and challenging discipline in the Iranian health care industry. Among the challenges for patient safety improvement, education of medical and paramedical students is intimidating. The present study was designed to assess students’ perceptions of patient safety, and their knowledge and attitudes to patient safety education. This cross-sectional analytical study was conducted in 2012 at Urmia University of Medical Sciences, West Azerbaijan province, Iran. 134 students studying medicine, nursing, and midwifery were recruited through census for the study. A questionnaire was used for collecting data, which were then analyzed through SPSS statistical software (version 16.0), using Chi-square test, Spearman correlation coefficient, F and LSD tests. A total of 121 questionnaires were completed, and 50% of the students demonstrated good knowledge about patient safety. The relationships between students’ attitudes to patient safety and years of study, sex and course were significant (0.003, 0.001 and 0.017, respectively). F and LSD tests indicated that regarding the difference between the mean scores of perceptions of patient safety and attitudes to patient safety education, there was a significant difference among medical and nursing/midwifery students. Little knowledge of students regarding patient safety indicates the inefficiency of informal education to fill the gap; therefore, it is recommended to consider patient safety in the curriculums of all medical and paramedical sciences and formulate better policies for patient safety.

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Patient Safety in Medical Education: Students’ Perceptions, Knowledge and Attitudes

Background: Studies in higher education indicated that students’ expectation for their educational services are not provided sufficiently, particularly in developing countries that implies on gap between the students perception on current situation and their expectations from educational services. Objectives: The aim of this study was to determine the gap between student perception and expectations of students in various levels of the undergraduate educational courses at Urmia University of Medical Sciences, Iran. Patients and Methods: This is a longitudinal study, which was conducted in academic year 2007-2008 at the Urmia University of Medical Sciences. In total, 173 students were selected as sample size, among various courses. SERVQUAL questionnaire was used as instrument. Descriptive statistics following by Friedman and Wilcoxon tests were used to determining significance of quality gap between five dimensions and to evaluate significant gap between student perceptions and their expectations, respectively. Spearman test was also used to determine the relationship between dimensions. Results: In overall, 80% of educational expectations were not meet; there was a negative gap at all phrases and dimensions and the gap was more negative for educational experts (-1.45 ± 0.89) compared to teachers (-0.97 ± 0.97). The highest gap for teachers was in empathy dimension (-1.11 ± 1.51), while for experts it was in assurance dimension (-1.58 ± 1). Conclusions: Existences of gap in dimensions indicated that expectations of students are not met and it indicates their dissatisfaction, and thus it is a necessity for improvement in all dimensions.

The Bridge Between Real and Ideal: Students Perception on Quality Gap in Reality and Their Educational Expectations

Background: Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study. 

Methods: In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, inputoriented and variable return to scale assumptions were applied and Deap2.1 software was used. 

Results: The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked. 

Conclusion: Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful.

http://mjiri.iums.ac.ir/article-1-3431-en.pdf

The productivity and its barriers in public hospitals: case study of Iran

Background: Health care education is an important issue in the development of countries, and student's academic achievement plays an important role in this respect. Test anxiety can affect the academic performance of students. This study aimed to investigate the effect of study preparation on test anxiety and performance of public health students. Methods: This quasi-experimental study investigated the effect of study preparation on reducing test anxiety and improving the performance of public health students at Urmia University of Medical Sciences, Urmia, Iran, in the academic year 2016-2017. All second- and third-year bachelor's students in public health major were assigned into the intervention (n=20) and control groups (n=25). The assignment was based on the study preparation items and the defined benchmark. Data on general stress and test anxiety were collected by subjective self-assessment via paper-and-pencil surveys in the first week of the semester and before the final exam, respectively. Results: No significant difference was found in the level of general stress between the two groups at the beginning of the semester (p=0.55) based on the study preparation items. The level of test anxiety in the intervention group (47.90) was lower than in the control group (34.64) at the end of the semester (p=0.001). The mean value of exam scores was higher in the intervention group (p=0.015). Conclusions: The intervention reduced the level of test anxiety and improved the performance of students. Faculty members and heads of the departments should help students learn about the study preparation over the semester with engagement in learning-oriented approaches and class activities.

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Bahram Nabilou

Papers

Psychosocial predictors of breast self-examination behavior among female students: an application of the health belief model using logistic regression

Patient Safety in Medical Education: Students’ Perceptions, Knowledge and Attitudes

The Bridge Between Real and Ideal: Students Perception on Quality Gap in Reality and Their Educational Expectations

The productivity and its barriers in public hospitals: case study of Iran

The effect of study preparation on test anxiety and performance: a quasi-experimental study.