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Iranian Smart Health Intervention Assessment (ISHIA)

Tehran University of Medical Sciences. Iranian Smart Health Intervention Assessment (ISHIA). Farshad Farzadfar, MD, MPH, MHSc, D.Sc Chair of Non-Communicable Diseases Research Center (NCDRC) Endocrinology and Metabolism Research Institute Tehran University of Medical Sciences

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Iranian Smart Health Intervention Assessment (ISHIA)

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  1. Tehran University of Medical Sciences Iranian Smart Health Intervention Assessment (ISHIA) Farshad Farzadfar, MD, MPH, MHSc, D.Sc Chair of Non-Communicable Diseases Research Center (NCDRC) Endocrinology and Metabolism Research Institute Tehran University of Medical Sciences March 11, 2014

  2. Fifth Five Year Plan and eHealth in Iran • Universal Electronic Medical Record (article 35, fifth five year development plan) • Family Physician (article 32, fifth five year development plan) • Political willing for inequity reduction(article 38, fifth five year development plan)

  3. Barekatel Is a private company which is active in providing ehealth services for: • Health Providers • Health payers • Government • Health consumers Recent story: Barekatel have a contract with a charity and MoH to improve health status of population in remote and deprived areas using a package of ehealth interventions and consequently reducing the level of inequity

  4. What is the package of ehealth interventions?

  5. Interventions Contact center (Call center, Web consult service, Tele medicine center) Mobile application Service SMS service Electronic Health File Health Library Package Health Card Desktop health application package Health GIS Monitoring system in Ambulance Multimedia package and software Tele-health education Bluetooth (Sending data) Smart bed Health App store Digital Health Magazine Mobile Package Laboratory Package

  6. ISHIA Formation • Barekatel is going to established the abovementioned package in three remote and deprived areas (Paveh in west, Kalibar in north-west, and Zahak in East) • Barakatel asked NCDRC to evaluate the effect of the package of the interventions on population health • NCDRC called the project as Iranian Smart Health Intervention Assessment (ISHIA) and created a scientific and an executive team within NCDRC. • Dr. Javier Carnicero is ISHIA’s external evaluator and advisor

  7. Who we are? • Non-Communicable Diseases Research Center (NCDRC) is a research center affiliated with Tehran University of Medical Sciences and provides more than 30% of evidence for policy makers (including MoH and public insurance organizations) in population health in recent years, which are applied directly into policy formation. • Goals: • Health Metrics • Tracking performance • Maximizing effect

  8. What is ISHIA? A systematic effort to measure the effect of the ehealth package in three remote and deprived areas in Iran. It is a quasi-experimental study that uses difference-in-difference method to explore the effect of the ehealth package on: Access Utilization Quality Equity Efficiency

  9. Conceptual Framework

  10. Health Care Delivery System Cardiovascular Diseases- 16.7% Mental disorders-13.8% Transport injuries-7.6% Low back pain-7.5% Neonatal Disorders-6.1% Access Cancers-5.3% Utilization Respiratory diseases-4.2% Quality Nutritional Deficiency- 2.8% Equity Diabetes- 2.3% Efficiency Drug abuse- 2%

  11. Needed Changes for better equity Equity Inpatient PHC Emergency care Outpatient specialty Geographical/ Rural/urban Integrated in PHC Using call center Outreach services Using low cost technology assisted Emergency Medical Services Disadvantaged groups/nomads/slums Using call center Socioeconomics Medication availability in HFs Using mobile health Age and sex groups/ elderly/ female Pro poor payment Other sectors collaborations on E.M.S People with special needs Using low cost Technology assisted intervention Revising standards in resource allocation Health promoting hospital Revising HCDS for disadvantaged groups Defining more equitable service packages/health programs Payment based on high quality care Concentration on home care and follow up system Empower abovementioned groups for self care UHC/ F.P Total needed budget

  12. eHealth Package Additional Human resource No intervention Outcomes Intermediate outcomes: Access Utilization Quality Equity Efficiency Ultimate Outcome: Health status Satisfaction Finance (cost) Full Intervention Kermanshah Province Pavah Method Only Human resource Intervention Javanroud No Intervention Ravansar Sistan & Balouchestan Province Zahak Hamoon West Azar Province Kalibar Hashtroud

  13. Data Sources Households Providers (Physician, Nurse, Midwife, Health care-providers, Laboratory and Radiography service provider, ….) Health care centers ( Hospitals, clinics, diagnostic imaging centers, Laboratory centers, Pharmacies, and so on) Health System (information from health authorities and public insurance companies) Barekatel company (information on package, number of days of functioning and so on)

  14. Questionnaires 1) Household questionnaires including: Demographic information (census and socio-economic) Utilization of outpatient and inpatient services The quality of life (SF12) and Rose questionnaires Diseases Knowledge (Hypertension, Diabetes type 2, TB and cardiovascular) 2) Outpatient care centers mapping and Human Resource Data 3) Performance of health care provision 4) Financing

  15. Baseline data

  16. Percentage of attending for different health care

  17. Thank You Comment/Question?

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