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
1436/06/24
1
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)
1436/06/24
2
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
1436/06/24
3
What is the package of ehealth interventions?
1436/06/24
4
Interventions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
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
1436/06/24
5
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
1436/06/24
6
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
1436/06/24
7
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-indifference method to explore the effect of the ehealth package
on:





Access
Utilization
Quality
Equity
Efficiency
1436/06/24
8
Conceptual Framework
1436/06/24
9
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%
Cancers-5.3%
Respiratory diseases4.2%
Nutritional
Deficiency2.8%
Diabetes
- 2.3%
Drug
abuse2%
Needed Changes for better equity
Equity
PHC
Geographical/
Rural/urban
Disadvantaged
groups/nomads/slu
ms
Socioeconomics
Age and sex groups/
elderly/ female
People with special
needs
Emergency care
Outpatient specialty
Inpatient
Using call center
Integrated in PHC
Using low cost
technology assisted
Emergency Medical
Services
Outreach services
Using mobile health
Other sectors
collaborations on
E.M.S
Using call center
Medication
availability in HFs
Pro poor payment
Using low cost
Technology assisted
intervention
Revising standards in
resource allocation
Revising HCDS for
disadvantaged groups
Health promoting hospital
Defining more equitable
service packages/health
programs
Payment based on high quality care
Empower abovementioned
groups for self care
Concentration on home care and
follow up system
UHC/ F.P
Total needed budget
Method
1436/06/24
Additional
Human
resource
No intervention
Access
Utilization
Quality
Equity
Efficiency
Ravansar
No Intervention
Only Human resource Intervention
Full Intervention
Javanroud
Kalibar
Intermediate
outcomes:
Outcomes
Kermanshah
Province
Zahak
West Azar
Province
Pavah
Sistan &
Balouchestan
Province
eHealth Package
Ultimate
Outcome:
Health status
Satisfaction
Finance (cost)
Hamoon
Hashtroud
12
Data Sources
1) Households
2) Providers (Physician, Nurse, Midwife, Health care-providers,
Laboratory and Radiography service provider, ….)
1) Health care centers ( Hospitals, clinics, diagnostic imaging
centers, Laboratory centers, Pharmacies, and so on)
2) Health System (information from health authorities and public
insurance companies)
3) Barekatel company (information on package, number of days of
functioning and so on)
1436/06/24
13
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
1436/06/24
14
Baseline data
1436/06/24
15
1436/06/24
16
Percentage of attending for different health care
1436/06/24
17
1436/06/24
18
1436/06/24
19
1436/06/24
20
1436/06/24
21
1436/06/24
22
1436/06/24
23
Thank You
Comment/Question?
1436/06/24
24