A Systematic Review and Meta‑Analysis of Health Care Quality in Iran Based on the Comprehensive Quality Measurement in Health Care Model

Nader MarkaziMoghaddam, Sanaz Zargar Balaye Jame, Mahdi Nikoomanesh, Ramin Rezapour

Abstract


Background: Comprehensive assessment of health care quality is the first step in improving care and achieving health service goals. Therefore, this study aimed to conduct a systematic review and meta‑analysis of health care quality in Iran based on the Comprehensive Quality Measurement in Health Care model. Methods: In this study, the databases of PubMed, Scopus, Web of Science, Iranian Scientific Information Database (SID), MagIran, and Google Scholar were searched using English and Iran keywords without time limit. STATA 16 software and a random effect model were used for conducting meta‑analysis. Results: Of the 750 articles found, 20 were finally included; 13 of which were related to service quality, five to customer quality, and four to technical quality. Overall mean score of service quality was 7.79 [95% CI 7.43–8.15, df = 12, I2 = 98.48, P value < 0.000] out of 10, and overall mean score of customer quality was 73.20 ± 4.56 [95% CI 65.18–81.22, df = 5, I2 = 99.34, P value < 0.001] out of 100. Among the 12 dimensions of service quality, the confidentiality dimension (9.55 ± 0.12) had the highest mean score and the group support dimension (5.92 ± 0.901) had the lowest score. In general, from the viewpoint of service receivers, the technical quality is relatively favorable. Conclusions: According to the results of this study, the quality of health care in Iran is significantly far from ideal. Therefore, planning to improve providing health care is essential.

Keywords


Customer quality; health care; meta‑analysis; service quality; systematic review; technical quality

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References


Wijeysundera HC, Mitsakakis N, Witteman W, Paulden M,

van der Velde G, Tu JV, et al. Achieving quality indicator

benchmarks and potential impact on coronary heart disease

mortality. Can J Cardiol 2011;276:756‑62.

Azami‑Aghdash S, Mohammadi R. Using tracer methodology

in clinical setting and research to measure and improve quality.

J Clin Res Gov 2013;21:39‑40.

Kleinman LC, Dougherty D. Assessing quality

improvement in health care: Theory for practice. Pediatrics

;131(Suppl 1):S110‑9.

Stokes H. Cardiac rehabilitation: The quest for quality. Coronary

Health Care 1999;34:171‑7.

Tabrizi J, O’Rourke P, Wilson A, Coyne E. Service quality for

type 2 diabetes in Australia: The patient perspective. Diabetic

medicine 2008;255:612‑7.

Coffey RM, Ho K, Adamson DM, Matthews TL, Sewell J,

Kassed CA. Asthma care quality improvement: A resource

guide for state action. Rockville (MD): Agency for Healthcare Research and Quality. 2006.

Murphy K. A Qualitative study explaining nurses’ perceptions

of quality care for older people in long-term care settings in

Ireland. J Clin Nurs 2007;163:477‑85.

Brook RH, McGlynn EA, Shekelle PG. Defining and measuring

quality of care: A perspective from US researchers. Int J Qual

Health Care 2000;124:281‑95.

DuPlessis HM, Inkelas M, Halfon N. Assessing the performance

of community systems for children. Health Serv Res

;33:1111‑42.

Sharifirad GR, Shamsi M, Pirzadeh A, Farzanegan PD.

Quality gap in primary health care services in Isfahan:

Women’s perspective. JEduc Health Promot2012;1:45.doi:

4103/2277‑9531.104815.

Koenig MA, Foo GH, Joshi K. Quality of care within the

Indian family welfare programme: A review of recent evidence.

StudFamPlan 2000;311:1‑18.

Aghamolaei T, Zare S. Quality gap of educational services

in viewpoints of students in Hormozgan University

of medical sciences. BMC Med Educ2008;81:34.doi:

1186/1472‑6920‑8‑34.

Yarmohammadian MH, Nazari M, Moradi R, Mirzaei H,

Navvabi E. Evaluation of educational services quality for

healthcare services management students of Isfahan University

of Medical Sciences based on SERVQUAL model. Iran J Med

Educ 2015;15:319‑29.

Kavosi Z, Rahimi H, Qanbari P, Haidari L, Bahmaei J.

Investigation of quality gap of educational services from the

viewpoints of students of Shiraz University of Medical Sciences,

‑2013. Sadra Med Sci J 2014;2:161‑72.

Mohseni M, Raeisi A, Azami‑Aghdash S, Moosavi A,

Mousavi SM. Hospital services quality from patients’ viewpoint

in Iran: A systematic review and meta‑analysis. Evid Based

Health Policy Manag Econ 2017;14:261‑9.

Tabrizi JS. Quality of delivered care for people with type 2

diabetes: A new patient‑centred model. J Res Health Sci

;9:1‑9.

Vinter‑Repalust N, Petricek G, Katic M. Obstacles which patients

with type 2 diabetes meet while adhering to the therapeutic

regimen in everyday life: Qualitative study. CroatMed

J2004;455:630‑6.

Kenagy JW, Berwick DM, Shore MF. Service quality in health

care. JAMA 1999;2817:661‑5.

Irwin RS, Richardson ND. Patient‑focused care: Using the right

tools. Chest 2006;1301:73S‑82S.

Khan K, Kunz R, Kleijnen J, Antes G. Systematic Reviews

to Support Evidence‑Based Medicine. Crc Press; American

publishing group 2011.

Tabrizi J‑S, Ghojazadeh M, Azami‑Aghdash S, Daemi A,

Hassanzadeh R. Quality of angiography services as perceived by

the cardiovascular diseases patient. Int J Hosp Res 2014;34:167‑72.

Tabrizi JS, Wilson AJ. Customer quality and type 2 diabetes

from the patients’perspective: A cross‑sectional study. J Res

Health Sci 2010;10:69‑76.

Porritt K, Gomersall J, Lockwood C. JBI’s systematic reviews:

Study selection and critical appraisal. AJN Am J Nurs

;1146:47‑52.

Tabrizi JS, Vahidi R, Kalantari H, Ala A, Pouraghayee M,

Asghari‑Jafarabadi M, et al. Assessing delivered services quality

in emergency department of Imam Reza Hospital, Tabriz, Iran:

Depiction of Health 2015;61:25‑30.

Somi M‑H, Tabrizi JS, Gholipour K, Iezadi S, Shokri A,

Nasiri S. Patient’s perception and expectation of service quality

in an endoscopic ward. J Clin Res Gov 2015;4:1-5.

Karimi S, Mottaghi P, Shokri A, Yarmohammadian MH,

Tabrizi J‑S, Gholipour K, et al. Service quality for people with

rheumatoid arthritis: Iranian patients’ perspective. International

Journal of Health System and Disaster Management 2013;14:243.

Tabrizi J, Alidoost S, Bahrami A, Farahbakhsh M, Jafarabadi MA.

Service quality for people with type 2 diabetes in Tabriz, Iran:

The patients’ perspective. J Clin Res Gov 2014;3:105‑9.

Gholipour K, Tabrizi JS, Azimzadeh S, Ghafari S, Iezadi S.

Service quality from the perspective of myocardial infarction

patients. Turk Kardiyoloji Dernegi arsivi 2018;463:197‑204.

Tabrizi JS, Gharibi F, Oskuie A, Jafarabadi AM. Service quality

in physiotherapy from the services recipients’ perspective.

Jentashapir JHealth Res2013;4:53‑63.

Tabrizi JS, Farahsa S, Taghizadieh A, Jafarabadi MA. Service

Quality of Delivered Care for People with Asthma in Tabriz:

The Patients’ Perspective. Journal of Clinical Research &

Governance. 2016;5.

Tabrizi JS, Askari S, Fardiazar Z, Koshavar H, Gholipour K.

Service quality of delivered care from the perception of women

with caesarean section and normal delivery. Health Promot

Perspect 2014;42:137‑43.

Tabrizi J, Gholipour K, Alipour R, Farahbakhsh M,

Asghari‑Jafarabadi M, Haghaei M. Service quality of maternity

care from the perspective of pregnant women in Tabriz health

centers and health posts–2010‑2011. J Hosp 2014;124:9‑18.

Gholipour K, Tabrizi JS, Jafarabadi MA, Iezadi S, Mardi A.

Effects of customer self‑audit on the quality of maternity care

in Tabriz: A cluster‑randomized controlled trial. PloS One

;1310:e0203255.doi: 10.1371/journal.pone. 0203255.

Alidoost S, Tabrizi J, Mohamadi F, Somi M,

Asghari‑Jafarabadi M, Gharibi F. Assessment of delivered care

service quality in inflammatory bowel disease from the patients’

perspective. Depiction of Health 2013;44:6‑14.

Azami‑Aghdash S, Tabrizi J‑S, Ghojazadeh M,

Naghavi‑Behzad M, Imani S. Customer quality: A self‑reporting

survey among angiography patients. Int J Hosp Res

;23:119‑26.

Tabrizi J‑S, Jafarabadi MA, Farahbakhsh M, Mohammadzedeh M.

Customer quality and maternity care in Tabriz urban health

centers and health posts. J Clin Res Gov 2012;11:11‑5.

Tabrizi JS, Gharibi F. The customer quality of delivered care to

patients with inflammatory bowel disease in Tabriz City, Iran,

Iran J Health Sci 2015;33:29‑36.

Shokri A, Yarmohammadian MH, Mottaghi P, Karimi S,

Gholipour K, Sadegh Tabrizi J. Customer quality and rheumatoid

arthritis in the Iranian patient’s perspective: A cross‑sectional

study. J Patient Saf Qual Improv 2014;23:110‑5.

Gholipour K, Tabrizi J, Asghari Jafarabadi M, Iezadi S,

Farshbaf N, Farzam Rahbar F, et al. Customer’s self‑audit

to improve the technical quality of maternity care in Tabriz:

A community trial. East Mediterr Health J 2016;225:309‑17.

Wilson A, Tabrizi JS, Gholipour K, Farahbakhsh M. Technical

quality of maternity care: The pregnant women’s perspective.

Health Promot Perspect2013;31:23‑30.

Nahangi H, Mottaghi P, Gholipour K, Shokri A, Fattahi H,

Iezadi S, et al. Technical quality of rheumatoid arthritis care:

The patient perspective. Global J Med Res Stud 2014;12:45‑50.

Tabrizi JS, Somi MH, Asghari S, Jafarabadi MA, Gharibi F,

Alidoost S. The technical quality of delivered care for people

with inflammatory bowel disease in Tabriz gastroenterology

clinics. Health Promot Perspect2015;53:198‑206.

Al-Borie HM, Damanhouri AM. Patients’ satisfaction of service quality in Saudi hospitals: A SERVQUAL analysis. IntJHealth

Care Qual Assur2013;26:20‑30.

Altuntas S, Dereli T, Yilmaz MK. Multi‑criteria decision

making methods based weighted SERVQUAL scales to measure

perceived service quality in hospitals: A case study from Turkey.

Total Qual Manag Bus Excell 2012;2311‑12:1379‑95.

Purcărea VL, Gheorghe IR, Petrescu CM. The assessment of

perceived service quality of public health care services in Romania

using the SERVQUAL scale. Proc EconFinanc 2013;6:573‑85.

Akter MS, Upal M, Hani U. Service quality perception

and satisfaction: A study over sub‑urban public hospitals in

Bangladesh. J Serv Res 2008:125.

Butt MM, de Run EC. Private healthcare quality: Applying a

SERVQUAL model. IntJHealth Care Qual Assur2010;23:658‑73.

Nekoei-Moghadam M, Amiresmaili M. Hospital services quality

assessment. IntJHealth Care Qual Assur 2011;24:57-66.

Zarei A, Arab M, Froushani AR, Rashidian A, Tabatabaei SM.

Service quality of private hospitals: The Iranian patients’ perspective.

BMC Health ServRes2012;121:31.doi: 10.1186/1472‑6963‑12‑31.

Gorji HA, Tabatabaei S, Akbari A, Sarkhosh S, Khorasan S.

Using the service quality gap’s model (SERVQUAL)

in Imam Khomeini teaching hospital: 2012. J Health

Admin2013;1651:7‑18.

Havasbeigi F, Yasbalaghisharahi B, Mohamadi E, Mohamadi A.

Measuring the quality of services provided for outpatients in

public hospitals in Ilam and Kermanshah cities based on the

SERVQUAL instrument. J Ilam Univ Med Sci 2013;211:207‑1.

Mohammadi A, Eftekhar Ardebffi H, Akbari Haghighi F,

Mahmoudi M, Poorreza A. Evaluation of services quality based

on the patients’expectations and perceptions in Zanjanhospitals.

J Sch Public Health InstPublic Health Res 2004;22:71‑84.

Torabipour A, Sayaf R, Salehi R, Ghasemzadeh R. Analyzing

the quality Gapsin the services of rehabilitation centers using the

SERVQUAL technique in Ahvaz, Iran. Jundishapur J Health Sci

;81. doi: 10.17795/jjhs‑32560

Gholami A, Nori AA, Khojastehpour M, Askari M. Quality

gap in primary health care in Neyshabour health care centers.

Daneshvar 2011;1892:5‑14.

Bahadori M, Raadabadi M, Ravangard R, Baldacchino D.

Factors affecting dental service quality. IntJHealth Care Qual

Assur 2015;28:678‑89.

Ghobadi H, Mehrnoush N, Hamidkholgh G, Amani F. Measuring

the quality of services provided for outpatients in Kowsar clinic

in Ardebil city based on the SERVQUAL model. Journal of

Ardabil University of Medical Sciences 2014;144:387‑79.

Mauri AG, Minazzi R, Muccio S. A review of literature on the

gaps model on service quality: A 3‑decades period: 1985‑2013.

International Business Research 2013;612:134.

Li M, Lowrie DB, Huang C‑Y, Lu X‑C, Zhu Y‑C, Wu X‑H, et al.

Evaluating patients’ perception of service quality at hospitals in

nine Chinese cities by use of the ServQual scale. Asian Pac J

Trop Biomed 2015;56:497‑504.

Joung H‑W, Kim H‑S, Yuan JJ, Huffman L. Service quality,

satisfaction, and behavioral intention in home delivered meals

program. NutrResPract2011;52:163‑8.

Mittal B, Lassar WM. Why do customers switch? The dynamics

of satisfaction versus loyalty. JServ Mark 1998;12:177‑94.

Seth N, Deshmukh S, Vrat P. Service quality models: A review.

IntJQualReliabil Manag2005;22:913‑49.

Carron‑Arthur B, Reynolds J, Bennett K, Bennett A,

Cunningham JA, Griffiths KM. Community structure of a

mental health internet support group: Modularity in user thread

participation. JMIR Mental Health 2016;32:e20.doi: 10.2196/

mental. 4961.

Flickinger TE, DeBolt C, Wispelwey E, Laurence C,

Plews‑Ogan E, Waldman AL, et al. Content analysis and user

characteristics of a smartphone‑based online support group for

people living with HIV. Telemed JEHealth 2016;229:746‑54.

Sanchez LT, Candilis PJ, Arnstein F, Eaton J, Barnes Blood D,

Chinman GA, et al. Effectiveness of a unique support group

for physicians in a physician health program. JPsychiatr

Pract2016;221:56‑63.

Brijmohan A, Famure O, Sihota K, Shea M, Marzario B,

Mitchell M. Psychosocial needs assessment post kidney

transplant: Feasibility of a post‑transplant specific support group.

CANNT J 2015;253:14‑21.

Roberts RM, Ejova A, Giallo R, Strohm K, Lillie ME. Support

group programme for siblings of children with special needs:

Predictors of improved emotional and behavioural functioning.

Disabil Rehabil 2016;3821:2063‑72.

Cutts T, Holmes S, Kedar A, Beatty K, Mohammad MK, Abell T.

Twenty‑five years of advocacy for patients with gastroparesis:

Support group therapy and patient reported outcome tool

development. BMC Gastroenterol 2016;161:107.

Rezaei MA, Ghahramani F, Sadravi G. Comparison study of

quality control standards between private and public medical

diagnostic laboratories in Shiraz‑2011. J Hosp 2012;11:83‑8.

Seidi M, Heidary A, Khorramy‑Rad A, Ahmary‑Tehran H.

Comparative study of patient satisfaction, physical space and

medical equipment between governmental and private hospitals.

Iran J Nurs 2009;2259:42‑50.

Fazaeli S, Ebrahimipour H, Banikazemi S, Yousefi M, Valinejadi A.

Public or private hospitals: Survey of households’ tendencies in some

selected areas of Mashhad. J Health Admin 2016;1862:75‑86.

Moradi‑Lakeh M, Vosoogh‑Moghaddam A. Health sector

evolution plan in Iran; equity and sustainability concerns.

IntJHealth Policy Manag 2015;410:637‑40.

Sajadi Hs, Zaboli R. An assessment of the positive effects of

health reform plan implementation from the perspective of

hospital directors. Health Inf Manag 2016;13:55‑60.

Chang C‑S, Weng H‑C, Chang H‑H, Hsu T‑H. Customer

satisfaction in medical service encounters‑‑a comparison between

obstetrics and gynecology patients and general medical patients.

JNurs Res 2006;141:9‑23.

Tabrizi JS, Wilson AJ, O’Rourke PK. Customer quality in health

care. Patient EducCouns 2009;741:130‑1.

Swinton L. The 9 Principles of Quality Customer Service.

Available from: https://www.academia.edu/download/41071950/

quality-customer-service.pdf. 2009. [Last accessed on 2021 May

.

Rejler M. Quality Improvement in the Care of Patients with

Inflammatory Bowel Disease. Linköping University Electronic

Press; Sweden 2012.

Chauhan U, Currie BK, Fedorak RN, Frost K, Halder S,

Ismond KP, et al. Best practices in IBD care: taking steps to

introduce an integrated multidisciplinary Patient-Centric Care

Model. Toronto: Canadian Digestive Health Foundation; 2013:913. Available from: http://www.cdhf.ca/bank/document_en/75bestpractices-in-ibd-care.pdf. [Last accessed on 2021 May 14].

Kappelman MD, Palmer L, Boyle BM, Rubin DT. Quality of

care in inflammatory bowel disease: A review and discussion.

InflammBowel Dis 2010;161:125‑33.

Wyke A. Patient Groups on Rheumatoid Arthritis and the NHS:

A National Survey of Patient Organisations and Other Health

Campaigners & APPENDIX. London: National Audit Office;