How the service delivery works in the Iranian specialised burns hospitals? A qualitative approach

What Fuels the Fire: A Narrative Review of the Role Social Determinants of Health Play in Burn Injuries

Social determinants of health (SDOH) are the conditions where people live, learn, work, and play that affect their health and quality of life. There has been an increasing focus on the SDOH in the field of medicine to both explain and address health outcomes. Both the risk of burn injuries and outcomes after burns have been found to be associated with multiple aspects of the SDOH. This narrative review seeks to explore the main domains of the social determinants of health, reiterate their importance to the general and burn injury population, examine each's association with risks of burn injuries and burn-related outcomes, and provide an overview of the current burn research landscape that describes the social determinants of health.

Sparsity of burn centers and prolonged length of hospital stay: A nationwide study

INTRODUCTION

The optimal distribution of burn centers remains unclear. We aimed to determine the appropriate number of burn centers per population (density) and examined a nationwide registry with the hypothesis that low-density burn centers would be associated with unfavorable outcomes.

PATIENTS AND METHODS

A retrospective study was conducted using the Japanese Society of Burn Injury registry (2011-2021). Burn center density was defined as the number of burn centers per one million population in each prefecture, and centers were trisected on the basis of density. Hospital-free days until day 30 were compared between patients at high-, middle-, and low-density centers. Inverse probability weighting was conducted to adjust baseline characteristics, including age, burn mechanism, and burn severity.

RESULTS

We included 6764, 6209, and 2200 patients at high-, middle-, and low-density burn centers, respectively. After adjusting for patient demographics and burn severity, patients at high- and middle-density centers (≥0.4 centers per one million population) had longer hospital-free days compared with those at low-density centers (11 [0-23] vs 11 [0-23] vs 8 [0-22] days; p < 0.001).

CONCLUSIONS

Low burn center density (<0.4 centers per one million population) was associated with longer hospital stay, whereas no higher limit was determined.

'Poverty's scar: A qualitative inquiry of financing shortcomings in specialized burn hospitals

BACKGROUND

Victims of burn have particular characteristics such as high vulnerability, expensive treatment, and cost of burn services. Thus, the financing of burn services is crucially important. The purpose of the present work is to recognize the financing challenges in Iranian specialized burn hospitals (SBHs).

METHODS

In the present qualitative descriptive research, purposive sampling was used for selecting key informants with maximum variation at local, provincial, and national levels. Semi-structured interviews were used for data collection. Interviews were continued as long as the saturation point was achieved at the 21 st interview. We employed conventional content analysis using an inductive data-driven coding process and theme development for the analysis of the transcribed documents by MAXQDA Analytics Pro 2018 (VERBI GmbH Release 18.2.0 Berlin).

RESULTS

We extracted 3 themes and 12 sub-themes, including resource mobilization (the poor burnt victims, unique feature of the single- SBH, high direct and indirect costs, and poor intra-sectoral advocacy), insurance coverage for burn care (incomplete breadth of population coverage, inadequate depth of benefits package and coverage of costs, and reimbursements of burn care) and mechanism of financial resource allocation (unsuitable payment system, less sustainable budgeting, inappropriate tariffing for burning services, top-down budgeting approach, and politicized budget process).

CONCLUSIONS

We suggest that health policy-makers in Iran could modify the SBHs financing system by improving resource mobilization, scaling up insurance coverage for burns, and optimizing the allocation of financial resources. Besides, we propose several points for policy entry to address SBHs financial difficulties. These points are serious attention to vulnerable and the poor burn patients, provision of burn care in multi-specialized hospitals, strengthening intra-collaboration, revision of tariffs, and payments for burn services, and preservation and realization of burn budgeting.

Home care for burn survivors: A phenomenological study of lived experiences

Background: Burn injuries have negative impacts on all dimensions of the quality of life of burn victims. This study aimed to explore the lived experiences of burn survivors after a 6-month period of home care following hospital discharge.Method: This is a qualitative study with a phenomenological approach. Sixteen burn survivors from a university hospital in Kermanshah province participated in the study. Qualitative data were analyzed by Colaizzi's descriptive phenomenological approach.Results: "Rehabilitation in the process of life" was the main theme of the study with four sub-themes, including "conducting process", "caring bridge", "humanitarian commitment for human revival", and "healing care".Conclusions: Home care is necessary for burn survivors after discharge from the hospital. The connection of healthcare services between home and hospital, safety feeling in the patient and his/her family, cost-effectiveness of healthcare services, and encouraging the patient to perform self-care can be achieved by home care follow-ups.