Background: Electronic referral system (e-Referral system) in Iran was launched to increase access to care and improve interaction.
Objectives: The present study aimed to design an appropriate model for evaluating the performance of the e-Referral system in Iran.
Methods: This study was conducted in three stages: 1) review of literature related to electronic referral systems, 2) qualitative phase, and 3) quantitative phase. Participants in the qualitative phase included 42 managers, policymakers of the Ministry of Health, medical universities, service providers, and recipients who were purposively selected for this study. Data were analyzed through content analysis. In the quantitative phase, the target group consisted of 604 staff of medical universities implementing the e-Referral system. Data were analyzed using the EQS (version 6.3) and SPSS (version 20) software. Chi-square test, degree of freedom, the goodness of fit index, root mean square error, adjusted goodness of fit index, and the Friedman test were used to investigate the suitability of the model.
Results: Fourteen main themes were identified and classified for the model design Based on the results of the present study. The components of developing rules and regulations, stakeholder advocacy, economic evaluation, and quality of health services had average ratings of 13.99, 13.00, and 11.35, respectively, regarding their role in designing the evaluation model for the e-Referral system in Iran.
Conclusion: The results of structural equation modeling showed that the components play an essential role in designing the performance evaluation model of e-Referral in the Iranian health system. This study addressed various aspects affecting the e-Referral and provided the possibility of performance evaluation in the health sector in a principled and systematic format. Health managers and policymakers can use the present study findings to discover the strengths and weaknesses of the e-Referral performance.
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