YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ

Cuma FİDAN, (Muş Alparslan Üniversitesi, Sağlık Bilimleri Fakültesi, Sağlık Yönetimi Bölümü, Muş, Türkiye)
İsmail AĞIRBAŞ (Ankara Üniversitesi, Sağlık Bilimleri Fakültesi, Sağlık Yönetimi Bölümü, Ankara, Türkiye)
Hacettepe Sağlık İdaresi Dergisi
8 1
Yıl: 2020 Cilt: 23 Sayı: 3 Sayfa Aralığı: 485 - 504 Metin Dili: Türkçe İndeks Tarihi: 03-11-2020

YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ

Öz:
Bu çalışmada, ulusal ve uluslararası literatürde nitel ve nicel araştırma türünde yapılan yoğun bakımmaliyet çalışmalarının mevcut durumunun analizinin ortaya konulması amaçlanmıştır. Araştırma nitel araştırmayöntemi kapsamında gerçekleştirilmiştir. Araştırmada verilerin toplanmasında doküman incelemesikullanılmıştır. Literatürde yoğun bakım maliyet çalışmaları kapsamında yapılan 240 çalışma araştırmakapsamına alınmıştır. Verilerin analizinde içerik analizi yöntemi kullanılmıştır. Araştırma konusu hakkındagenel bir bilgiye sahip ve nitel araştırma yöntemleri konusunda uzman beş kişinin görüşlerine başvurularakaraştırmanın inanırlığı arttırılmıştır. Araştırma sonuçlarına göre nicel araştırma yöntemi kapsamında yapılançalışmaların çoğunluğu oluşturduğu; enfeksiyon, ilaç, sağlık personeli ve kronik hastalık araştırma konularındadaha fazla araştırmanın yapıldığı görülmüştür. Veri analiz yöntemi olarak ekonomik analiz ve maliyet etkililikanalizi daha çok tercih edilmiştir. Yatılan gün sayısının uzaması ve ilaçların yoğun bakım maliyetini arttırdığı;teletıp ve parenteral beslenmenin ise yoğun bakım maliyetini azalttığı görülmüştür. Ayrıca geri ödeme kurumutarafından yapılan ödemelerin ve hemşire takip programının yoğun bakım maliyetini hem arttırdığı hem deazalttığı görülmüştür. Araştırma sonuçlarına göre yoğun bakım maliyetlerindeki değişmenin hangi yoğun bakımünitesinin neden olduğunu belirlemeye yönelik nicel çalışmaların yapılması önerilmektedir.
Anahtar Kelime:

INTENSIVE CARE COSTS AND ANALYSIS OF INTENSIVE CARE COST STUDIES

Öz:
This study aimed to analyze the current state of qualitative and quantitative studies in the national and international literature on intensive care costs. A qualitative research method was employed. Data were collected using a document review. The sample consisted of 240 studies on intensive care costs. Data were analyzed using content analysis. The credibility of the study was improved by consulting with five experts in qualitative research methods who had a general knowledge of the subject matter. The results showed that most of the 240 studies were carried out using quantitative research methods and that there were more studies on infection, medication, health personnel, and chronic disease. Most of the 240 studies employed economic analysis and cost-effectiveness analysis. The results showed that prolonged hospital stay and medications increased the intensive care costs whereas telemedicine and parenteral feeding reduced them. Moreover, reimbursements by agencies and nurse follow-up programs increased the intensive care costs in some cases and decreased them in others. Based on the results, it is recommended that further quantitative studies be conducted to determine which intensive care unit causes the change in intensive care costs.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • Abdul-Jabbar, S., Bates, I., Davies, G., & Shulman, R. (2014). An analysis of medicine of adult patients on a critical care unit. Journal of Critical Care, 29(3), 472.E7-472.E12.
  • Altawalbeh, S. M., Saul, M. I., Seybert, A. L., Thorpe, J. M., & Kane-Gill, S. L. (2018). Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment effots. Journal of Critical Care, 44, 77-81.
  • Angus, D. C., Shorr, A. F., White, A., Dremsizov, T. T., Schmitz, R. I., & Kelley, M. A. (2006). Critical care delivery in the united states: distribution of services and compliance with leapfrog recommendations. Critical Care Med, 34(4), 1016-1024.
  • Berger, M. M., Achamrah, N., & Pichard, C. (2018). Parenteral nutrition in intensive care patients: Medicoeconomic aspect. Current Opinion in Clinical Nutrition & Metabolic Care, 21(3), 223-227.
  • Bice, T., Cox, C. E., & Carson, S. S. (2013). Cost and healthcare utilization in ards- different from other critical illness? Seminars Respiratory and Critical Care Medicine, 34(4), 529-536.
  • Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27-40.
  • Brandström, H., Winso, O., Lindholm, L., & Haney, M. (2014). Regional intensive care transports: A prospective analysis of distance, time and cost for road, helicopter and fixed-wing ambulances. Scandinavian of Trauma, Resuscitation and Emergency Medicine, 22(1), 36-44.
  • Chang, B., Lorenzo, J., & Macario, A. (2015). Examining health care costs oppurtunites to provide value in the intensive care unit. Anesthesiology Clinics, 33(4), 753-770.
  • Chen, J., Sun, D., Yang, W., Liu, M., Zhang, S., Peng, J., & Ren, C. (2018). Clinical and economic outcomes of telemedicine programs in the intensive care unit: A sistematic review and meta analysis. Journal of Intensive Care Medicine, 33(7), 383-393.
  • Chidi, O. O., Perman, S. M., & Ginde, A. A. (2017). Characteristics of short-stay critical care admissions from emergency departments in Maryland. Academic Emergency Medicine, 24(10), 1204- 1211.
  • Chin-Yee, N., D’egido, G., Thavorn, K., Heyland, D., & Kyerementeng, K. (2017). Cost analysis of the very elderly admitted to intensive care units. Critical Care, 21(1), 109-116.
  • Creswell, J. W. (2012). Research design: Qualitative, quantitative and mixed methods approaches. (4th Edition), Sage Publications, California.
  • Curtis, J. R., Engelberg, R. A., Bensink, M. E., & Ramsey, S. D. (2012). End of life care in the intensive care unit. American Journal Respiratory Critical Care Medicine, 186(7), 587-592.
  • Dalal, A. A., Christensen, L., Liu, F., & Riedel, A. A. (2010). Direct costs of chronic obstructive pulmonary disease among managed care patients. International Journal of Chronic Obstructive Pulmonory Disease, 5, 341-349.
  • Dasta, J. F, Kane-Gill, S. L., Pencina, M., Shehabi, Y., Bokesch, P. M., Wisemandle, W., & Riker, R. R (2010). A cost-minimization analysis of dexmedetomidine compared with midazolam for longterm sedation in the intensive care unit. Critical Care Medicine, 38(2), 497-503.
  • Dasta, J. F., Mclaughlin, T. P., Mody, S. H. & Piech, C. T. (2005). Daily cost of an intensive care unit day: The contribution of mechanical ventilation. Critical Care Medicine, 33(6), 1266-1271.
  • Edbrooke, D. L., Ridley, S. A., Hibbert, C. L., & Corcoran, M. (2001). Variations in expenditure between adult general intensive care units in The UK. Anaesthesia, 56(3), 208-216.
  • Edger, M. (2017). Effect of a patient repositioning device in an intensive care unit on hospital acquired pressure injury accurences and cost. Journal of Wound Ostomy & Continence Nursing, 44(3), 236-240.
  • Elliott, D. (1997). Costing intensive care services: A review of study methods, results and limitations. Australian Critical Care, 10(2), 55-63.
  • Endacott, R. (2012). The continuning imperative to measure workload in ICU: Impact on patient safety and staff well-being. Intensive Care Medicine, 38(9), 1415-1417.
  • Flannery, A. H., Pandya, K., Laine, M. E., Almeter, P. J., & Flynn, J. D. (2017). Managing the rising costs and high drug expenditures in critical care pharmacy practice. Pharmacotherapy, 37(1), 54-64.
  • Frampton, G. K., Harris, P., Cooper, K., Cooper, T., Cleland, J., Jones, J., Shepherd, J., Clegg, A., Graves, N., Welch, K., & Cuthbertson, B. H. (2014). Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation. Health Technology Assessment, 18(15).
  • Franzini, L., Sail, K. R., Thomas, E. J., & Wueste, L. (2011). Costs and cost effectiveness of a tele- ICU program in six intensive care units in a large healthcare system. Journal of Critical Care, 26(3), 329.El-339.E6.
  • Halpern, N. A., Bettes, L., & Greenstein, R. (1994). Federal and nationwide intensive care units and healthcare costs: 1986-1992. Critical Care Medicine, 22(12), 2001-2007.
  • Halpern, N. A., Goldman, D. A., Tan, K. S., & Pastores, S. M. (2016). Trends in critical care beds and use among population groups and medicare and medcaid beneficiaries in United States: 2000- 2010. Critical Care Medicine, 44(8), 1490-1499.
  • Halpern, N. A., & Pastores, S. M. (2010). Critical care medicine in The United States 2000-2005: An analysis of bed numbers, occupancy rates, payer mix, and costs. Critical Care Medicine, 38(1), 65-71.
  • Heyland, D. K, Barwich, D., Pichora, D., Dodek, P., Lamontagne, F., You, J. J., Tayler, C., Porterfield, P., Sinuff, T., & Simon, J. (2013). Failure to engage hospitalized elderly patients and their famillies in advance care planning. JAMA Internal Medicine, 173(9), 778-787.
  • Houser, J. (2015). Nursing research: Reading, using and creating evidence. (3rd Edition), Jones and Bartlett Learning, Burlington.
  • Huynh, T. N., Kleerup, E. C., Wiley, J. F., Savitsky, T. D., Guse, D., Garber, B. J., & Wenger, N. S. (2013). The frequency and cost of treatment perceived to be futile in critical care. JAMA Internal Medicine, 173(20), 1887-1894.
  • Johnson, D. W., Schmidt, U. H., Bittner, E. A., Christensen, B., Levi, R., & Pino, R. M. (2013). Delay of transfer from the intensive care unit: A prospective observational study of incidence, causes, and financial impact. Critical Care, 17(4), R128-R133.
  • Kerrigan, M. R. (2014). A framework for understanding community colleges’ organizational capacity for data use: A convergent parallel mixed methods study. Journal of Mixed Methods Research, 8(4), 341-362.
  • Khwannimit, B., & Bhurayanontachai, R. (2015). The direct costs of intensive care managament and risk factors for financial burden of patients with severe sepsis and septic shock. Journal of Critical Care, 30(5), 929-934.
  • Kox, M., & Pickkers, P. (2013). Less is more in critically ill patients: Not too intensive. JAMA Internal Medicine, 17(14), 1369-1372.
  • Kumar, G., Falk, D. M., Bonello, R. S., Kahn, J. M., Perencevich, E., & Cram, P. (2013). The costs of critical care telemedicine programs a systemic review and analysis. Critical Care, 143(1), 19-29.
  • Kumar, P., Jitbesh, V., & Gupta, S. K. (2015). Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in trauma center in India. Saudi Journal of Anaesthesia, 9(2), 189-194.
  • Kyeremanteng, K., Gagnon, L. P., Thavorn, K., Heyland, D., & D’egido, G. (2018). The impact of palliative care consultation in the ICU on length of stay: A systematic review and cost evaluation. Journal of Intensive Care Medicine, 33(6), 346-353.
  • Lefrant, J. Y., Garrigues, B., Pribil, C., Bardoul, I., Courtial, F., Maurel, F., & Bazin, J. E. (2015). The daily cost of ICU patients: A micro-costing study in 23 French intensive care units. Anaesthesia Critical Care & Pain Medicine, 34(3), 151-157.
  • Lewis, K. S., Kane-Gill, S. L., Bobek, M. B., & Dasta, J. F. (2004). Intensive insülin therapy for critically ill patients. Annals of Pharmacotherapy, 38(7-8), 1243-1251.
  • Merrit, C. L. (2011). Clinical imperative versus economic consequence exploring the cost burden and opportunities in the care of patients with sepsis. Nursing Administration Quarterly, 35(1), 61-67.
  • Milbrandt, E. B., Kersten, A., Rahim, M. T., Dremsizov, T. T., Clermont, G., Cooper, L. M., Angus, D. C., & Linde-Zwirble, W. T. (2008). Growth of intensive care unit resource use and its estimated cost in medicare. Critical Care Medicine, 36(9), 2504-2510.
  • Miranda, D. R., & Jegers, M. (2012). Monitoring costs in the ICU: A search for a partinent methodology. Acta Anaesthesiol Scandinavica, 56(9), 1104-1113.
  • Moerer, O., Plock, E., Mgbor, U., Schmid, A., Schneider, H., Wischnewsky, M. B., & Burchardi, H. (2007). A German national prevelance study on the cost of intensive care: An evaluation from 51 intensive care units. Critical Care, 11(3), R69-R79.
  • Morgan, L., Howe, L., Whitcomb, J., & Smith, K. (2011). Improving communication and cost effectiveness in the intensive care unit through palliative care a review of literatüre. Dimensions of Critical Care Nursing, 30(3), 133-138.
  • Morillo Garcia, A., Aldana Espinal, J. M., De Labry Lima, A. O., Valencia Martin, R., Lopez Marquez, R., Loscertales Abril, M., & Conde Herrera, M. (2015). Hospital costs associated with nosocomial infections in pediatric intensive care unit. Gac Sanit, 29(4), 282-287.
  • Mullins, P. M., Goyal, M., & Pines, J. M. (2013). National growth in intensive care unit admissions from emergency departments in the United States from 2002 to 2009. Academic Emergency Medicine, 20(5), 479-486.
  • Nakamura, I., Fukushima, S., Hayakawa, T., Sekiya, K., & Matsumoto, T. (2015) The additioanal costs of catheter-related bloodstream infections in intensive care units. American Journal of Infection Control, 43(10), 1046-1049.
  • Needham, D. M., Bronskill, S. E., Calinawan, C. R., Sibbald, W. J., Pronovost, P. J., & Laupacis, A. (2005). Projected incidence of mechanical ventilation in ontario to 2026: Preparing for the aging baby boomers. Critical Care Medicine, 33(3), 574-579.
  • Neudendorf, K. A.. (2017). The Content analysis guidebook. (2nd Edition), Sage Publications, USA.
  • O’Mahony, S., Johnson, T. J., Amer, S., Mchugh, M. E., Mchenry, J., Fosler, L., & Kvetan, V. (2017). Integration of palliative care advanced practice nurses into intensive care unit teams. American Journal of Hospice and Palliative Medicine, 34(4), 330-334.
  • Olukoga, A. (2007). Unit costs of impatient days in district hospitals in South Africa. Singapore Medical Journal, 48(2), 143-147.
  • Oostrenbrink, J. B., Buijs-Van Der Woude, T., Van Agthoven, M., Koopmanschap, M. A., & Rutten, F. F. H. (2003). Unit costs of impatient hospital days. Pharmacoeconomics, 21(4), 263-271.
  • Paradelli, L., Povero, M., Muscaritoli, M., & Eandi, M. (2015). Updated cost effectiveness analysis of supplemental glutamine for parenteral nutrition of intensive care patients. European Journal of Clinical Nutrition, 69(5), 546-551.
  • Parikh, A., Huang, S. A., Murthy, P., Dombrovskiy, V., Nolledo, M., Lefton, R., & Scardella, A. T. (2012). Quality improvement and cost savings after implementation of the leapfrog intensive care unit physician staffing standard at a community teaching hospital. Critical Care Medicine, 40(10), 2754-2759.
  • Penrod, J. D., Deb, P., Dellenbaugh, C., Burgess, J. F., Zhu, C. W., Christiansen, C. L., Luhrs, C. A., Cortez, T., Allen, V., & Morrison, S. M. (2010). Hospital-based palliative care consultation: Effects on hospital cost. Journal of Palliative Medicine, 13(8), 973-979.
  • Peter, J. V., Thomas, K., Jeyaseelan, L., Yadav, B., Sudarsan, T. I., Christina, T. I., Revath,. A., John, K. R., & Sudarsanam, T. D. (2016). Cost of intensive care in India. International Journal of Technology Assessment in Health Care, 32(4), 241-245.
  • Petrie, J., Easton, J., Naik, V., Lockie, C., Brett, S. J., & Stumpfle, R. (2015). Hospital costs of outof- hospital cardiac arrest patients treated in intensive care: A single centre evaluation using the natioanal tariff-based system. BMJ Open, 5(4), E005797.
  • Pines, J. M., Fager, S. S., & Milzman, D. P. (2002). A review of costing methodologies in critical care studies. Journal of Critical Care, 17(3), 181-186.
  • Raad, S., Elliott, R., Dickerson, E., Khan, B., & Diab, K. (2017). Reduction of laboratory utilization in the intensive care unit. Journal of Intensive Care Medicine, 32(8), 500-507.
  • Reynolds, H. N., Regove, H., Bander, J., Mccambridge, M., Cowboy, E., & Niemeier, M. A. (2011). A working lexicon for the tele-intensive care unit: We need to define tele-intensive care unit to grow and understand it. Telemedicine and E-Health, 17(10), 773-783.
  • Rivello, E. D., Letchford, S., Achieng, L., & Newton, M. W. (2011). Critical care in resource-poor settings: Lessons learned and future directions. Critical Care Medicine, 39(4), 860-867.
  • Sadatsafavi, H., Niknejad, B., Zadeh, R., & Sadatsafavi, M. (2016) Do cost saving from reductions in nosocomial infections justify additional costs of single-bed rooms in intensive care units? A simulation case study. Journal of Critical Care, 31(1), 193-199.
  • Saleh, S. S., Callan, M., Therriault, M., & Landor, N. (2010). The cost impact of hospital-acquired conditions among critical care patients. Medical Care, 48, 518-526.
  • Scurlock, C., Raikhelkar, J., & Mechanick, J. I. (2011). The economics of glycemic control in the United States. Current Opinion in Clinical Nutriton and Metabolic Care, 14(2), 209-212.
  • Stafseth, S. K., Tonnessen, T. I., & Fagerstrom, L. (2018). Association between patient classification systems and nurse staffing costs in intensive care units: An exploratory study. Intensive and Critical Care Nursing, 45, 78-84.
  • Streubert, H. S., Streubert, H. J. & Carpenter, D. R. (2011). Qualitative research in nursing: Advancing the humanistic imperative. (5th Edition), Lippincott Williams and Wilkins, Philadelphia.
  • Tan, S. S., Bakker, J., Hoogendoorn, M. E., Kapilla, A., Martin, J., Pezzi, A., Pittoni, G., Spronk, P. E., Welte, R., & Hakkaart-Van Roijen, L. (2012). Direct cost analysis of intensive care unit stay in four european countries: Applying A standardized costing methodology. Value in Health, 15(1), 81- 86.
  • Than, T. M., Saw, Y. M., Khaing, M., Win, E. M., Cho, S. M., Kariya, T., Yamamoto, E., & Hamajima, N. (2017). Unit cost of healthcare service at 200 bed public hospitals in Myanmar: What plays an important role of hospital budgeting? BMC Health Service Research, 17(1), 669-681.
  • Van Dijk, F. E., & Van Der Werken, C. (1998). What are costs of an intensive care patient? The direct costs of a surgical patient per ICU-admission and per impatient day. Medisch Contact, 53, 1154- 1156.
  • Voigt, J., & Mosier, M. (2013). Remote care costs for congestive heart failure: A systematic review and meta analysis of randomized controlled trials in the United States comparing remote versus more intensive care settings. Congestive Heart Failure, 19(4), 192-199.
  • Weber, R. J., Kane, S. L., Oriolo, V.A., Saul, M., Skledar S. J., & Dasta, J. F. (2003). Impact of intensive care unit (ICU) drug use on hospital costs: A descriptive analysis, with recommendations for optimizing ICU pharmacotherapy. Critical Care Medicine, 31(1), 17-24.
  • Wunsch, H., Gershengorn, H., & Scales, D. C. (2012). Economics of ICU organization and management. Critical Care Medicine, 28(1), 25-37.
  • Yoo, B. K., Sasaki, T., & Marcin, J. P. (2018). Selected use of telemedicine in intensive care units based on severity of illness improves cost effectiveness. Telemedicine and E-Health, 24(1), 21-36.
  • Younis, M. Z., Jaber, S., Mawson, A. R., & Hartman, M. (2013). Estimating The unit costs of public hospitals and primary healthcare centers. The International Journal of Health Planning and Management, 28(4), 320-332.
APA FİDAN C, AĞIRBAŞ İ (2020). YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. , 485 - 504.
Chicago FİDAN Cuma,AĞIRBAŞ İsmail YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. (2020): 485 - 504.
MLA FİDAN Cuma,AĞIRBAŞ İsmail YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. , 2020, ss.485 - 504.
AMA FİDAN C,AĞIRBAŞ İ YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. . 2020; 485 - 504.
Vancouver FİDAN C,AĞIRBAŞ İ YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. . 2020; 485 - 504.
IEEE FİDAN C,AĞIRBAŞ İ "YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ." , ss.485 - 504, 2020.
ISNAD FİDAN, Cuma - AĞIRBAŞ, İsmail. "YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ". (2020), 485-504.
APA FİDAN C, AĞIRBAŞ İ (2020). YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. Hacettepe Sağlık İdaresi Dergisi, 23(3), 485 - 504.
Chicago FİDAN Cuma,AĞIRBAŞ İsmail YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. Hacettepe Sağlık İdaresi Dergisi 23, no.3 (2020): 485 - 504.
MLA FİDAN Cuma,AĞIRBAŞ İsmail YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. Hacettepe Sağlık İdaresi Dergisi, vol.23, no.3, 2020, ss.485 - 504.
AMA FİDAN C,AĞIRBAŞ İ YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. Hacettepe Sağlık İdaresi Dergisi. 2020; 23(3): 485 - 504.
Vancouver FİDAN C,AĞIRBAŞ İ YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ. Hacettepe Sağlık İdaresi Dergisi. 2020; 23(3): 485 - 504.
IEEE FİDAN C,AĞIRBAŞ İ "YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ." Hacettepe Sağlık İdaresi Dergisi, 23, ss.485 - 504, 2020.
ISNAD FİDAN, Cuma - AĞIRBAŞ, İsmail. "YOĞUN BAKIM MALİYETLERİ VE YOĞUN BAKIM MALİYET ÇALIŞMALARININ İNCELENMESİ". Hacettepe Sağlık İdaresi Dergisi 23/3 (2020), 485-504.
Sayfa Oluşturulma Tarihi
17-04-2024 16:47

İLETİŞİM

TÜBİTAK ULAKBİM TR Dizin

Yüzüncüyıl, İşçi Blokları Mahallesi

Muhsin Yazıcıoğlu Caddesi No:51/C

06530 Çankaya / ANKARA +90 (312) 298 92 00

trdizin@tubitak.gov.tr

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © Tüm Hakları Saklıdır. Gizlilik Politikası Kullanım Şartları