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Background and Purpose: The electronic referral system was established in Iran with the aim of increasing access to care, improving interaction, and efficient use of resources. The purpose of this study was to determine the effective factors in the establishment and implementation of electronic referral system in Iran. Methods: The present study was qualitative with a content analysis approach. In order to collect information, in-depth and semi-structured interviews were used. After interviewing 42 people, the information was saturated. The interviews were transcribed and analyzed, and the main topics were quoted, cited, and coded. The content analysis method was used and all authors participated in the analysis process to avoid bias and agreement. Results: Four main themes and eleven sub-themes were mentioned as effective themes in the implementation of the electronic referral system by the interviewees including resource management (human resource management, financing and equipment, and infrastructure), stewardship (policy-making, inter-sectorial leadership, and intra-sectorial governance), advocacy stakeholders (senior officials and policy-makers related to the program, service providers, community), and social commitment (commitment and accountability of service providers). Conclusions: Successful implementation of electronic referral systems requires the development of an operational plan that correctly identifies the factors affecting the establishment and implementation, as well as the cooperation of all responsible organizations which can help improve the establishment and sustainability of the program. It is suggested that managers and officials active in the field of health services use the results of this study in the establishment and implementation of electronic referral system.

Background:: Motor vehicle crashes (MVC) are considered to be the most common safety challenge, causing more than a million deaths worldwide annually. Objectives:: The current study was aimed at identifying the etiological role of human and vehicle safety factors in road crashes, and their effects on the severity of injury and fatality in the Sistan and Baluchistan Province, South East Iran. Patients and Methods:: In this study, 2 703 MVC recorded at the police office during one year period, were reviewed. The profile of the crashes was comprised of data that included; demographic characteristics of the injured persons in a MCV, type of crash, type of vehicles involved, location of crash, as well as human, environmental and mechanical factors which contributed to the crash. Data were analysed using binary and multinomial logistic regressions. Results:: After adjusting for confounding factors, vehicles with passengers were 33% more likely to have a crash. Furthermore, pickup trucks and heavy trucks increased the chance of causing a crash, 1.66 and 1.84 times more than saloon cars, respectively. Vehicles made after 2005 had twice the risk of causing a crash than those made in 1980 or before. In addition, in a multivariate model; drivers age, type of vehicle and circumstances of car damage were contributing factors to the severity of injury. Conclusions:: Type and age of the car, the presence of passengers and the degree of damage to the car were the determinant factors for car crashes, and consequent severity of injury in the study area. Educational programs must be directed at promoting public knowledge about the consequences of their behavior as either a passenger or driver.