Tabriz University of Medical Sciences Depiction of Health 2008-9058 12 3 2021 09 23 Quality of Health Services and the Factors Affecting it: A Cross-Sectional Study in Pilot Hospitals for Electronic Referral System 214 223 10.34172/doh.2021.22 EN Mohammad Javad Kabir https://orcid.org/0000-0001-7960-7670 Alireza Heidari https://orcid.org/0000-0001-9262-7967 Zahra Khatirnamani https://orcid.org/0000-0003-0381-8687 Sakine Beygom Kazemi https://orcid.org/0000-0002-7122-1535 Mohammad Reza Honarvar https://orcid.org/0000-0002-9302-3791 Ali Ebrazeh https://orcid.org/0000-0001-5694-667X Mansoureh Lotfi https://orcid.org/0000-0001-7621-6308 Journal Article 10.34172/doh.2021.22 2021 01 26 2021 04 04 Background and objectives Health system services are not reliable without quality assessment. It is important to explore gaps between standard services and the existing situation to improve the quality of health system. This study aimed at studying the quality assessment of electronic referral system in one of the major provinces of Iran. Material and Methods This study was a cross-sectional study, utilizing SERVQUAL model. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in proportion to each city’s population. A sample of 384 patients who had used electronic referral service at level 2 and received outpatient services made up the population of the study. The data were collected through a two-part questionnaire. The validity of the questionnaire was confirmed by 10 experts, including senior and mid-level managers and medical science university faculty members. The questionnaire assessed demographic data and the patients' perceptions and expectations. The data were analyzed using descriptive statistics and analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption, including Wilcoxon test, Mann-Whitney and Kruskal-Wallis. Spearman correlation test was used to determine the intensity of correlation between the study variables. The significance level of all tests was considered 0.05. Results There were identified gaps throughout all dimensions of health services among the studied clinics (P <0.001). The biggest gap was observed in the empathy dimension (0.57) and the smallest one was observed in the tangible dimension (-0.38). The gap between the services provided to patients was different in terms of guarantee, gender (P = 0.005), empathy, level of education (P = 0.028) and reliability based on the particular city considered (P = 0.028). Conclusion In the hospitals implementing the electronic referral system in Golestan province, there is a gap in all dimensions and it indicates that the expectations of the recipients have not been fully met in virtually any of the dimensions.