Impact of the Iranian Health Sector Evolution Plan on Rehospitalization: An Analysis of 158000 Hospitalizations

Background: in may 2014, iran launched the most farreaching reform for the health sector, so-called health sector evolution plan (hsep), since introduction of the primary health care network, with a systematic plan to bring about universal health coverage. we aimed to analyze the time to first all-caused rehospitalization and all-caused 30-day readmission rate in the biggest referral hospital of northwest of iran before and after the reform. methods: we retrospectively analyzed discharge data for all hospitalization occurred in the six-year period of 2011-2017. the primary endpoints were readmission-free survival, and overall 30-day readmission rate. using multivariate cox proportional hazards regression and logistic regression, we assessed between-period differences for readmission-free survival time and overall 30-day rehospitalization, respectively. results: overall, 157969 admissions were included. after adjusting for available confounders including age; sex; ward of admission; length of stay; and admission in first/second half of year, the risk of being readmitted within 30 days after the reform was significantly higher (worse) compared to prereform hospitalization (odd ratio 1.22, p<0.001, 95% ci, 1.15-1.30 ). adjusting for the same covariates, after-reform period also was slightly significantly associated with decreased (deteriorated) readmission-free time compared with pre-hsep period (hr 1.06, p=0.005, 95% ci 1.01-1.11). conclusion: hsep seems insufficient to improve neither readmission rate, nor readmission-free time. it is advisable some complementary strategies to be incorporated in the hsep, such as continuity of care promotion, self-care enhancement, effective information flow, and post-discharge follow up programs.