Original Article

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

Abstract

Background: In May 2014, Iran launched the most far-reaching 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 pre-reform 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.

1. Karami Matin B, Hajizadeh M, Najafi F, et al (2018). The impact of health sector evolution plan on hospitalization and cesarean section rates in Iran: an interrupted time series analysis. Int J Qual Health Care, 30(1):75-79.
2. Heshmati B, Joulaei H (2016). Iran's health-care system in transition. Lancet, 387(10013):29-30.
3. Moradi-Lakeh M, Vosoogh-Moghaddam A (2015). Health sector evolution plan in Iran; equity and sustainability concerns. Int J Health Policy Manag, 4:637-640.
4. Piroozi B, Rashidian A, Moradi G, et al (2017). Out-of-pocket and informal payment before and after the health transformation plan in Iran: evidence from hospitals located in Kurdistan, Iran. Int J Health Policy Manag, 6:573-586.
5. Piroozi B, Moradi G, Nouri B, et al (2016). Catastrophic health expenditure after the implementation of health sector evolution plan: a case study in the west of Iran. Int J Health Policy Manag, 5:417-423.
6. Najafi F, Karami-Matin B, Rezaei S, et al (2016). Health system responsiveness after health sector evolution plan (HSEP): An inpatient survey in Kermanshah in 2015. Med J Islam Repub Iran, 30:387.
7. Asghari SA, Sahbaei F, Abianeh EE (2016). Comparing the satisfaction of patients before and after the implementation of the healthcare reform in hospitals of Qazvin, 2015. Int J Med Res Health Sci, 5(7S):532-8.
8. Hashemi B, Baratloo A, Forouzafar MM, et al (2015). Patient satisfaction before and after executing health sector evolution plan. Ṭibb-i urzhāns-i Īrān, 2:127-133.(in Persian)
9. Moradi G, Piroozi B, Safari H, et al (2017). Assessment of the efficiency of hospitals before and after the implementation of health sector evolution plan in Iran based on Pabon Lasso model. Iran J Public Health, 46:389-395.
10. Gholami S, Sahraei Z, Khoshghadam M, et al (2018). Assessment of the Efficiency of hospitals before and after the implementation of the Health Reform Plan in Qazvin province based on the Pabon Lasso model (2011-2016). World Family Medicine,16(6): 33-40.
11. Sadati AK, Rahnavard F, Heydari ST, et al (2017). Health Sector Reform, Emotional Exhaustion, and Nursing Burnout: A Retrospective Panel Study in Iran. J Nurs Res, 25:368-374.
12. Pearson B, Skelly R, Wileman D, Masud T (2002). Unplanned readmission to hospital: a comparison of the views of general practitioners and hospital staff. Age Ageing, 31:141-143.
13. Rahman M, Foster AD, Grabowski DC, et al (2013). Effect of hospital–SNF referral linkages on rehospitalization. Health Serv Res, 48(6 Pt 1):1898-919.
14. Mehralian H, Imani R, Khaledifar A, Hatami Pour K (2008). Effect of continuous caring and educational intervention (home visit) on quality of life in the congestive heart failure patients. Journal of Shahrekord University of Medical Sciences, 10:14-19.
15. Delgado‐Passler P, McCaffrey R (2006). The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure. J Am Acad Nurse Pract, 18:154-160.
16. Jencks SF, Williams MV, Coleman EA (2009). Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med, 360:1418-1428.
17. Ashton CM, Del Junco DJ, Souchek J, et al (1997). The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care, 35:1044-1059.
18. Benbassat J, Taragin M (2000). Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med, 160:1074-1081.
19. Cox DR (1992). Regression models and life-tables. In: Breakthroughs in statistics. Ed(s): Springer, pp. 527-541.
20. Schoenfeld D (1982). Partial residuals for the proportional hazards regression model. Biometrika, 69:239-241.
21. Toth M, Holmes M, Van Houtven C, et la (2017). Rural–urban Differences in the Effect of Follow‐up Care on Postdischarge Outcomes. Health Serv Res, 52:1473-1493.
22. Lasser KE, Hanchate AD, McCormick D, et al (2014). The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics. BMJ, 348:g2329.
23. Zhu J, Brawarsky P, Lipsitz S, et al (2010). Massachusetts health reform and disparities in coverage, access and health status. J Gen Intern Med, 25:1356-1362.
24. Arbaje AI, Wolff JL, Yu Q, et al (2008). Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist, 48:495-504.
25. Amarasingham R, Moore BJ, Tabak YP, et al (2010). An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical record data. Med Care, 48:981-988.
26. Anderson DR, Burnham KP, Thompson WL (2000). Null hypothesis testing: problems, prevalence, and an alternative. J Wildl Manage, 64:912-923.
27. Kühberger A, Fritz A, Lermer E, Scherndl T (2015). The significance fallacy in inferential statistics. BMC Res Notes, 8:84.
28. Lantz B (2013). The large sample size fallacy. Scand J Caring Sci, 27:487-492.
29. Davies SM, Saynina O, McDonald KM, Baker LC (2013). Limitations of using same-hospital readmission metrics. Int J Qual Health Care, 25:633-639.
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IssueVol 50 No 1 (2021) QRcode
SectionOriginal Article(s)
Published2020-12-28
DOI https://doi.org/10.18502/ijph.v50i1.5083
Keywords
Readmission rate Readmission-free time Health transformation plan Health care quality

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How to Cite
1.
JANATI A, EBRAHIMOGHLI R, SADEGHI-BAZARGANI H, GHOLIZADEH M, TOOFAN F, GHARAEE H. Impact of the Iranian Health Sector Evolution Plan on Rehospitalization: An Analysis of 158000 Hospitalizations. Iran J Public Health. 50(1):161-169.