Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 50 1 2020 12 28 161 169 Ali JANATI Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Reza EBRAHIMOGHLI Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Homayoun SADEGHI-BAZARGANI Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Masoumeh GHOLIZADEH Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Firooz TOOFAN Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Hojatolah GHARAEE District Health Center of Hamadan City, Hamadan University of Medical Sciences, Hamadan, Iran 2019 02 04 2019 04 24 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/14820 https://ijph.tums.ac.ir/index.php/ijph/article/download/14820/7107