The impact of health sector evolution plan on hospitalization and cesarean section rates in Iran: an interrupted time series analysis

Objective: To investigate the effect of the health sector evolution plan (HSEP) on hospitalization and cesarean section (C-section) rates in Kermanshah province in the western region of Iran. Design: Interrupted time series analysis. Setting: Hospital care system in Kermanshah province. Study Participants: Fifteen hospitals affiliated to Ministry of Health and Medical Education (MoHME) in Kermanshah province. Intervention(s): Health sector evolution plan. Main Outcome Measures: Hospitalization rate and C-section rate. Results: We observed a statistically significant increase in the hospitalization rate (12.9 hospitalizations per 10 000 population, P < 0.001) in the first month after the implementation of the HSEP. Compared with the monthly trend in hospitalization rate before the intervention, we found a significant increase of 0.70 hospitalizations per 10 000 population (P < 0.001) in monthly trend in hospitalization rate after the HSEP. Although the proportion of C-section from total deliveries decreased by 11% (P = 0.044) in the first month after the implementation of the HSEP, the proportion of C-section from total deliveries increased at the rate of 0.0017% (P = 0.001) per month during post-intervention period. Conclusion: We found an increase in the hospitalization rate after the intervention of HSEP. Although the C-section rate in the first month after the HSEP decreased, we observed an increasing trend in C-section rate over the study period; this implies that the HSEP did not promote vaginal delivery in Iran, which is outlined as one of the objectives of the intervention.