Length-of-Stay Policies and Ascertainment of Postdischarge Problems in Newborns
- 1 January 2004
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 113 (1), 42-49
- https://doi.org/10.1542/peds.113.1.42
Abstract
Objective. The purpose of this study was to evaluate the effects of an early postpartum discharge program and a subsequent legislative mandate for 48 hours of hospital coverage on incidence of newborn jaundice and feeding problems. We tested the hypothesis that heightened postdischarge ascertainment (rather than short stays) is responsible for apparent increases in these outcomes. Methods. Interrupted time series analysis was conducted on retrospective data from the automated medical records of a large Massachusetts health maintenance organization (HMO). A population of 20 366 mother–infant pairs with normal vaginal deliveries between October 1990 and March 1998 was identified. The interventions included a new HMO protocol in 1994 of 1 hospital overnight after delivery, plus a nurse home visit, then the Massachusetts’ 1996 minimum coverage law. Postpartum length of stay, clinical evaluation on day 3 or 4 of life, health center visits up to day 21, health center diagnoses of jaundice or feeding problems, bilirubin testing and test severity, rehospitalizations, and emergency department visits were measured. Results. Postpartum stays Conclusions. Sudden increases in jaundice-related measures and identification of infant feeding problems were not associated with changes in length of stay in this setting. Instead, these increases seem to be the result of more frequent evaluation of newborns during the critical day 3 to 4 period and may also have been elevated by a new climate of concern about neonatal vulnerability. “Ascertainment bias” may have confounded findings in previous reports that raised concerns about the safety of early discharge.Keywords
This publication has 38 references indexed in Scilit:
- Effects of a Law against Early Postpartum Discharge on Newborn Follow-up, Adverse Events, and HMO ExpendituresNew England Journal of Medicine, 2002
- The safety of early postpartum discharge: A review and critiqueObstetrics & Gynecology, 1997
- Hospital readmission with feeding-related problems after early postpartum discharge of normal newbornsJAMA, 1997
- The safety of newborn early discharge. The Washington State experienceJAMA, 1997
- Early discharge and evidence-based practice. Good science and good judgmentJAMA, 1997
- The effect of early discharge after vaginal delivery on neonatal readmission ratesObstetrics & Gynecology, 1997
- Association between duration of neonatal hospital stay and readmission rateThe Journal of Pediatrics, 1995
- Controversies of early discharge of infants from the well-newborn nurseryCurrent Opinion in Pediatrics, 1995
- Early Postpartum Discharge Programs in the United States: A Literature Review and CritiqueWomen & Health, 1991
- Payment Restrictions for Prescription Drugs under MedicaidNew England Journal of Medicine, 1987