Emergency Department Care in the Postpartum Period
- 1 November 2017
- journal article
- other
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 130 (5), 1073-1081
- https://doi.org/10.1097/aog.0000000000002269
Abstract
To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days (“high utilization”) and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08–2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98–2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49–1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42–1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37–1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.Keywords
This publication has 22 references indexed in Scilit:
- Women’s Use of Health Care in the First 2 Years Postpartum: Occurrence and CorrelatesMaternal and Child Health Journal, 2016
- Evaluating the effect of maternal health conditions on severe maternal morbidity adjusting for emergent cesarean delivery: A mediation analysis approachJournal of Epidemiological Research, 2015
- Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims AnalysisJournal of Women's Health, 2015
- Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013The Lancet, 2014
- Maternity Leave Duration and Postpartum Mental and Physical Health: Implications for Leave PoliciesJournal of Health Politics, Policy and Law, 2013
- Professional support and emergency visits during the first 2 weeks postpartumScandinavian Journal of Caring Sciences, 2013
- Impact of prenatal care provider on the use of ancillary health services during pregnancyBMC Pregnancy and Childbirth, 2013
- Emergency department use during the postpartum period: implications for current management of the puerperiumAmerican Journal of Obstetrics and Gynecology, 2010
- Health service use and outcomes among disabled Medicaid pregnant womenWomen's Health Issues, 2006
- Time Off Work and the Postpartum Health of Employed WomenMedical Care, 1997