A new study sponsored by the Agency for Healthcare Research and Quality found no ill effects from discharging infants in a large Massachusetts HMO from the hospital 1 day after uncomplicated vaginal birth, compared with sending them home with their mothers 2 days after birth. But, because a sharp rise in hospital costs offset the savings realized by limiting postpartum stays to 1 day, the health plan's average per-delivery expenses decreased only $90 while this policy was in practice, according to the researchers who conducted the study.
After studying data on more than 20,000 pairs of mothers and newborn infants covered by the HMO, researchers found that emergency room visit and hospital readmission rates following hospital discharge did not change after the State established a 48-hour minimum stay. Prior to the minimum-stay legislation, effective in 1996, the HMO normally covered only a 1-night hospital stay for infants and their mothers after birth. This early discharge protocol, first implemented in 1994, also included one home visit by a nurse within 48 hours of birth.
Rates of newborn hospital readmissions and emergency room visits were found to be stable over nearly 8 years, regardless of which hospital discharge policy was in place at the time of birth. On average, 1.1 percent of the newborns had emergency room visits not resulting in hospital admission, and 1.5 percent were readmitted to hospitals during the first 10 days of birth. However, the percentage of newborns receiving clinical evaluations on either the third or fourth day after birth—which is when postpartum problems such as jaundice and feeding difficulties are most likely to occur—dropped when the State mandate requiring a longer hospital stay replaced the early discharge program (from roughly 64 percent to 53 percent).
The research team was headed by lead author Jeanne M. Madden, Ph.D., and principal investigator Stephen B. Soumerai, Sc.D., both at Harvard Medical School and Harvard Pilgrim Health Care in Boston.
Details are in "Effects of a law against early postpartum discharge on newborn follow-up, adverse events, and health maintenance organization expenditures," by Drs. Madden and Soumerai, Tracy A. Lieu, M.D., and others, in the December 19, 2002 New England Journal of Medicine 347(25), pp. 2031-2038.
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