Impact of early discharge on newborns

The impact of early discharge laws on the health of newborns

Using an interrupted time series design and a census of births in California over a 6-year period, we show that state and federal laws passed in the late 1990s designed to increase the length of postpartum hospital stays reduced considerably the fraction of newborns that were discharged early. The law had little impact on re-admission rates for privately insured, vaginally delivered newborns, but reduced re-admission rates for privately insured c-section-delivered and Medicaid-insured vaginally delivered newborns by statistically significant amounts. Our calculations suggest the program was not cost saving.

Use of hospital-based services in the first three months of life: impact of an early discharge program

OBJECTIVE

To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life.

DESIGN

Retrospective cohort study.

SETTING

Metropolitan university hospital and a children's hospital.

PATIENTS

Term infants cared for in a single term nursery, before and after implementation of an early discharge program.

INTERVENTION

Early discharge program.

METHODS

Linking of the birth hospital and the children's hospital records and chart review.

OUTCOME MEASURES

Pattern of emergency department visits and rehospitalizations in the first 3 months of life.

RESULTS

The early discharge group had a shorter stay, 32 +/- 21 hours (mean +/- SD) than the control group (48 +/- 22 hours). There was no effect of early discharge on mean age at rehospitalization, rehospitalization rate, or reason for rehospitalization. Twenty-eight percent of infants in both study and control groups had at least one emergency department visit by 3 months of age. There was no difference between study and control groups in mean age or frequency of emergency department visits. Maternal age and race had a significant effect on the odds of visiting the emergency department. For any maternal age, nonwhite mothers were more likely to visit the emergency department.

CONCLUSIONS

Early discharge of newborn infants to inner city parents can be accomplished without increasing hospital-based resource use in the first 3 months of life provided coordinated postdischarge care and home visiting services are available.