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PEDIATRICS Vol. 106 No. 4 Supplement October 2000, pp. 937-941

Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

Received Jan 25, 2000; accepted Jun 13, 2000.

Kenneth D. Mandl*, parallel , Charles J. Homer*, Dagger , parallel , Oren Harary*, and Jonathan A. Finkelstein*, §

From the * Program in Clinical Effectiveness, Children's Hospital; Dagger  National Initiative for Children's Healthcare Quality, Institute for Healthcare Improvement; § Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care; and parallel  Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

Objective.  To determine the impact of reduced postpartum length of stay (LOS) on primary care services use.

Methods.  Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends. Setting: A managed care plan. Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services. Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect. Independent Measures: Pre-ROLOS or the post-ROLOS year. Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events.

Results.  Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not.

Conclusion.  This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.  Key words:  infant, newborn, length of stay, early discharge, outcomes, health services utilization, pregnancy, postpartum, patient discharge.


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