PEDIATRICS Vol. 108 No. 3 September 2001, pp. 719-727
A Randomized Comparison of Home Visits and Hospital-Based Group Follow-Up Visits After Early Postpartum Discharge
Received Dec 13, 2000; accepted Apr 13, 2001.
,
, and
From * Kaiser Permanente Medical Care Program Perinatal Research
Unit Division of Research, Oakland, California; Objective. Short postpartum stays are
common. Current guidelines provide scant guidance on how routine
follow-up of newly discharged mother-infant pairs should be performed.
We aimed to compare 2 short-term (within 72 hours of discharge)
follow-up strategies for low-risk mother-infant pairs with postpartum
length of stay (LOS) of <48 hours: home visits by a nurse and
hospital-based follow-up anchored in group visits.
Methods. We used a randomized clinical trial design with
intention-to-treat analysis in an integrated managed care setting that
serves a largely middle class population. Mother-infant pairs that met LOS and risk criteria were randomized to the control arm
(hospital-based follow-up) or to the intervention arm (home nurse
visit). Clinical utilization and costs were studied using computerized
databases and chart review. Breastfeeding continuation, maternal
depressive symptoms, and maternal satisfaction were assessed by means
of telephone interviews at 2 weeks postpartum.
Results. During a 17-month period in 1998 to 1999, we
enrolled and randomized 1014 mother-infant pairs (506 to the control
group and 508 to the intervention group). There were no significant
differences between the study groups with respect to maternal age,
race, education, household income, parity, previous breastfeeding
experience, early initiation of prenatal care, or postpartum LOS. There
were no differences with respect to neonatal LOS or Apgar scores. In
the control group, 264 mother-infant pairs had an individual visit only, 157 had a group visit only, 64 had both a group and an individual visit, 4 had a home health and a hospital-based follow-up, 13 had no
follow-up within 72 hours, and 4 were lost to follow-up. With respect
to outcomes within 2 weeks after discharge, there were no significant
differences in newborn or maternal hospitalizations or urgent care
visits, breastfeeding discontinuation, maternal depressive symptoms, or
a combined clinical outcome measure indicating whether a mother-infant
pair had any of the above outcomes. However, mothers in the home visit
group were more likely than those in the control group to rate multiple
aspects of their care as excellent or very good. These included the
preventive advice delivered (76% vs 59%) and the skills and abilities
of the provider (84% vs 73%). Mothers in the home visit group also
gave higher ratings on overall satisfaction with the newborn's
posthospital care (71% vs 59%), as well as with their own
posthospital care (63% vs 55%). The estimated cost of a postpartum
home visit to the mother and the newborn was $265. In contrast, the
cost of the hospital-based group visit was $22 per mother-infant pair;
the cost of an individual 15-minute visit with a registered nurse was
$52; the cost of a 15-minute individual pediatrician visit was $92; and
the cost of a 10-minute visit with an obstetrician was $92.
Conclusions. For low-risk mothers and newborns in an
integrated managed care organization, home visits compared with
hospital-based follow-up and group visits were more costly but achieved
comparable clinical outcomes and were associated with higher maternal
satisfaction. Neither strategy is associated with significantly greater
success at increasing continuation of breastfeeding. This study had
limited power to identify group differences in rehospitalization and
may not be generalizable to higher-risk populations without comparable access to integrated hospital and outpatient care.
Kaiser Permanente
Medical Center Department of Pediatrics, Walnut Creek, California;
§ Department of Family and Community Medicine University of California,
San Francisco, San Francisco, California; Kaiser Permanente Medical
Center Department of Pediatrics, Santa Clara, California; and
¶ Department of Ambulatory Care and Prevention Harvard Pilgrim Health
Care and Harvard Medical School, Boston, Massachusetts.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  M. W. Kuzniewicz, G. J. Escobar, and T. B. Newman Impact of Universal Bilirubin Screening on Severe Hyperbilirubinemia and Phototherapy Use Pediatrics, October 1, 2009; 124(4): 1031 - 1039. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. Coker, P. J. Chung, B. O. Cowgill, L. Chen, and M. A. Rodriguez Low-Income Parents' Views on the Redesign of Well-Child Care Pediatrics, July 1, 2009; 124(1): 194 - 204. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Heisler Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research Fam. Pract., March 17, 2009; (2009) cmp003v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Heisler Overview of Peer Support Models to Improve Diabetes Self-Management and Clinical Outcomes Diabetes Spectr, October 1, 2007; 20(4): 214 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Madlon-Kay and S. E. Asche Factors That Influence the Receipt of Well Baby Care in the First 2 Weeks of Life. J Am Board Fam Med, May 1, 2006; 19(3): 258 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Jaber, A. Braksmajer, and J. S. Trilling Group visits: a qualitative review of current research. J Am Board Fam Med, May 1, 2006; 19(3): 276 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Heisler and J. D. Piette "I Help You, and You Help Me": Facilitated Telephone Peer Support Among Patients With Diabetes The Diabetes Educator, November 1, 2005; 31(6): 869 - 879. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G J Escobar, J D Greene, P Hulac, E Kincannon, K Bischoff, M N Gardner, M A Armstrong, and E K France Rehospitalisation after birth hospitalisation: patterns among infants of all gestations Arch. Dis. Child., February 1, 2005; 90(2): 125 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Labarere, N. Gelbert-Baudino, A.-S. Ayral, C. Duc, M. Berchotteau, N. Bouchon, C. Schelstraete, J.-P. Vittoz, P. Francois, and J.-C. Pons Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs Pediatrics, February 1, 2005; 115(2): e139 - e146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Paul, T. A. Phillips, M. D. Widome, and C. S. Hollenbeak Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration Pediatrics, October 1, 2004; 114(4): 1015 - 1022. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Committee on Fetus and Newborn Hospital Stay for Healthy Term Newborns Pediatrics, May 1, 2004; 113(5): 1434 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Beal, J. P. T. Co, D. Dougherty, T. Jorsling, J. Kam, J. Perrin, and R. H. Palmer Quality Measures for Children's Health Care Pediatrics, January 1, 2004; 113(1/S1): 199 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-M. Guise, V. Palda, C. Westhoff, B. K. S. Chan, M. Helfand, and T. A. Lieu The Effectiveness of Primary Care-Based Interventions to Promote Breastfeeding: Systematic Evidence Review and Meta-Analysis for the US Preventive Services Task Force Ann. Fam. Med, July 1, 2003; 1(2): 70 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Taveras, A. M. Capra, P. A. Braveman, N. G. Jensvold, G. J. Escobar, and T. A. Lieu Clinician Support and Psychosocial Risk Factors Associated With Breastfeeding Discontinuation Pediatrics, July 1, 2003; 112(1): 108 - 115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02) Evid. Based Nurs., January 1, 2003; 6(1): e1 - 1. [Full Text] [PDF]
|
|
