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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1619-1627

Impact of Early Newborn Discharge Legislation and Early Follow-up Visits on Infant Outcomes in a State Medicaid Population

Ellen Meara, PhD*,{ddagger}, Uma R. Kotagal, MBBS, MS§,||,¶, Harry D. Atherton, BSEE, MS§ and Tracy A. Lieu, MD, MPH#,**

* Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
{ddagger} National Bureau of Economic Research, Cambridge, Massachusetts
§ Center for Health Policy & Clinical Effectiveness
|| Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Institute of Health Policy and Health Services Research, University of Cincinnati, Cincinnati, Ohio
# Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
** Division of General Pediatrics, Children's Hospital Boston, Boston, Massachuestts

Objective. Scant information exists on the effects of legislation mandating coverage of minimum postnatal hospital stays on infant health outcomes. There are also gaps in knowledge regarding the effectiveness of early follow-up visits for newborns. The objective of this study was to determine the impact of 1) legislation mandating coverage of minimum postnatal hospital stays and 2) early follow-up visits by the age of 4 days on infant outcomes during the first month of life.

Methods. A retrospective analysis was conducted of Ohio Medicaid claims data linked with birth certificate data for the period 1991-1998. The impact of the legislation was evaluated using interrupted time-series analysis of health-related utilization. The effects of early follow-up visits for vaginally delivered newborns with short stays were analyzed using the day of the week on which the birth occurred (eg, Monday, Tuesday) as an instrumental variable to account for potential confounding. A total of 155 352 full-term newborns who were born to mothers who receive Medicaid were studied. The main outcomes measured were rehospitalizations, emergency department (ED) visits, and diagnoses of dehydration and infection within 10 and 21 days of birth.

Results. Few outcomes exhibited significant changes after legislation mandating coverage of minimum postnatal hospital stays. Rates of rehospitalization for jaundice within 10 days of birth fell from 0.78% to 0.47% in the year after legislation was introduced but leveled off after the legislation took effect. Rates of ED visits within 21 days increased from 6.0% to 10.4% during periods of increasing short stay but fell to 8.0% during the year after introduction of the legislation and leveled off when the legislation took effect. Rates of all-cause rehospitalization, dehydration, and infection diagnoses showed no consistent relationship to Ohio's legislation. Using instrumental variable analysis, newborns who received early follow-up visits were significantly less likely to have rehospitalizations within the first 10 days of life than those who did not.

Conclusions. In this state Medicaid population, legislation mandating coverage of minimum postnatal hospital stays was associated with reductions in the rates of rehospitalization for jaundice and ED visits. For newborns with short stays, early follow-up visits may reduce rehospitalizations in the early postpartum period.

Key Words: length of stay • newborn • legislation • follow-up • Medicaid

Abbreviations: ED, emergency department • AAP, American Academy of Pediatrics • IV, instrumental variable

Received for publication Feb 20, 2003; Accepted Jul 18, 2003.




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