This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (12)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Meara, E.
Right arrow Articles by Lieu, T. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Meara, E.
Right arrow Articles by Lieu, T. A.
Related Collections
Right arrow Office Practice
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.




This article has been cited by other articles:


Home page
PediatricsHome page
C. E. Mercier, S. E. Barry, K. Paul, T. V. Delaney, J. D. Horbar, R. C. Wasserman, P. Berry, and J. S. Shaw
Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project
Pediatrics, September 1, 2007; 120(3): 481 - 488.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
I. M. Paul, E. B. Lehman, C. S. Hollenbeak, and M. J. Maisels
Preventable Newborn Readmissions Since Passage of the Newborns' and Mothers' Health Protection Act
Pediatrics, December 1, 2006; 118(6): 2349 - 2358.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
A. Datar and N. Sood
Impact of Postpartum Hospital-Stay Legislation on Newborn Length of Stay, Readmission, and Mortality in California
Pediatrics, July 1, 2006; 118(1): 63 - 72.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
A. A. Galbraith, D. C. Grossman, T. D. Koepsell, P. J. Heagerty, and D. A. Christakis
Medicaid Acceptance and Availability of Timely Follow-up for Newborns With Medicaid
Pediatrics, November 1, 2005; 116(5): 1148 - 1154.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
G. K. Suresh and R. E. Clark
Cost-Effectiveness of Strategies That Are Intended to Prevent Kernicterus in Newborn Infants
Pediatrics, October 1, 2004; 114(4): 917 - 924.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
M. J. Maisels and on behalf of the Subcommittee on Hyperbilirubinemi
Hyperbilirubinemia Guidelines and Unintended Harms: In Reply
Pediatrics, October 1, 2004; 114(4): 1135 - 1137.
[Full Text] [PDF]