Postpartum Discharge Preferences of Pediatricians: Results From a National Survey
* Lakewood, Colorado
Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, Illinois
Ann Arbor, Michigan
|| Division of General Pediatrics, Children’s Hospital, Boston, Massachusetts
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Objective. To identify practice/physician characteristics that influence pediatricians’ self-reported newborn discharge practices.
Methods. Of the pediatricians randomly surveyed through a national American Academy of Pediatrics periodic survey conducted in 2000, 490 were identified as routinely providing care for newborns in the nursery. These respondents rated the importance of 22 infant, maternal, and peripartum factors in determining readiness for nursery discharge on a 5-point Likert scale and reported their perceptions of optimal and minimal lengths of stay (LOS) for healthy term newborns. Importance of readiness factors was dichotomized as "high" (very important or important) versus "low" (neither, unimportant, or very unimportant). Relationships between pediatricians’ responses and demographic information were explored using multivariate logistic regression.
Results. Most pediatricians (at least 81%) rated all 7 infant clinical factors (eg, stable, normal vital signs, successful feeding) as highly important determinants of discharge readiness. Women were 2 to 3 times more likely to rate maternal and peripartum factors such as maternal fatigue and stress, demonstration of maternal skills, breastfeeding knowledge or experience, adequacy of social support, maternal age <18 years, and low income/lack of financial resources as highly important. With respect to hospital LOS, women were twice as likely to identify an optimal LOS as >36 hours and a minimal LOS as >24 hours. Pediatricians in group settings were 3 times as likely as those in solo or 2-physician practices to advocate an optimal LOS >36 hours, and those with a high proportion of publicly insured or uninsured patients were less likely to identify an optimal LOS as >36 hours (odds ratio: 0.53).
Conclusions. Female pediatricians report a more biopsychosocial approach to determining discharge readiness than their male counterparts, taking into account infant characteristics, maternal skills, and socioemotional issues that may affect the mother-infant pair’s adjustment at home. The finding that those who provide care for the most financially vulnerable patients do not see the need for longer LOS is both surprising and of concern. The results support the need for a prospective critical examination of perinatal hospital discharge practices, such as the Pediatric Research in Office Settings Life Around Newborn Discharge Study.
Key Words: postpartum discharge • physician practice preferences • newborn
Abbreviations: LOS, length of stay • NMHPA, Newborns’ and Mothers’ Health Protection Act • AAP, American Academy of Pediatrics • ACOG, American College of Obstetricians and Gynecologists • HMO, health maintenance organization • AOR, adjusted odds ratio • CI, confidence interval
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INTRODUCTION |
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Perinatal hospitalization practices, especially those that pertain to the length of stay (LOS), have varied considerably during the past half-century in the United States. Before the 1920s, hospital birth was uncommon; with progress in perinatal care, hospital delivery became more popular such that by 1945 80% of births occurred in the hospital.1 At that time, average LOS after vaginal delivery ranged from 3 to 5 days, but in the 1960s and 1970s, shorter stays became popular, primarily as a result of the women’s movement at that time. During the 1980s and early 1990s, financial constraints imposed by third-party payers led to additional shortening of the perinatal hospitalization such that by 1992 the average LOS after vaginal delivery was 2.1 days.2 As a result, many physicians and families felt frustrated with loss of control over the hospitalization experience,3,4 and in a 1996 national survey of pediatricians, 43% of the respondents indicated that they had cared for infants who were discharged early and experienced adverse outcomes related to the short stay.5 The national controversy over this issue culminated in the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA),6 legislation that facilitated reimbursement by third-party payers for postnatal stays of up to 2 days after vaginal delivery and 4 days after cesarean section.
Although the controversy surrounding early perinatal hospital discharge has subsided, most of the underlying questions remain. The debate raised a host of unresolved questions regarding the medical and psychosocial needs of the mother and infant during the perinatal period; the optimum care to meet those needs; and the best mechanisms for provision of that care in a safe, efficient, and cost-effective manner.7 Unfortunately, most of these questions have remained unanswered, prompting the NMHPA to call for additional research on issues related to perinatal hospitalization.6 Furthermore, the Secretary’s Advisory Committee on Infant Mortality, the group charged by that legislation with the task of conducting studies of the factors that affect care for mothers and newborns, recently concluded that "there is a need to define the postnatal/postpartum services (including hospital, outpatient, and home-based services) actually being received by newborns and mothers in the United States."8
In the midst of the perinatal hospital discharge controversy, the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) outlined criteria to be met before discharge of the mother and newborn.9,10 Arguably, these official guidelines constitute the best current statement of the prevailing standard of care pertaining to the perinatal hospitalization, yet the extent to which physician practice conforms to them remains unknown, as it does for many pediatric practice guidelines.11 Variations in compliance with official guidelines for several pediatric practices have been described with respect to physician and practice characteristics,12,13 and it is possible that such factors may influence the degree to which the AAP-ACOG guidelines for postpartum discharge are followed. In a prospective cohort pilot study14 about newborn discharge and postpartum services conducted just before the NMHPA went into effect January 1, 1998, maternal and pediatric perceptions of readiness for postpartum discharge of mothers and infants showed substantial variation on the day of discharge and over time. This pilot study further documented that differences in perceptions of readiness do occur and may have significant associations with maternal and infant health status, health-related behaviors, and health care utilization during the 4 weeks after postpartum discharge.
In light of these considerations, the present study was designed to evaluate the preferences of pediatricians with respect to postpartum discharge of healthy, term newborns. We postulated that there would be significant variation in postpartum discharge preferences with respect to physician and practice characteristics. Because the decision to discharge a newborn assumes that the goals of perinatal hospitalization have been met, we sought to identify the criteria evaluated by pediatricians in determining discharge readiness. We also attempted to determine whether physician perceptions of appropriate lengths of perinatal stay conformed to those recommended by the AAP and ACOG and to assess the extent to which pediatricians believe that control over the discharge process had been regained by physicians and families. Finally, because questions regarding optimal postdischarge follow-up are intimately related to those pertaining to the perinatal hospitalization, we attempted to delineate current follow-up practice preferences during the first month after discharge.
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METHODS |
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Population and Survey
Physicians were surveyed by means of a written questionnaire that contained 27 questions, 6 of which addressed newborn discharge practice preferences. It was mailed to a random sample of 1634 US members of the AAP. Pediatricians who did not respond to the first mailing were sent identical questionnaires approximately 3 weeks later, with a total of 6 mailings conducted. The survey was fielded between February and June 2000. Mailings were sent in an AAP envelope along with a postage-paid return envelope. The periodic surveys are conducted 4 times annually, each one to a different random sample of fellows. Topics are initiated by AAP committees or other groups and typically are intended to inform AAP policy statements, programs, and program evaluations. The Institutional Review Board of the AAP approved the survey protocol.
Questionnaire
Individual questions addressed determinants of discharge readiness, determinants of hospital LOS, and minimal and optimal LOS. Criteria offered were selected after review of the literature and recommendations of the AAP-ACOG.9,10 Additional questions evaluated postdischarge follow-up (office visit, home nurse visit, telephone contact) for breastfed and nonbreastfed infants during the first month after discharge. For convenience of interpretation, specific questions are given in the "Results" section with the corresponding responses. In addition, 10 questions assessed demographic features of the physician (age, gender, ethnicity/race, and duration of pediatric practice) and practice (community, practice setting, patient insurance status, and number of newborns discharged monthly). These questions were structured in the standard format used in all AAP periodic surveys.
Analysis of Data
Responses to individual questions were compared among groups defined by physician and practice characteristics using the 
2 test. Variables that showed significant differences in bivariate analyses were included in logistic regression models, all of which included physician age, gender, and an age-gender interaction term. Backward stepwise procedure was used initially. Physician and practice characteristics that were strongly correlated were not incorporated into the same final models because of multicollinearity issues; rather, separate models were fit. For example, practitioner age and gender were related, with women much more likely to be aged 42 years or younger and men more likely to be older than 42 years (P < .001). A similar relationship was found between age and duration of pediatric practice. Practice characteristics (insurance status of patients, community, and setting) were also highly correlated. For example, practitioners in solo or 2-physician practices were much more likely to practice in rural areas than were physicians from group, community health, or hospital settings (P < .001). All analyses were performed using SPSS 9.0 (SPSS, Inc, Chicago, IL). Statistical significance was defined as P < .05.
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RESULTS |
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Characteristics of Respondents
A total of 1048 pediatricians (64%) responded to the survey. A total of 575 respondents (resident fellows excluded) indicated that they spent the plurality of their time in direct patient, primary care; of these, 490 (85%) respondents who reported that they routinely provided primary care to newborn infants in a nursery were included in the analysis. Among these, approximately one third reported discharging 6 to 10 healthy term newborns each month and another third reported discharging 11 to 20 each month. Physician and practice characteristics of the respondents are shown in Table 1.
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Factors Considered in Assessing Discharge Readiness
Respondents were asked the question, "Assuming that the final decision will be yours, how important to you are the following factors in your decision to discharge a healthy term newborn from the hospital?" Each factor shown in Table 2 was rated on a 5-point Likert scale, and the percentage of respondents who rated the factor as "important" or "very important" (4 or 5 on the scale) is shown. Clearly, a majority of pediatricians rated infant and mother-infant factors among the most important determinants; peripartum factors such as drug abuse, medical complications, adequacy of prenatal care, and breastfeeding experience, together with young maternal age and adequacy of social support, were also ranked highly. However, mother’s income/financial resources factors, and attendance at prenatal classes were not considered important by a majority of the respondents.
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Relationships Between Determinants of Discharge Readiness and Physician and Practice Characteristics
The potential relationships of these determinants to physician and practice characteristics were explored using
2 analyses. As seen in Table 2, summarizing determinants of discharge readiness by 2 critical physician characteristics and overall, women and young physicians (
42 years of age) were more likely than their male or older counterparts to rate several maternal, mother-infant, and peripartum factors important in determining discharge readiness. The only exception was that older physicians were more likely to value attendance at prenatal classes, a factor considered important by a minority of the respondents as a whole. Only a few of the factors differed in emphasis with respect to practice setting. Pediatricians in solo or 2-physician practices were less likely (71%) than those in pediatric groups (83%), multispecialty groups (80%), health maintenance organizations (HMOs), and community health settings (79%) or hospitals (96%) to consider maternal knowledge and experience regarding breastfeeding important in the discharge decision (P = .03). Physicians who were affiliated with HMOs, medical school faculties, and community health centers were similarly low in rating single parenthood (38% vs 43% of solo/2-physician practitioners, 57% in pediatric groups, 59% in multispecialty groups, and 65% in hospital practices; P = .02) and passage of urine by the infant (79% vs 84% of solo/2-physician practitioners, 93% in pediatric groups, 96% in multispecialty groups, and 89% in hospital practices; P = .005). Perceptions of other factors did not vary significantly with respect to practice community, setting, or patient insurance status.
Given these differences, a variety of multivariate logistic regression models were constructed to assess the strength of the differences when controlling for other potential confounders. In these analyses, the majority of the bivariate results obtained (Table 2) demonstrate physician gender as the most consistent predictor of response. For example, female pediatricians were more likely to value adequacy of social support after controlling for practice setting (adjusted odds ratio [AOR]: 2.44; 95% confidence interval [CI]: 1.54–100), more likely to consider maternal knowledge or experience regarding breastfeeding important controlling for insurance status (AOR: 2.17; 95% CI: 1.49–9.09), and more likely to rate low income/lack of financial resources (AOR: 2.94; 95% CI: 1.85–20) and maternal fatigue and stress (AOR: 2.04; 95% CI: 1.45–6.67) important controlling for practice community.
Pediatrician Perception of Control Over Discharge Timing
Physicians were asked to do the following: "Please rank the following in order of their importance in determining the length of hospital stay for healthy term newborns under your care in the nursery (1 = most important, 5 = least important)." The percentages of physicians who rated the corresponding factor "most important" are as follows: my decision as the infant’s physician (80%), preference of the mother and family (8%), decision of the obstetrician in determining the mother’s discharge time (6%), insurance coverage limitations/no insurance (6%), and hospital bed space limitations (4%). Clearly, most respondents believed that they and/or the family were in control of the LOS for the infant.
Minimal and Optimal Postnatal LOS
Physicians were next asked 2 questions: "For healthy term newborns under your care in the nursery, what do you feel is the minimal (optimal) length of postnatal hospital stay?" The selected responses included <12 hours, 12 to 24 hours, 25 to 36 hours, 37 to 48 hours, 49 to 60 hours, 61 to 72 hours, and >72 hours. Two thirds of the pediatricians believed that the minimal LOS was >24 hours, yet only 19% indicated that the minimal stay exceeded 36 hours (Fig 1). In contrast, most physicians (59%) believed that the optimal LOS for a healthy term newborn should be 37 to 48 hours and 23% preferred an LOS >48 hours.
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Relationships of Minimal and Optimal LOS to Physician and Practice Characteristics
With respect to physician and practice characteristics, women were significantly more likely to advocate a minimal LOS >24 hours (73% vs 60%; P = .003), and physicians who practice in rural communities were less likely to favor minimal LOS >36 hours (6% vs 27% in urban inner city, 22% in urban non-inner city, and 20% in suburban areas; P = .03). The preferences for optimal LOS were somewhat similar, with women more likely to prefer LOS >36 hours (86% vs 77%; P = .02) and rural practitioners more likely to advocate shorter LOS (29% vs 25% in urban inner city, 15% in urban non-inner city, and 16% in suburban areas; P = .004). Respondents in pediatric group practices were also more likely to advocate optimal LOS in excess of 48 hours (29% vs 19% solo/2-physician practitioners, 15% in multispecialty groups, 15% in HMOs and community health settings, and 15% in hospitals; P = .001).
Female pediatricians were significantly more likely to prefer optimal LOS > 36 hours even after controlling for practice setting (AOR: 2.17; 95% CI: 1.49–8.33), practice community (AOR: 2.0; 95% CI: 1.45–5.26), and the insurance status of patients in their practices (AOR: 2.04; 95% CI: 1.61–5.56). Pediatricians with a high proportion of publicly insured or uninsured patients were significantly less likely than their colleagues to identify an optimal LOS as >36 hours (OR: 0.53; 95% CI: 0.38–0.82).
Routine Postdischarge Follow-up Practice Preferences: Type of Follow-up
Physicians were asked, "For healthy, term, nonjaundiced infants who are feeding well and are being discharged 
48 hours of age, do you routinely schedule any of the following contacts during the first 4 weeks after discharge?" Options, any number of which could be chosen, included 1) nurse home visit, 2) telephone contact, and 3) office visit. Identical questions were posed separately for breastfed and nonbreastfed infants. Responses are shown in Fig 2. Almost all of the respondents scheduled an office visit within the first 4 weeks after discharge. In addition, approximately one third established telephone contact during this time and one quarter used home nursing visits. There were no differences in these practice preferences with respect to infant feeding method.
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Routine Postdischarge Follow-up Practice Preferences: Timing of First Office Visit
When the physicians indicated that they scheduled an office visit for healthy, term, nonjaundiced infants who are feeding well and are being discharged
48 hours of age, they were then asked to indicate the timing of the first office visit (<7 days, 7–13 days, 14–20 days, or 21 days). As before, identical questions were posed separately for breastfed and nonbreastfed infants. Although feeding method was not associated with differences in the type of follow-up, it was associated with differences in the timing of physician office visits (Fig 3). Breastfeeding infants were significantly more likely to return for office visits during the first week after discharge than their nonbreastfeeding counterparts (46% vs 28%, respectively; P < .01), and they were less likely to have their first postdischarge office visit scheduled after 13 days (18% vs 35%, respectively; P < .01).
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Relationships of Follow-up Practice Preferences to Physician and Practice Characteristics
In light of the gender differences noted with respect to perceptions of discharge timing and readiness, the relationship of gender to timing of follow-up office visits was explored in logistic regression models. Male pediatricians were more likely than female pediatricians to schedule routine office visits beyond the first week after discharge, controlling for practice setting (AOR: 1.50; 95% CI: 1.03–2.18) for healthy, term, breastfed, nonjaundiced infants discharged after a 2-day postnatal hospital stay.
Because a moderate number of respondents indicated that they scheduled telephone contacts and nurse home visits for healthy, term, nonjaundiced infants discharged after 48 hours, regression models were also constructed to explore possible physician and demographic determinants of these practice preferences. In a model controlling for physician gender and patient insurance status, older pediatricians were more likely to schedule nurse home visits in the first 4 weeks after discharge for both breastfed (AOR: 1.37; 95% CI: 1.14–2.56) and nonbreastfed (AOR: 1.47; 95% CI: 1.15–4.55) infants. In the same model, however, physicians who reported having a high proportion of uninsured or publicly insured patients in their practices were more likely to schedule nurse home visits during the first postdischarge month for both breastfed (AOR: 2.18; 95% CI: 1.17–4.03) and nonbreastfed (AOR = 2.14; 95% CI: 1.11–4.11) infants. In a model controlling for physician age and patient insurance status, follow-up telephone contacts were more likely to be used for nonbreastfed infants by older pediatricians (AOR: 1.79; 95% CI: 1.35–4.0) and those with a low proportion of uninsured or publicly insured patients in their practices (AOR: 1.43; 95% CI: 1.15–3.03). These differences were not significant for breastfed infants (AOR: 2.78; 95% CI: –16.67–1.61 for age; AOR: 2.13; 95% CI: –25.0–1.37 for insurance status).
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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In determining discharge readiness, pediatricians seem to use a variety of factors in their decision-making process. For the most part, these focus on infant factors of a physical nature, although aspects that reflect the potential ability of the mother to care for the infant, such as parent-infant interaction, maternal skills, and fatigue and stress, seem to be important. Social risk factors and social support also seem to be considerations. Conversely, socioeconomic factors such as marital status, maternal educational level, and financial resources together with prenatal class attendance seem to be less relevant considerations in the discharge decision. Most of the factors chosen by pediatricians are among those advised in the current hospital discharge recommendations of the AAP and ACOG and are similar to those used by pediatricians and obstetricians in early discharge decisions based on national surveys conducted in 1995 to 1996.5,15
Before the NMHPA,6 limitations in third-party payment for postnatal hospitalization curtailed the LOS for many infants, and physicians often expressed a perceived lack of control over the discharge process.3,4 With the advent of this legislation, which facilitated hospital stays of up to 48 hours, we speculated that physicians would experience a return to the perception of control over the discharge process. This is suggested by the results of our survey. As expected, most respondents indicated that their decision as the infant’s physician was the most important factor in determining the postnatal hospital LOS. The preference of the mother and the family and the decision of the obstetrician in determining the mother’s discharge time were perceived as less important determinants. That insurance coverage was ranked fourth in importance suggests that physicians no longer feel pressure from third-party payers to discharge the infant against their judgment. These results are in sharp contrast to a national survey of obstetricians conducted in 1995 to 1996, before the NMHPA took effect.15 This survey showed that only 55% of physicians considered their decision as the patient’s physician to be the most important determinant of the LOS. Finances, including insurance considerations, were considered to be the most important determinant of the LOS by 30% of respondents in that survey.
Before the NMHPA, postnatal LOS <24 hours were not unusual.1 The results of our survey suggest that such stays are well below the minimal LOS considered safe by two thirds of pediatricians. However, many pediatricians seem to be comfortable with minimum stays <48 hours currently advised by the AAP. Although 23% of our respondents indicated that they believe that the infant should optimally remain in the hospital for >48 hours, 76% preferred a stay of 25 to 48 hours. Taken together, these results suggest that most pediatricians prefer to discharge a well newborn on the second postnatal day rather than on the first. These preferences seem to be consistent with the trend toward longer newborn hospital stays that has been noted since passage of the NMHPA.16–18
Ironically, although financial constraints limiting LOS have been relaxed, there may be a trend toward preference for shorter stays among pediatricians. A random survey of 731 fellows of the AAP conducted in 1996, before the NMHPA had taken effect, revealed that 47% selected an optimal LOS of >48 hours.5 In the current survey, those who provide care for the most financially vulnerable patients did not see the need for longer LOS. In fact, only 23% preferred an optimal stay exceeding 48 hours for all healthy term newborns. These results resemble those of a survey of ACOG fellows conducted in 1995 to 1996, which showed that 24% of obstetricians preferred an optimal LOS of >48 hours.15 Possibly, obstetrician preference for shorter stays may have influenced pediatrician perceptions during the past few years, accounting for this change in practice preference.
Almost all of the pediatricians in our survey indicated that they scheduled office follow-up within the first month of birth for healthy term infants discharged after a 48-hour stay. Surprising is that a moderate percentage of respondents noted that they scheduled the first office visit for such infants before 7 days. This practice preference is not inconsistent with current recommendations of the AAP,10 and it suggests that many pediatricians believe that the traditional 2-week follow-up visit1 may be inadequate even for infants who complete a 48-hour stay. Unfortunately, our data did not permit analysis of pediatrician compliance with the current AAP-ACOG recommendation that newborns discharged <48 hours after birth be examined within 48 hours of discharge.9,10 Compared with nonbreastfed infants, breastfed infants seem more likely to be scheduled for pediatrician office visits during the first week after hospital discharge and their office visit is less likely to be delayed beyond 13 days. These results suggest that pediatricians perceive a greater need for physician contact among such infants, who are known to lose more weight, take fewer calories, gain weight more slowly, and have higher serum bilirubin levels during the first week than formula-fed infants.19 Presumably, early visits are scheduled to monitor for potential related problems and perform necessary counseling.20
Telephone contacts and nurse home visits were scheduled by approximately one third and one quarter of the respondents, respectively, during the first postnatal month. These percentages are similar to those reported in a 1996 survey of pediatricians discharging newborns early,5 and taken together these surveys suggest that these forms of postdischarge follow-up seem to be used less frequently than office visits. Nurse home visits seem to be advised more frequently by pediatricians whose practices include substantial portions of publicly insured and/or uninsured patients, presumably because they consider such patients to be at higher risk. The less frequent use of telephone follow-up may reflect diminished telephone accessibility in this population.
The results of our survey suggest that physician gender may be a major factor in determining perinatal hospital discharge practice preferences. Among the determinants of discharge readiness, female pediatricians were more likely than their male counterparts to value maternal factors such as adequacy of social support, young maternal age, lack of financial resources, infant care skills, fatigue and stress, breastfeeding knowledge and experience, and adequacy of prenatal care. Women were also more likely to advocate longer minimal and optimal hospital LOS and to schedule follow-up office visits within the first week after discharge. Taken together, these results suggest that female pediatricians may be more cautious than male pediatricians in their approach to evaluation and monitoring of normal term infants, placing greater emphasis on maternal and social factors in their management decisions. Such observations are consistent with reports that female physicians generally place greater emphasis on preventive medicine and are more attuned to their patients’ psychosocial needs than are male physicians.21
Variations in primary care practices have been described previously with respect to physician age and practice characteristics.13,22 In our survey, several discharge practice preferences seemed to be related to pediatrician age and practice setting. Although younger pediatricians (those 42 years or younger) place more value on young maternal age in making discharge decisions, they seem less likely to establish telephone contact for nonbreastfed infants or schedule nurse home visits for either breastfed or nonbreastfed infants during the first postnatal month. Practice characteristics seemed to influence discharge and follow-up practice preferences minimally, with rural practitioners preferring somewhat shorter minimal and optimal LOS than urban and suburban practitioners do. Possibly, rural pediatricians may feel more comfortable with shorter stays because of enhanced opportunities for postdischarge follow-up contact in their smaller communities.
It is important to emphasize that surveys similar to that reported here reflect physician attitudes and do not directly measure actual behavior in practice. Although early workers questioned the ability of attitudes to predict behavior,23,24 more recent data indicate that when attitudes and behaviors are measured at the same level of specificity, the ability of attitudes to predict behavior is strong25,26 and that attitudes may be among the most important predictors of behavior.27 The response rate of 64% is generally considered very good in survey research,28 yet it is possible that nonresponders may have differed substantially from responders in their attitudes and perceptions. Finally, the membership of the AAP constitutes a subset of the pediatricians in the United States, and it is possible that selection bias may have been present because only this group was surveyed. The last 2 factors may limit the ability to generalize our results to the general population of all pediatricians in the United States who routinely provide primary care to newborn infants in the nursery.
The data presented in this article have delineated the hospital discharge practice preferences of pediatricians since passage of the NMHPA of 1996. Although they suggest that most pediatricians adhere to current AAP-ACOG guidelines for determining discharge readiness, they indicate that there may be substantial variations in practice with respect to physician gender, age, and practice characteristics. Additional study of actual perinatal hospital discharge practices is clearly warranted.
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ACKNOWLEDGMENTS |
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Primary funding sources for this study were the Health Resources and Services Administration, Maternal and Child Health Bureau, and American Academy of Pediatrics Corporate Friends of Children.
We gratefully acknowledge Karen O’Connor, Survey Manager, and Sandy Sharp, Survey Assistant, from the Division of Health Policy Research at the American Academy of Pediatrics for outstanding contributions on the Periodic Survey of Fellows #45.
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FOOTNOTES |
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Received for publication Jun 7, 2001; Accepted Dec 13, 2001.
Address correspondence to John R. Britton, MD, PhD, Box 260067, Lakewood, CO 80226
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PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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C. Lannon and A. R. Stark Closing the Gap Between Guidelines and Practice: Ensuring Safe and Healthy Beginnings Pediatrics, August 1, 2004; 114(2): 494 - 496. [Full Text] [PDF]
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Committee on Fetus and Newborn Hospital Stay for Healthy Term Newborns Pediatrics, May 1, 2004; 113(5): 1434 - 1436. [Abstract] [Full Text] [PDF]
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