CINCINNATI - A reduction in length of stay for newborns insured by Medicaid appears to be a safe practice - if post-discharge care is well-coordinated, according to a Children's Hospital Medical Center of Cincinnati study published in the September 22/29 edition of The Journal of the American Medical Association (JAMA).
"Early discharge of full-term, Medicaid newborns in Ohio has not resulted in an increase in rehospitalization rates in the two week period following their discharge," says neonatologist Uma Kotagal, M.D., director of health policy and clinical effectiveness at Cincinnati Children's and the study's main author.
"In fact, rehospitalizations for Medicaid newborns decreased 23 percent during this period, perhaps because of better post-discharge coordination of care."
The study involved more than 102,000 healthy, full-term neonates born in Ohio from July 1, 1991, to June 15, 1995, to mothers receiving Medicaid. The mean length of stay decreased 27 percent during that period, from 2.2 days in 1991 to 1.6 days in 1995. In 1991, 20 percent of newborns were discharged one day after birth, and 76 percent two days after birth. By 1995, 54 percent of newborns were discharged one day after birth, and 88 percent two days after birth.
Length of stay varied considerably by region. Mean length of stay decreased each year in every region, with southwest Ohio showing the greatest change, a decrease of 43.5 percent.
The percentage of children who received a primary care visit within two weeks of discharge increased in each year of the study, with an overall increase of 117 percent. There also was an increase in the number of newborns who received a home health visit within 14 days of discharge.
Most rehospitalizations were due to jaundice. Other diagnoses associated with rehospitalization included respiratory problems, fever, infections, digestive disorders, bronchiolitis, dehydration, and feeding problems. "The risk for jaundice is known to be greater in breast-fed newborns compared to formula-fed newborns, and breast-feeding rates are historically low in the Medicaid population," says Dr. Kotagal. "This may have played an important role in the low rehospitalization rates we observed."
Mothers whose children were rehospitalized tended to be white, married, new mothers, and to have delivered vaginally and had a shorter pregnancy. Post-discharge coordination of care resulted in "dramatic increases" in primary care visits and home health visits, according to Dr. Kotagal.
"This, along with low rates of breast-feeding, may explain the reduced rates of rehospitalization - even in the face of decreasing hospital lengths of stay," she says.
"However, follow-up visits remain considerably less than optimal," adds Dr. Kotagal. "More attention needs to be paid to these services for new mothers."