"The first 10 days after birth is a medically risky time for new babies. The most common reasons for infant hospital readmissions or trips to the ED in that time period are jaundice and dehydration, both of which are usually preventable," said Ian Paul, M.D., assistant professor of pediatrics, Penn State Children's Hospital, Penn State Milton S. Hershey Medical Center. "Our study suggests that a low-cost home nurse visit can significantly reduce the need for comparatively expensive hospital and ED services for jaundice and dehydration and, most importantly, prevent babies from getting sick."
The study, "Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration" was published today (Oct. 4, 2004) in the journal Pediatrics.
The Newborns' and Mothers' Health Protection Act of 1996 mandates insurance coverage of a minimum 48 hour hospital stay after childbirth. The American Academy of Pediatrics (AAP) also has stated that a newborn should be in the hospital at least 48 hours after birth and in most cases should be reassessed by a physician 48 hours to 72 hours after discharge. However, many babies are discharged before 48 hours and less than one half of all infants are taken to follow up appointments in the recommended timeframe.
"That initial post-discharge evaluation is critically important, yet compliance with the timing of the guidelines is poor," Paul said. "Our study focuses on the impact that one well-timed visit can have on health outcomes and suggests a great need for this alternative to outpatient physician visits in the immediate postnatal period so that infants are evaluated on the third or fourth day after delivery."
Investigators reviewed hospital billing data to determine the number of home nurse visits scheduled by discharge physicians, and the number of hospital readmissions and ED visits for the 2,967 babies discharged from the newborn nursery at Penn State Children's Hospital from January 2000 through December 2002. A total of 326 infants were discharged with a scheduled home health nurse visit and 2,641 infants were discharged without a scheduled nurse visit.
Two of 326 who had a home nurse visit were readmitted within the first 10 days of life (0.6 percent) compared with 73 of 2,641 (2.8 percent). Ninety-two of the 2,641 infants (3.5 percent) who did not receive a home nurse visit returned to the hospital ED within the first 10 days of life and 21 of those were readmitted. In contrast, none of the 326 who had a home nurse visit returned to the ED.
The average cost of a home nurse visit to insurers is about $85 while the cost of an ED visit and readmission is about is $400 and $4,000, respectively. In the current study, after nursery discharge, the average cost per child who received a home health visit was $109.80 compared to $118.70 for each newborn who did not receive a visit. When totaled, the data suggest that insurance payers will save $181.82 for every additional child who does not use hospital services (ED or inpatient) in the first 10 days of life.
"This data demonstrates that home nurse visitation is less costly and affords a significant reduction in the need for subsequent hospital and ED visits due to jaundice and dehydration in newborns," Paul said. "These data also show that a program in which each infant receives a home visit may be less expensive to payers as a result of the reduction in the need for more expensive hospital-based services."
Although not a specific goal of this study, home nurse visits often provide support for mothers in addition to assessing the health of infants. Nurses can help mothers with breastfeeding problems, assess the home environment and evaluate the mother's physical and mental health.
Home nurse visits also may occur in a more timely manner than scheduled outpatient physician visits. Therefore a home visit one to two days after hospital discharge could, in theory, result in earlier recognition of problems like jaundice and dehydration. Although home nurse visits are available in the United States, they are not routinely scheduled even when insurance covers the cost. In most states, insurance carriers are required to pay for a home visit for infants and mothers discharged less than 48 hours after delivery. Many insurance programs and Medicaid pay for postnatal home nurse visits regardless of the time of discharge.
"This study indicates that physicians should strongly consider home nurse visits as a way to improve compliance with the AAP guidelines because it is an effective method to reduce the morbidity associated with common conditions like jaundice and dehydration that present in the immediate postnatal period," Paul said. "Most importantly, the visits can improve overall quality of care for newborns and their parents."
The study team included: Troy Phillips, Mark D. Widome, M.D., M.P.H., and Christopher Hollenbeak, Ph.D., Penn State Milton S. Hershey Medical Center.
Journal
PEDIATRICS