Clinical Outcomes and Maternal Perceptions of an Updated Model of Perinatal Care

Lieu, Tracy A.; Wikler, C; Capra, Angela M.; Martin, Krystle; Escobar, Gabriel J.; Braveman, Paula

doi:10.1542/peds.102.6.1437

Cited by 29 publications

(14 citation statements)

References 16 publications

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“…Although 88% of all mothers in this study initiated breastfeeding, 19% of those who started breastfeeding had stopped by 14 days after delivery. These findings are similar to those in a previous study in this HMO 23 and highlight the need for additional research on breastfeeding promotion. One in 5 mothers had depressive symptoms on the telephone interview at 14 days' postpartum; this was higher than the 9% reported in a previous study using telephone surveys at 3 weeks' postpartum in a Massachusetts HMO.…”

Section: Clinical and Legislative Contextsupporting

confidence: 89%

A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge

et al. 2000

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For low-risk mothers and newborns in this integrated health maintenance organization, home visits compared with pediatric clinic visits on the third or fourth postpartum hospital day were more costly, but were associated with equivalent clinical outcomes and markedly higher maternal satisfaction. This study had limited power to identify group differences in rehospitalization, and may not be generalizable to higher-risk populations without comparable access to integrated hospital and outpatient care.

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Section: Clinical and Legislative Contextsupporting

confidence: 89%

A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge

et al. 2000

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“…Another study of 926 low-risk vaginally delivered infants discharged at less than 48 hours identified 27 re-hospitalizations (2.9%) within the first 2 weeks of life. [23] This rate was is in keeping with our rates of re-admission to a pediatric hospital ward or PICU and was within the range of several studies. [242526] Moreover, Liu et al .…”

Section: Discussionsupporting

confidence: 88%

Neonatal visits to the pediatric emergency center and its implications on postnatal discharge practices in Qatar

2013

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Background:An early discharge from postnatal policy has been practiced at Women's Hospital, Hamad Medical Corporation.Aim:This observational cohort study was conducted to evaluate the effect of early postnatal discharge practice on neonatal morbidity in the State of Qatar.Setting and Design:This is a data-based cohort study. All neonates ≤28 days visiting the Pediatric Emergency Centers (PEC) were evaluated for the need for re-hospitalization, referral for clinic appointments, or observation at the PEC setting.Materials and Methods:Differences in outcome rates were compared in neonates who visited in the first 24 hours postnatal discharge (2-3 days of life) and those who visited after the third day of life.Statistical Analysis:Crude differences in incidence rate assessed by χ2 or Fisher exact test were applicable.Results:Of 3528 PEC visits for 1915 neonates, 1.7% required admission (3.1% of neonates), 8.4% were observed, 1.1% were referred to a clinic, and the remaining were discharged home. There was no significant difference in re-hospitalization rates of neonates visiting PEC in the first 3 days and those visiting at a later age (OR 0.78, 95% CL 0.19-3.23, P=1). However, early presentations to PEC was more likely to result in periods of observation (OR 1.88, 95% CL 1.17-3.04, P=0.01), or clinic referral (OR 4.96, 95% CL 2.16-11.38, P=0.001) when compared to older neonates. Moreover, those who presented early were significantly more likely to revisit any of the PECs with in the 28 days period (OR 3.20, 95% CL 2.17-4.97, P<0.0001).Conclusion:These results clearly demonstrate the need for a structured early post-discharge follow-up service that addresses the needs of all neonates and their families. The results, however, do not provide sufficient evidence that delaying postnatal discharges for apparently healthy neonates will provide significant health benefits to these neonates and their families.

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“…Several economic analyses based on cohort studies or case series have concluded that the economic value of the resources released by early postnatal discharge are not offset by increased costs to other sectors of the health service or the wider economy 10–20 . However, in addition to basing assessments of the efficacy of early postnatal discharge policies on observational evidence, these economic analyses were characterised by a number of methodological limitations.…”

Section: Introductionmentioning

confidence: 99%

Home‐based care after a shortened hospital stay versus hospital‐based care postpartum: an economic evaluation

Petrou

Boulvain

Simon

et al. 2004

BJOG

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Objectives To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Design Cost minimisation analysis within a pragmatic randomised controlled trial. Setting The University Hospital of Geneva and its catchment area. Population Four hundred and fifty‐nine deliveries of a single infant at term following an uncomplicated pregnancy. Methods Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n= 228) or a traditional postnatal hospital stay (n= 231). Main outcome measures Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Results Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non‐medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother–infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. Conclusions A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant.

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Clinical Outcomes and Maternal Perceptions of an Updated Model of Perinatal Care

Abstract: We conclude that the revised model of perinatal care in this health maintenance organization medical center improved clinical outcomes and maternal satisfaction for low-risk mothers and newborns without increasing costs.

Cited by 29 publications

References 16 publications

A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge

A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge

Neonatal visits to the pediatric emergency center and its implications on postnatal discharge practices in Qatar

Home‐based care after a shortened hospital stay versus hospital‐based care postpartum: an economic evaluation

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