Impact of Postpartum Hospital-Stay Legislation on Newborn Length of Stay, Readmission, and Mortality in California

Abstract

OBJECTIVES. The objectives of this study were to examine the impact of postpartum hospital-stay legislation on newborns' length of stay, neonatal readmissions, and 1-year mortality in California, and whether this legislation had differential impacts by demographics and complications during delivery or pregnancy.METHODOLOGY. This study used linked birth certificates, death certificates and hospital discharge records for all full-term, normal birth weight, and singleton-birth newborns during 1991-2000 in California (n ϭ 662 753). Interrupted time-series analyses were used to examine changes in newborns' length of stay and outcomes after 1 year, 2 years, and 3 years since the passage of postpartum laws. Multivariate linear and logistic regressions were estimated separately by maternal characteristics (race, education, age, and partity), delivery type, and complications during pregnancy or delivery.RESULTS. Length of stay increased by 9.5, 12, and 14 hours in years 1, 2, and 3, respectively, after the passage of the law. Increases were larger for newborns of white mothers, more educated mothers, mothers Ͼ35 years of age, primaparous mothers, cesarean deliveries, and Medicaid recipients, but there were no differences by pregnancy or delivery complications. The odds of neonatal readmission declined by 9.3%, 11.8%, and 19.7% in years 1, 2 and 3 after the law, respectively. The odds of infection-related readmissions declined by 21.5% and 30.3% in years 2 and 3, respectively. The odds of jaundice-related readmissions increased by 7% in year 1. There was no significant change in either the odds of readmission due to respiratory problems or the odds of 1-year mortality in the postlaw years. Demographic differences in the impact of the law on readmissions and mortality could not be detected because of lack of statistical power.CONCLUSIONS. Postpartum length of stay legislation was associated with increased length of stay among all births in California, with significant variation in the law's impact across demographic groups. After the law's passage, there was a significant decline in neonatal readmissions but not in 1-year mortality.www.pediatrics.org/cgi

The impact of early discharge laws on the health of newborns

“…Our methods are similar to Datar and Sood (2006) who examined the same question using a public use version of the data we discuss below. Their paper reported estimates of the impact of the federal law on early discharge and re-admission rates in California.…”

The Impact of Maternity Minimum Stay Mandates on Hospitalizations: An Extension

“…One of the health outcomes analyzed is hospital readmissions after discharge. Datar and Sood (2006) and Evans et al (2008) find an improvement in that mandates decreased readmissions; however, Madden et al (2002), Brumfield et al (1996), Cooper and Kotagal (1996), Bragg et al (1997), and Kotagal et al (1999) fail to find a significant decrease in rehospitalizations. On the other hand, Malkin et al (2000) find that newborns discharged in under 30 h from time of birth are significantly more likely to die within 1 month of birth, between 1 month and 1 year of birth, and within the first year overall.…”

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“…Therefore, it is understandable that mortality is the other outcome analyzed by the literature. However, the literature finds no significant impact on neonatal/infant mortality (Datar and Sood 2006;Evans et al 2008).…”

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