TY  - JOUR
T1  - SAfety of early discharge for medicaid newborns
AU  - Kotagal UR, Atherton HD, Eshett R, Schoettker PJ, Perlstein PH
Y1  - 1999/09/22
N1  - 10.1001/jama.282.12.1150
JO  - JAMA
SP  - 1150
EP  - 1156
VL  - 282
IS  - 12
N2  - Context 
                  Neonates are being discharged from the hospital more rapidly, but the
risks associated with this practice, especially for low-income populations,
are unclear.Objective 
                  To determine the impact of decreasing postnatal length of stay on rehospitalization
rates in the immediate postdischarge period for Medicaid neonates.Design and Setting 
                  Retrospective, population-based cohort study using Ohio Medicaid claims
data linked to vital statistics files from July 1, 1991, to June 15, 1995.Participants 
                  A total of 102,678 full-term neonates born to mothers receiving Medicaid
for at least 30 days after birth.Main Outcome Measures 
                  Rehospitalization rates within 7 and 14 days of discharge, postdischarge
health care use, and regional variations in length of stay and rehospitalization.Results 
                  The proportion of neonates who were discharged following a short stay
(less than 1 day after vaginal delivery, less than 2 days after cesarean birth)
increased 185%, from 21% to 59.8% (P<.001) and
the mean (SD) length of stay decreased 27%, from 2.2 (1.0) to 1.6 (0.9) days
(P<.001), over the course of the study. The proportion
of neonates who received a primary care visit within 14 days of birth increased
117% (P=.001). Rehospitalization rates within 7 and
14 days of discharge decreased by 23%, from 1.3% to 1.0% (P=.01), and by 19%, from 2.1% to 1.7% (P=.03),
respectively. Short stay across the 6 regions of the state varied significantly
over time (P<.001). Factors significantly associated
with increased likelihood of rehospitalization within both 7 and 14 days of
discharge were white race, shorter gestation, primiparity, earlier year of
birth, lower 5-minute Apgar score, vaginal delivery, married mother, and region
of the state.Conclusion 
                  Our data suggest that reductions in length of stay for full-term Medicaid
newborns in Ohio have not resulted in an increase in rehospitalization rates
in the immediate postnatal period.
SN  - 0098-7484
M3  - doi: 10.1001/jama.282.12.1150
UR  - http://dx.doi.org/10.1001/jama.282.12.1150
ER  -