Health service use among low-risk newborns after early discharge with and without nurse home visiting.
BACKGROUND
To examine the potential benefits of routine nurse home visiting after early discharge, we compared health service use among low-risk newborns with and without a nurse home visit and telephone follow-up after short hospital stays.


METHODS
Records of newborns discharged routinely before (n = 83) and after (n = 91) implementation of a universal postpartum home visiting program were reviewed retrospectively. Acute care visits, rehospitalizations, and well-baby visits for newborns up to 74 days of age were compared between the groups.


RESULTS
Acute care visits, rehospitalizations, and missed well-baby visits consistently appeared less likely among newborns receiving home visiting services, in both unadjusted and adjusted analyses. Adjusting for insurance, parity, and breast-feeding, a twofold reduction in acute care visits by 14 days was significant. Although not statistically significant, adjusted analyses of acute care and missed well-baby visits revealed apparently similar patterns at all time intervals. There were too few rehospitalizations for multivariate analysis.


CONCLUSIONS
Despite the limitations of this small retrospective study, the consistency of the findings suggests potentially important benefits of home visiting services after early discharge of low-risk newborns, with substantial implications for clinical and reimbursement policy. Effects could be greater with more vulnerable populations and shorter stays than those in this study.
Braveman
P
P
Department of Family and Community Medicine, School of Medicine, University of California, San Francisco 94143-0900, USA.
Miller
C
C
Egerter
S
S
Bennett
T
T
English
P
P
Katz
P
P
Showstack
J
J
D016001:Confidence Intervals; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D017283:Neonatal Nursing / Q000191:economics / Q000379:methods*; D016017:Odds Ratio; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012495:San Francisco