Effect of a reduced postpartum length of stay program on primary care services use by mothers and infants.
OBJECTIVE
To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. METHODS.


METHODS
Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.


METHODS
A managed care plan.


METHODS
A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.


METHODS
mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect. INDEPENDENT MEASURES: Pre-ROLOS or the post-ROLOS year.


METHODS
Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events.


RESULTS
Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per day; after, there were 4.60. Well-child visits increased slightly to.98 visits per dyad, but urgent visits did not.


CONCLUSIONS
This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.
Mandl
K D
KD
Program in Clinical Effectiveness, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Homer
C J
CJ
Harary
O
O
Finkelstein
J A
JA
D000328:Adult; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008329:Managed Care Programs; D010351:Patient Discharge; D049590:Postpartum Period; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies