Newborn early discharge revisited: are California newborns receiving recommended postnatal services?
BACKGROUND
Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving.


OBJECTIVE
To describe rates of early discharge and of timely follow-up for early-discharged newborns.


METHODS
Retrospective, population-based cohort study using a 1999 postpartum survey in California.


METHODS
A total of 2828 infants of mothers with medically low-risk singleton births.


METHODS
Rates of early discharge (<or=1-night stay after vaginal delivery and <or=3-night stay after cesarean section) and untimely follow-up (no home or office visit within 2 days of early discharge).


RESULTS
Overall, 49.4% of newborns were discharged early. Of these, 67.5% had untimely follow-up. The odds of early discharge were greater with lower incomes: the adjusted odds ratios (AORs) (with 95% confidence intervals) were 2.06 (1.50-2.83) for incomes <or=100% of poverty, 2.20 (1.65-2.93) for incomes from 101%-200% of poverty, and 2.24 (1.63-3.08) for incomes from 201%-300% of poverty. Untimely follow-up was more likely for infants of women with incomes <or=100% of poverty (AOR = 1.89 [1.13-3.17]) and 201%-300% of poverty (AOR = 1.78 [1.09-2.91]), Medicaid coverage (AOR = 1.73 [1.20-2.47]), Latina ethnicity (AOR = 1.47 [1.02-2.14]), and non-English language (AOR = 1.72 [1.16-2.55]).


CONCLUSIONS
Despite an apparent decline in short stays after legislation, many newborns--particularly from lower-income families--continue to be discharged early. Most newborns discharged early--particularly those with Medicaid and those from low-income, Latina, and non-English-speaking homes--do not receive recommended follow-up. The most socioeconomically vulnerable newborns are receiving fewer postnatal services.
Galbraith
Alison A
AA
Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington 98195-7183, USA. agalb@u.washington.edu
Egerter
Susan A
SA
Marchi
Kristen S
KS
Chavez
Gilberto
G
Braveman
Paula A
PA
D000293:Adolescent; D000328:Adult; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006287:Health Planning Guidelines; D006792:House Calls / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*; D011159:Population Surveillance / Q000379:methods*; D011181:Postnatal Care / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012959:Socioeconomic Factors