Impact of postpartum hospital-stay legislation on newborn length of stay, readmission, and mortality in California.
OBJECTIVE
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.


METHODS
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 = 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 >35 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.
Datar
Ashlesha
A
RAND Corporation, 1776 Main St, Santa Monica, California 90407, USA. datar@rand.org
Sood
Neeraj
N
D002140:California; D005260:Female; D006801:Humans; D007194:India; D007226:Infant Mortality; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000453:epidemiology; D007902:Length of Stay / Q000331:legislation & jurisprudence*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008498:Medical Record Linkage; D017057:Medically Uninsured; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011181:Postnatal Care / Q000331:legislation & jurisprudence*; D049590:Postpartum Period; D012042:Registries