title: Adherence to discharge guidelines for late-preterm newborns.
abstract: OBJECTIVE
  To evaluate trends in adherence to American Academy of Pediatrics recommendations for early discharge of late-preterm newborns and to test the association between hospital characteristics and early discharge.
  
  
  METHODS
  This study was a population-based cohort study using statewide birth-certificate and hospital-discharge data for newborns in California, Missouri, and Pennsylvania from 1993 to 2005. A total of 282 601 late-preterm newborns at 611 hospitals were included. Using logistic regression, we studied the association of early discharge with regional and hospital factors, including teaching affiliation, volume, and urban versus rural location, adjusting for patient factors.
  
  
  RESULTS
  From 1995 to 2000, early discharge decreased from 71% of the sample to 40%. However, by 2005, 39% were still discharged early. Compared with Pennsylvania, California (adjusted odds ratio [aOR]: 5.95 [95% confidence interval (CI): 5.03-7.04]), and Missouri (aOR: 1.56 [95% CI: 1.26-1.93]) were associated with increased early discharge. Nonteaching hospitals were more likely than teaching hospitals to discharge patients early if they were uninsured (aOR: 1.91 [95% CI: 1.35-2.69]) or in a health maintenance organization plan (aOR: 1.40 [95% CI: 1.06-1.84]) but not patients with fee-for-service insurance (aOR: 1.04 [95% CI: 0.80-1.34]). A similar trend for newborns on Medicaid was not statistically significant (aOR: 1.77 [95% CI: 0.95-3.30]).
  
  
  CONCLUSIONS
  Despite a decline in the late 1990s, early discharge of late-preterm newborns remains common. We observe differences according to state, hospital teaching affiliation, and patient insurance. Additional research on the safety and appropriateness of early discharge for this population is necessary.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars, University of Pennsylvania, 423 Guardian Dr, 1310 Blockley Hall, Philadelphia, PA 19104, USA. goyaln@email.chop.edu
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.forename: Corinne
authors.initials: C
authors.lastname: Fager
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lorch
mesh_terms: D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data*