title: Impact of newborn follow-up visit timing on subsequent ED visits and hospital readmissions: an instrumental variable analysis.
abstract: OBJECTIVE
  To determine whether newborn first outpatient visit (FOV) within 3 days of discharge is associated with reduced rates of emergency department (ED) visits and hospital readmissions.
  
  
  METHODS
  Retrospective cohort analysis was performed of all newborns who were born and had outpatient follow-up within a large academic medical center to determine whether they had ED visits or hospital readmission within 2 weeks after hospital discharge. Multivariable regression using an instrumental variable for timing of FOV was conducted to estimate the relationship between FOV within 3 days of discharge and ED visits and hospital readmissions within 2 weeks of discharge, adjusting for potential confounders. Stratified analyses assessed this relationship in subpopulations with medical or social risk factors.
  
  
  RESULTS
  Of 3282 newborns, 178 (5%) had 1 or more ED visits or hospital readmissions within 2 weeks of hospital discharge. FOV within 3 days was not significantly associated with ED visits and readmissions in the instrumental variable analysis (IVA) (-0.035, P = .11) or the ordinary least squares analysis (OLS) (0.006, P = .52). The difference in coefficients between these analyses, however, suggests that IVA successfully adjusted for some unmeasured bias. In stratified analyses, only newborns born to African American mothers or discharged by family medicine providers demonstrated a significant relationship between FOV within 3 days and reduced odds of ED visits and readmissions.
  
  
  CONCLUSIONS
  No significant relationship between outpatient visit timing and ED visits and hospital readmissions was found. Further study is needed to assess the impact of early outpatient visits on other newborn outcomes.
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY. Electronic address: hodonnel@montefiore.org.
authors.forename: Heather C
authors.initials: HC
authors.lastname: O'Donnell
authors.affiliation: Pace University and National Bureau of Economic Research, New York, NY.
authors.forename: Gregory
authors.initials: G
authors.lastname: Colman
authors.affiliation: Department of Pediatrics, NYU Langone Medical Center, New York, NY.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Trachtman
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Nerissa
authors.initials: N
authors.lastname: Velazco
authors.affiliation: Montefiore Medical Center and Montefiore Medical Group, Bronx, NY.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Racine
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge; D010372:Pediatrics / Q000458:organization & administration*; D012189:Retrospective Studies
keywords: emergency service; hospital; infant; newborn; patient discharge; patient readmission