title: Universal bilirubin screening and health care utilization.
abstract: OBJECTIVE
  To evaluate the impact of the implementation of universal bilirubin screening on neonatal health care use in the context of a large jurisdiction with universal health insurance.
  
  
  METHODS
  We conducted a population-based retrospective cohort study of all newborns discharged after birth between April 2003 and February 2011 from 42 hospitals that implemented universal bilirubin screening between July 2007 and June 2010 in Ontario, Canada. We surveyed hospitals to determine their screening implementation date. We used multiple linked administrative health data sets to measure phototherapy use, length of stay (LOS), jaundice-related emergency department visits, and jaundice-related readmissions. We modeled the relationship between universal bilirubin screening and outcomes using generalized estimating equations to account for clustering by hospital, underlying temporal trends, and important covariates.
  
  
  RESULTS
  Screening was associated with an increase in phototherapy during hospitalization at birth (relative risk, 1.32; 95% confidence interval, 1.09-1.59) and a decrease in jaundice-related emergency department visits (relative risk, 0.79; 95% confidence interval, 0.64-0.96) but no statistically significant difference in phototherapy after discharge, LOS, or jaundice-related readmissions after accounting for preexisting temporal trends in health care service use and other patient sociodemographic and hospital characteristics.
  
  
  CONCLUSIONS
  Universal bilirubin screening may not be associated with increased neonatal LOS or increased subsequent hospital use. Our findings are relevant for determining the resource implications of universal bilirubin screening in Ontario. They highlight the limitations in generalizability of previous research on health care utilization associated with similar programs and underline the importance of context-specific local evaluation of guideline implementation.
authors.affiliation: Population Health Program and School of Midwifery, Laurentian University, Sudbury, Ontario, Canada;
authors.forename: Elizabeth Kathleen
authors.initials: EK
authors.lastname: Darling
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Departments of Epidemiology and Community Medicine and.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ramsay
authors.affiliation: Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada;
authors.forename: Ann E
authors.initials: AE
authors.lastname: Sprague
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada; Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada;
authors.forename: Mark C
authors.initials: MC
authors.lastname: Walker
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Paediatrics and Institute of Health Policy and Management and Evaluation, University of Toronto, Toronto, Ontario, Canada astrid.guttmann@ices.on.ca.
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D001663:Bilirubin / Q000032:analysis*; D015331:Cohort Studies; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000175:diagnosis* / Q000628:therapy*; D015997:Neonatal Screening / Q000639:trends*; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D010789:Phototherapy / Q000639:trends; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin
keywords: health services; hyperbilirubinemia; jaundice; length of stay; patient readmission; phototherapy; practice guideline