Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population.
In the first year of life, the rate of rehospitalization for infants has been shown to be between 4.4% and 9.5%. Reducing avoidable health care utilization is a population health priority. The goal of this study was to identify maternal and infant factors associated with rehospitalization and emergency department (ED) utilization in a cohort of newborn Medicaid recipients.



A longitudinal database was created by linking mother-infant dyads giving birth at a regional perinatal referral center with Delaware state Medicaid data. Multivariable logistic regression and negative binomial regression were used to examine inpatient hospitalization and ED utilization within 6 months after birth.



The study cohort included 4112 infants; 452 (11.0%) were rehospitalized, and 1680 (41%) used the ED within 6 months of birth. Variables independently associated with inpatient rehospitalization included NICU admission (odds ratio [OR]: 1.7 [95% confidence interval (CI): 1.3-2.3]), maternal bipolar diagnosis (OR: 1.5 [95% CI: 1.1-2.2]), count of maternal prenatal hospital admissions (OR: 1.3 [95% CI: 1.1-1.5]), and count of maternal ED visits (OR: 1.08 [95% CI: 1.04-1.1]). Black race (incident rate ratio [IRR]: 1.2 [95% CI: 1.1-1.3]), fall birth (IRR: 1.2 [95% CI: 1.01-1.3]), count of maternal ED visits (IRR: 1.1 [95% CI: 1.09-1.12]), number of maternal medications (IRR: 1.02 [95% CI: 1.01-1.03]), and maternal age (IRR: 0.97 [95% CI: 0.96-0.98]) were associated with ED utilization.



In this newborn Medicaid population, multiple maternal factors (including age, race, and mental health diagnoses) were associated with health care utilization in the 6 months after initial hospital discharge. Our data provide potential risk factors for targeted intervention and suggest that maternal factors should be considered in identifying a population at risk for rehospitalization and ED utilization.
Pediatrics and Neonatology, Christiana Care Health System, Newark, Delaware; Pediatrics, Sidney Kimmel Medical College at Jefferson University, Philadelphia, Pennsylvania; dpaul@christianacare.org.
David A
DA
Paul
HealthCore, Wilmington, Delaware.
Abiy
A
Agiro
Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware.
Matthew
M
Hoffman
Department of Health and Social Services, Division of Medicaid and Medical Assistance, State of Delaware, Dover, Delaware; and.
Cynthia
C
Denemark
Department of Health and Social Services, Division of Medicaid and Medical Assistance, State of Delaware, Dover, Delaware; and.
Anthony
A
Brazen
HealthCore, Wilmington, Delaware.
Michael
M
Pollack
HealthCore, Wilmington, Delaware.
Christiana
C
Boehmer
Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin.
Deborah
D
Ehrenthal
D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008423:Maternal Age; D008425:Maternal Behavior / Q000208:ethnology*; D000068101:Maternal-Child Health Services / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data*; D000069342:Medical Overuse / Q000517:prevention & control / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology