737 Risk factors for acute care utilization in the 90 days following childbirth

Abstract

One third of maternal deaths in the United States occur more than 7 days after delivery; improving the continuum of maternal care is therefore essential. As part of our institution's Postnatal Patient Safety Learning Lab, we sought to identify characteristics of birthing parents who utilized acute care, defined as emergency department, obstetric triage or readmission to inpatient care, following maternity discharge. We conducted a retrospective cohort study among individuals who gave birth at a gestational age > 23 weeks between January 1, 2018 and June 30, 2019 at a southeastern quaternary care hospital. We retrieved health utilization data from our institution’s electronic health record system through 90 days postpartum. Comorbidities were identified using billed diagnosis codes. We used chi-square tests and multivariable logistic regression to identify characteristics associated with acute care utilization (ACU). P values <0.05 were considered statistically significant. During the study period, there were 5845 eligible birthing parents and 983 ACU encounters, half of which occurred in the first 14 days after birth. A total of 696 (11.9%) women had at least one ACU event: 340 (5.8%) were seen in the emergency department but not admitted, 168 (2.9%) were readmitted, and 290 (5.0%) were seen in OB triage. Maternal factors associated with ACU in bivariate analyses included younger age, public insurance, race/ethnicity, pregravid body mass index > 30 kg/m2, cesarean birth, preterm birth, and pre-gestational diabetes or hypertension. In multivariable logistic regression, associations were similar (Table). Mothers classified as Asian, Hispanic and other Race/Ethnicity had lower odds of ACU compared with non-Hispanic White or Black mothers. Postpartum ACU is concentrated in the first 14 days after birth and clinical characteristics identify those at risk. Targeted, multi-level strategies have the potential to reduce the need for acute care and promote maternal safety and wellbeing through the 4th Trimester and beyond.