Use of hospital-based services in the first three months of life: Impact of an early discharge program

Abstract

Objective: To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life. Design: Retrospective cohort study. Setting: Metropolitan university hospital and a children's hospital. Patients: Term infants cared for in a single term nursery, before and after implementation of an early discharge program. Intervention: Early discharge program. Methods: Linking of the birth hospital and the children's hospital records and chart review. Outcome measures: Pattern of emergency department visits and rehospitalizations in the first 3 months of life. Results: The early discharge group had a shorter stay, 32 ± 21 hours (mean ± SD) than the control group (48 ± 22 hours). There was no effect of early discharge on mean age at rehospitalization, rehospitalization rate, or reason for rehospitalization. Twenty-eight percent of infants in both study and control groups had at least one emergency department visit by 3 months of age. There was no difference between study and control groups in mean age or frequency of emergency department visits. Maternal age and race had a significant effect on the odds of visiting the emergency department. For any maternal age, nonwhite mothers were more likely to visit the emergency department. Conclusions: Early discharge of newborn infants to inner city parents can be accomplished without increasing hospital-based resource use in the first 3 months of life provided coordinated postdischarge care and home visiting services are available. (J Pediatr 1997;130:250-6)