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July 23, 1997

Early Discharge and Evidence-based PracticeGood Science and Good Judgment

Author Affiliations

From the Departments of Family and Community Medicine (Drs Egerter and Braveman) and Epidemiology and Biostatistics (Dr Braveman), University of California, San Francisco; the Division of Science, Education, and Analysis, Maternal Child and Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Washington, DC (Dr Kessel); and the Department of Social Medicine, Harvard Medical School, Boston, Mass (Dr Richmond).

JAMA. 1997;278(4):334-336. doi:10.1001/jama.1997.03550040090044

Two articles in this issue of The Journal reach apparently conflicting conclusions regarding the safety of the short postpartum hospital stays that are now—and are likely to remain—standard for apparently well mothers and newborns. Both studies, 1 from Washington State1 and 1 from Wisconsin,2used case-control designs and large secondary databases to examine the association between early discharge and neonatal readmissions. Although this question has been explored before, few studies have been so large or have addressed limitations so skillfully. Interpreting the implications of these studies and their seemingly contradictory conclusions raises difficult issues about science and society; the issues are not unique to these studies.

Using linked birth certificate and hospital discharge abstracts from eligible vaginal singleton live births in Washington State from 1991 through 1994, Liu and colleagues2 investigated whether "early" (<30 hours after delivery) compared with "later" (30-78 hours after delivery) discharge increased the risk