Newborn Length of Stay, Health Care Utilization, and the Effect of Minnesota Legislation | Neonatology | JAMA Pediatrics | JAMA Network
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June 2003

Newborn Length of Stay, Health Care Utilization, and the Effect of Minnesota Legislation

Author Affiliations

From the Ramsey Family and Community Medicine Residency Program, St Paul, Minn (Dr Madlon-Kay); HealthPartners Research Foundation, Bloomington, Minn (Ms DeFor); and the Department of Family and Community Medicine, University of California, San Francisco (Dr Egerter).

Arch Pediatr Adolesc Med. 2003;157(6):579-583. doi:10.1001/archpedi.157.6.579

Objective  To describe newborn length of stay, postdischarge follow-up, and health care utilization in the context of Minnesota's early discharge legislation.

Design and Setting  Retrospective study using claims data from a large managed care organization.

Participants  Term newborns born from January 1995 through February 1999 (N = 22 944).

Outcome Measures  Newborn length of stay, home or clinic visits within 1 week of discharge (early follow-up), immunizations completed by age 3 months, readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge.

Results  After enactment of Minnesota's early discharge legislation in 1996, the percentage of newborns with short stays (0-1 days after vaginal birth or 2-3 days after cesarean birth) decreased from 52% to 16% for vaginally born infants and from 87% to 63% for cesarean-born infants (P = .001). Although the legislation mandated coverage for home visits after short stays, only 12.4% of short-stay newborns had early home visits. Overall, 50% of infants had early home or clinic follow-up; compared with those who did not receive early follow-up, these infants were more likely to have complete immunizations (adjusted odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.14), urgent care or emergency department visits (adjusted OR, 1.22; 95% CI, 1.07-1.39), and readmissions (adjusted OR, 2.49; 95% CI, 2.02-3.08).

Conclusions  Although implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay, very few short-stay infants received the postdischarge care for which coverage was mandated. Our findings indicate, however, that infants at higher risk for adverse outcomes were appropriately identified to receive early follow-up.