O'Donnell Heather C, Colman Gregory, Trachtman Rebecca A, Velazco Nerissa, Racine Andrew D
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
Pace University and National Bureau of Economic Research, New York, NY.
Acad Pediatr. 2014 Jan-Feb;14(1):84-91. doi: 10.1016/j.acap.2013.09.010.
To determine whether newborn first outpatient visit (FOV) within 3 days of discharge is associated with reduced rates of emergency department (ED) visits and hospital readmissions.
Retrospective cohort analysis was performed of all newborns who were born and had outpatient follow-up within a large academic medical center to determine whether they had ED visits or hospital readmission within 2 weeks after hospital discharge. Multivariable regression using an instrumental variable for timing of FOV was conducted to estimate the relationship between FOV within 3 days of discharge and ED visits and hospital readmissions within 2 weeks of discharge, adjusting for potential confounders. Stratified analyses assessed this relationship in subpopulations with medical or social risk factors.
Of 3282 newborns, 178 (5%) had 1 or more ED visits or hospital readmissions within 2 weeks of hospital discharge. FOV within 3 days was not significantly associated with ED visits and readmissions in the instrumental variable analysis (IVA) (-0.035, P = .11) or the ordinary least squares analysis (OLS) (0.006, P = .52). The difference in coefficients between these analyses, however, suggests that IVA successfully adjusted for some unmeasured bias. In stratified analyses, only newborns born to African American mothers or discharged by family medicine providers demonstrated a significant relationship between FOV within 3 days and reduced odds of ED visits and readmissions.
No significant relationship between outpatient visit timing and ED visits and hospital readmissions was found. Further study is needed to assess the impact of early outpatient visits on other newborn outcomes.
确定出院后3天内进行新生儿首次门诊就诊（FOV）是否与急诊就诊率和住院再入院率降低相关。
对在一家大型学术医疗中心出生并接受门诊随访的所有新生儿进行回顾性队列分析，以确定他们在出院后2周内是否有急诊就诊或住院再入院情况。使用FOV时间的工具变量进行多变量回归，以估计出院后3天内的FOV与出院后2周内的急诊就诊和住院再入院之间的关系，并对潜在混杂因素进行调整。分层分析评估了具有医疗或社会风险因素的亚人群中的这种关系。
在3282名新生儿中，178名（5%）在出院后2周内有1次或更多次急诊就诊或住院再入院。在工具变量分析（IVA）（-0.035，P = 0.11）或普通最小二乘法分析（OLS）（0.006，P = 0.52）中，3天内的FOV与急诊就诊和再入院无显著关联。然而，这些分析之间系数的差异表明IVA成功地调整了一些未测量的偏差。在分层分析中，只有非裔美国母亲所生的新生儿或由家庭医学提供者出院的新生儿显示出3天内的FOV与急诊就诊和再入院几率降低之间存在显著关系。
未发现门诊就诊时间与急诊就诊和住院再入院之间存在显著关系。需要进一步研究以评估早期门诊就诊对其他新生儿结局的影响。
