Batra Priya, Fridman Moshe, Leng Mei, Gregory Kimberly D
Center for Healthy Communities, School of Medicine, University of California, Riverside, and AMF Consulting, the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, and the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, California.
Obstet Gynecol. 2017 Nov;130(5):1073-1081. doi: 10.1097/AOG.0000000000002269.
To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth.
This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis.
Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95).
One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.
利用人群数据确定与产后出院后90天内产妇急诊就诊相关的患者特征。
这项回顾性横断面研究分析了2009年至2011年加利福尼亚州所有活产的产妇出院数据与急诊数据的关联。主要结局是产后出院后90天内至少有一次急诊就诊。次要结局包括90天内三次或更多次就诊（“高利用率”）和住院再入院。自变量包括人口统计学特征（年龄、种族或民族、付款人、收入）和临床特征（住院时间、产前并发症、分娩方式以及分娩时的严重孕产妇发病率）。多水平逻辑回归确定与研究结局相关的变量；我们采用样本分割法和受试者工作特征曲线分析对预测模型进行了验证。
在纳入的1,071,232例分娩中，88,67
