Department of Obstetrics & Gynecology (Darling) McMaster University; McMaster Midwifery Research Centre (Darling), McMaster University, Hamilton, Ont.; ICES (Babe, Perez), Hamilton, Ont.; Midwifery Education Program (Sorbara), Ryerson University; Institute of Health Policy, Management and Evaluation (Sorbara), University of Toronto, Toronto, Ont.
CMAJ Open. 2020 Jun 25;8(2):E462-E468. doi: 10.9778/cmajo.20190165. Print 2020 Apr-Jun.
Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time.
We conducted a retrospective population-based cohort study, including all midwife-attended singleton term cephalic newborns delivered by spontaneous vaginal birth at Ontario hospitals between April 2003 and February 2017. Our primary outcome was very early hospital discharge (< 6 h after birth) for newborns. Secondary outcomes were pediatric consultation before hospital discharge, phototherapy before hospital discharge and readmission for treatment of jaundice. We used generalized linear mixed models to estimate the relation between maternal, neonatal and hospital factors and very early discharge, while accounting for clustering by hospital.
The study cohort included 101 852 newborns born at 89 hospitals. Between 2003/04 and 2016/17, the unadjusted rate of very early discharge decreased from 34.3% to 30.7%. This trend was not significant after adjustment for covariates (odds ratio 1.0, 95% confidence interval 0.99-1.0). Unadjusted rates of pediatric consultation, phototherapy and readmission for jaundice all rose slightly over the study period. Hospital-specific risk-adjusted frequencies of very early discharge ranged from 5% ( = 1479) to 83% ( = 3459) across the 75 Ontario hospitals with at least 100 newborns included in the study cohort.
Hospital-level factors contributed to the observed decrease in crude rates of very early discharge for midwifery clients. Wide variation in these rates across Ontario hospitals points to room for improvement to make more efficient use of health care resources by promoting optimal levels of very early discharge.
尽早出院是安大略省助产护理的一个要素。本研究的目的是描述安大略省助产护理中新生儿尽早出院的频率随时间的变化情况。
我们进行了一项回顾性基于人群的队列研究，包括 2003 年 4 月至 2017 年 2 月期间在安大略省医院由自然阴道分娩的单胎足月头位助产士照料的新生儿。我们的主要结局是新生儿尽早出院（出生后 6 小时内）。次要结局是出院前儿科会诊、出院前光疗和因黄疸治疗而再次入院。我们使用广义线性混合模型来估计母亲、新生儿和医院因素与新生儿尽早出院之间的关系，同时考虑到医院聚类。
研究队列包括 101852 名出生于 89 家医院的新生儿。2003/04 年至 2016/17 年期间，未经调整的新生儿尽早出院率从 34.3%降至 30.7%。调整协变量后，这一趋势不显著（比值比 1.0，95%置信区间 0.99-1.0）。未经调整的儿科会诊、光疗和因黄疸再次入院的比例在研究期间均略有上升。75 家至少有 100 名新生儿纳入研究队列的安大略省医院中，每个医院的风险调整后尽早出院率范围从 5%（ = 1479）到 83%（ = 3459）。
医院层面的因素导致了观察到的助产客户尽早出院率的降低。安大略省各医院之间这些比率的广泛差异表明，通过促进新生儿尽早出院的最佳水平，可以进一步提高医疗资源的使用效率。
