Cooper W O, Kotagal U R, Atherton H D, Lippert C A, Bragg E, Donovan E F, Perlstein P H
Department of Pediatrics, Children's Hospital of Vanderbilt University Medical Center, Nashville, TN, USA.
Pediatrics. 1996 Oct;98(4 Pt 1):686-91.
To assess the use of health care services by inner-city infants enrolled in an early discharge program who received care in tertiary care children's hospital primary care clinic.
Retrospective cohort study.
Large, metropolitan university hospital and a children's hospital.
Term infants cared for in a single full-term nursery, before and after implementation of a coordinated early discharge program, who received primary care at the children's hospital.
The coordinated Early Discharge Program was characterized by in-hospital visits by hospital-based coordinating nurses, home visits by nurses from a home nursing agency, and communication with physicians for necessary adjustments in postdischarge care.
After linking birth hospital records and the children's hospital medical records, a retrospective chart review was performed to obtain maternal demographic information and birth hospital length of stay, as well as the infants' attendance at primary care clinic, immunizations, emergency department visits, and rehospitalization.
Number of primary care visits in the first 3 months of life, completion of one series of immunizations by 3 months of life, and number of emergency department visits and rehospitalization during the first 3 months of life.
The early discharge group (n = 253) had a significantly shorter birth hospital length of stay (35 +/- 24 hours, mean +/- SD) when compared with the control group (n = 212) (52 +/- 14 hours). The early discharge group was also younger than the control group at the first primary care visit, with significantly more infants visiting the primary care clinic in the first month of life. There was also a significant difference between the groups in the mean number of emergency department visits (early discharge = .61 visits/patient, control = .79 visits/patient) and the proportion of patients with no emergency department visits during the first 3 months of life (early discharge = 57%, control = 43%). There was no difference between the two groups in the proportion of infants completing one series of immunizations or in the number of infants rehospitalized during the study period.
Coordinated early discharge with home nursing visits for inner-city infants may result in earlier use of primary care services. Furthermore, there is a significant decrease in use of the emergency department during the first 3 months of life, and no increase in rehospitalization.
评估参加早期出院计划并在三级儿童医院初级保健诊所接受护理的市中心婴儿对医疗保健服务的利用情况。
回顾性队列研究。
大型都市大学医院和一家儿童医院。
在实施协调早期出院计划之前和之后，在单一足月婴儿室接受护理并在儿童医院接受初级保健的足月儿。
协调早期出院计划的特点是由医院协调护士进行住院访视、家庭护理机构的护士进行家访，以及与医生沟通以对出院后护理进行必要调整。
将出生医院记录与儿童医院病历关联后，进行回顾性病历审查，以获取产妇人口统计学信息和出生医院住院时间，以及婴儿在初级保健诊所的就诊情况、免疫接种情况、急诊科就诊次数和再次住院情况。
出生后前3个月的初级保健就诊次数、3个月大时完成一系列免疫接种的情况，以及出生后前3个月的急诊科就诊次数和再次住院次数。
与对照组（n = 212）（52 ± 14小时）相比，早期出院组（n = 253）的出生医院住院时间明显更短（35 ± 24小时，平均值 ± 标准差）。早期出院组在首次初级保健就诊时也比对照组年轻，在出生后第一个月到初级保健诊所就诊的婴儿明显更多。两组在急诊科就诊平均次数（早期出院组 = 0.61次/患者，对照组 = 0.79次/患者）以及出生后前3个月无急诊科就诊患者比例（早期出院组 = 57%，对照组 = 43%）方面也存在显著差异。两组在完成一系列免疫接种的婴儿比例或研究期间再次住院的婴儿数量方面没有差异。
为市中心婴儿协调早期出院并进行家庭护理访视可能会使初级保健服务的使用更早。此外，出生后前3个月急诊科的使用显著减少，再次住院率没有增加。
