Mandl K D, Brennan T A, Wise P H, Tronick E Z, Homer C J
Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Arch Pediatr Adolesc Med. 1997 Sep;151(9):915-21. doi: 10.1001/archpedi.1997.02170460053009.
The Newborns' and Mothers' Health Protection Act of 1996 prohibits payers from restricting "benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours." The law recognizes the basic right of women and physicians to make decisions about aptness of discharge timing.
To provide data as a basis for decisions about aptness of discharge timing by studying the effect of voluntary, moderate reductions in length of postpartum hospital stay on an array of maternal and infant health outcomes.
A prospective cohort study. Patients were surveyed by telephone at 3 and 8 weeks postpartum.
A teaching hospital where 38% of the patients are in a managed care health plan with a noncompulsory reduced stay program offering enhanced prepartum and postpartum services, including home visits.
Consecutive mothers discharged after vaginal delivery during a 3-month period.
The outcomes were health services use within 21 days, breast-feeding, depression, sense of competence, and satisfaction with care. Multivariate analyses adjusted for sociodemographic factors, payer status, services, and social support.
Of 1364 eligible patients, 1200 (88%) were surveyed at 3 weeks; of these 1200, 1015 (85%) were resurveyed at 8 weeks. The mean length of stay was 41.9 hours (SD, 12.2 hours). Of patients going home in 30 hours or less, 60.8% belonged to a managed care health plan. The length of stay was not related to the outcomes, except that women hospitalized shorter than 48 hours had more emergency department visits than those staying 40 to 48 hours (adjusted odds ratio, 5.78; 95% confidence interval, 1.19-28.05).
When adequate postpartum outpatient care is accessible, a moderately shorter length of postpartum stay after an uncomplicated vaginal delivery had no adverse effect on an array of outcomes. Researchers and policy makers should seek to better define the content of postpartum services necessary for achieving optimal outcomes for women and newborns; funding should be available to provide such services, regardless of the setting in which they are provided.
1996年的《新生儿与母亲健康保护法》禁止支付方将“正常阴道分娩后母亲或新生儿在医院的住院时长相关福利限制在少于48小时”。该法律认可女性和医生对出院时间适宜性做出决策的基本权利。
通过研究自愿适度缩短产后住院时长对一系列母婴健康结局的影响，提供数据作为出院时间适宜性决策的依据。
一项前瞻性队列研究。在产后3周和8周通过电话对患者进行调查。
一家教学医院，其中38%的患者参加了管理式医疗健康计划，该计划有一个非强制性的缩短住院项目，提供强化的产前和产后服务，包括家访。
在3个月期间阴道分娩后连续出院的母亲。
结局包括21天内的医疗服务使用情况、母乳喂养、抑郁、能力感以及对护理的满意度。多变量分析对社会人口学因素、支付方状态、服务和社会支持进行了调整。
在1364名符合条件的患者中，1200名（88%）在产后3周接受了调查；在这1200名患者中，1015名（85%）在产后8周接受了再次调查。平均住院时长为41.9小时（标准差，12.2小时）。在30小时或更短时间内出院的患者中，60.8%属于管理式医疗健康计划。住院时长与结局无关，只是住院时间短于48小时的女性比住院40至48小时的女性急诊就诊次数更多（调整后的优势比，5.78；95%置信区间，1.19 - 28.05）。
当可获得充分的产后门诊护理时，无并发症的阴道分娩后适度缩短产后住院时长对一系列结局没有不良影响。研究人员和政策制定者应寻求更好地界定实现女性和新生儿最佳结局所需的产后服务内容；无论服务提供的环境如何，都应提供资金以提供此类服务。
