Meikle S F, Lyons E, Hulac P, Orleans M
Colorado Permanente Medical Group, Denver, USA.
Am J Obstet Gynecol. 1998 Jul;179(1):166-71. doi: 10.1016/s0002-9378(98)70268-6.
Our purpose was to determine whether length of hospital stay after vaginal delivery as determined by the discharging physician is associated with rehospitalizations or increased outpatient contacts by mothers and neonates and to assess the impact of home health care visits.
An inception cohort study of all rehospitalizations and outpatient contacts of mothers and neonates after vaginal delivery at St. Joseph Hospital, Denver, Colorado, was done from January 1, 1994, to September 30, 1995. All Kaiser Permanente mother-neonate pairs in which the delivery was vaginal (excluding those with multiple gestations or birth weight < 2500 g) were included. Length of initial hospital stay was divided into three time periods: < or = 24 hours, 25 to 48 hours, and > 48 hours. The Colorado Kaiser Permanente Perinatal Database was used to identify perinatal and demographic factors that might have increased health care use. Additional information was sought in administrative databases, bill records, and inpatient charts. Mothers were followed up for 6 weeks and neonates for 28 days after delivery. Home care visits were provided to more than half the mothers and neonates by means of a standardized protocol. The main outcome measures were rehospitalizations and outpatient visits for mothers and neonate, controlling for home care visits.
A total of 4323 mother-neonate pairs were identified. For the mothers, a longer initial hospital stay (> 48 hours) was significantly associated with both readmission (P < .01) and increased outpatient care use (P = .01) in the 6-week postpartum period. Thirty-five mothers (.81%) were rehospitalized by 6 weeks. Maternal factors associated with increased outpatient contacts were preeclampsia, preterm delivery, and instrument delivery. Sixty-seven neonates (1.55%) were readmitted to the hospital. Home care visits reduced the need for both readmissions and outpatient visits.
For mothers in this cohort a longer initial hospital stay was significantly associated with hospital readmission and increased outpatient care in the postpartum period. Further analysis revealed that mothers with recognized potential and observed problems were rarely discharged in < or = 24 hours. We did not find statistically significant problems among neonates that were related to the length of their initial hospital stay. Those neonates receiving home care were less likely to require hospital readmission and less likely to seek outpatient care. It is unlikely that a single discharge policy will be appropriate for all mothers and neonates.
我们的目的是确定由出院医生确定的阴道分娩后的住院时间是否与母亲和新生儿再次住院或门诊就诊次数增加相关，并评估家庭医疗访视的影响。
对1994年1月1日至1995年9月30日在科罗拉多州丹佛市圣约瑟夫医院阴道分娩后的所有母亲和新生儿的再次住院和门诊就诊情况进行了一项队列研究。纳入所有分娩方式为阴道分娩的凯撒医疗母婴对（不包括多胎妊娠或出生体重<2500g的情况）。首次住院时间分为三个时间段：≤24小时、25至48小时和>48小时。使用科罗拉多凯撒医疗围产期数据库来确定可能增加医疗服务使用的围产期和人口统计学因素。从行政数据库、账单记录和住院病历中获取更多信息。产后对母亲随访6周，对新生儿随访28天。通过标准化方案为一半以上的母亲和新生儿提供家庭医疗访视。主要结局指标是母亲和新生儿的再次住院和门诊就诊情况，并对家庭医疗访视进行了控制。
共确定了4323对母婴。对于母亲来说，较长的首次住院时间（>48小时）与产后6周内的再次入院（P<.01）和门诊医疗服务使用增加（P=.01）显著相关。35名母亲（.81%）在6周内再次住院。与门诊就诊次数增加相关的母亲因素包括先兆子痫、早产和器械助产。67名新生儿（1.55%）再次入院。家庭医疗访视减少了再次入院和门诊就诊的需求。
在这个队列中的母亲中，较长的首次住院时间与产后再次入院和门诊医疗服务增加显著相关。进一步分析显示，有潜在问题且被观察到的母亲很少在≤24小时内出院。我们没有发现新生儿的初始住院时间与其相关的统计学显著问题。那些接受家庭医疗访视的新生儿再次入院的可能性较小，寻求门诊医疗服务的可能性也较小。单一的出院政策不太可能适用于所有母亲和新生儿。
