Few reliable data exist on the clinical and economic effects of private sector efforts to reduce lengths of stay following childbirth or on the effects of more recent state and federal legislation guaranteeing longer maternity stays. The proposed study will evaluate the effects of two successive policies relating to hospital delivery services: first, one large health maintenance organization's (HMO) internal program aimed at reducing inpatient length of stay (LOS) at the time of childbirth; and second, state legislation mandating that health insurers provide a minimum 48- hour hospital coverage alter normal delivery. The study will analyze a large HMO's computerized medical record system and linked hospital patient records for deliveries within the HMO over a seven and a half year period (N= approximately 40,000 women and infants) encompassing both policy changes. Through the use of interrupted time series analysis, we will measure effects of these policy changes on the costs, quality, and outcomes of care. In particular we will examine the effects of the two sequential policies on: 1) hospital LOS alter delivery; 2) indicators of health or quality-of-life outcomes, such as rehospitalizations (maternal or infant); post-natal infections; breastfeeding; and post-partum depression or anxiety; 3) rates of services utilization, such as office visits, home care, ER visits, and telephone consultations with providers; and, 4) total costs of inpatient and outpatient care. Subgroup analyses on vulnerable populations (e.g., poorer, less educated, teenage mothers) will be conducted to determine whether these policies might have had differential effects on these at-risk populations.
| Sinha, Anushua; Madden, Jeanne; Ross-Degnan, Dennis et al. (2003) Reduced risk of neonatal respiratory infections among breastfed girls but not boys. Pediatrics 112:e303 |
