A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge
- PMID: 11533342
- DOI: 10.1542/peds.108.3.719
A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge
Abstract
Objective: Short postpartum stays are common. Current guidelines provide scant guidance on how routine follow-up of newly discharged mother-infant pairs should be performed. We aimed to compare 2 short-term (within 72 hours of discharge) follow-up strategies for low-risk mother-infant pairs with postpartum length of stay (LOS) of <48 hours: home visits by a nurse and hospital-based follow-up anchored in group visits.
Methods: We used a randomized clinical trial design with intention-to-treat analysis in an integrated managed care setting that serves a largely middle class population. Mother-infant pairs that met LOS and risk criteria were randomized to the control arm (hospital-based follow-up) or to the intervention arm (home nurse visit). Clinical utilization and costs were studied using computerized databases and chart review. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks postpartum.
Results: During a 17-month period in 1998 to 1999, we enrolled and randomized 1014 mother-infant pairs (506 to the control group and 508 to the intervention group). There were no significant differences between the study groups with respect to maternal age, race, education, household income, parity, previous breastfeeding experience, early initiation of prenatal care, or postpartum LOS. There were no differences with respect to neonatal LOS or Apgar scores. In the control group, 264 mother-infant pairs had an individual visit only, 157 had a group visit only, 64 had both a group and an individual visit, 4 had a home health and a hospital-based follow-up, 13 had no follow-up within 72 hours, and 4 were lost to follow-up. With respect to outcomes within 2 weeks after discharge, there were no significant differences in newborn or maternal hospitalizations or urgent care visits, breastfeeding discontinuation, maternal depressive symptoms, or a combined clinical outcome measure indicating whether a mother-infant pair had any of the above outcomes. However, mothers in the home visit group were more likely than those in the control group to rate multiple aspects of their care as excellent or very good. These included the preventive advice delivered (76% vs 59%) and the skills and abilities of the provider (84% vs 73%). Mothers in the home visit group also gave higher ratings on overall satisfaction with the newborn's posthospital care (71% vs 59%), as well as with their own posthospital care (63% vs 55%). The estimated cost of a postpartum home visit to the mother and the newborn was $265. In contrast, the cost of the hospital-based group visit was $22 per mother-infant pair; the cost of an individual 15-minute visit with a registered nurse was $52; the cost of a 15-minute individual pediatrician visit was $92; and the cost of a 10-minute visit with an obstetrician was $92.
Conclusions: For low-risk mothers and newborns in an integrated managed care organization, home visits compared with hospital-based follow-up and group visits were more costly but achieved comparable clinical outcomes and were associated with higher maternal satisfaction. Neither strategy is associated with significantly greater success at increasing continuation of breastfeeding. This study had limited power to identify group differences in rehospitalization and may not be generalizable to higher-risk populations without comparable access to integrated hospital and outpatient care.
Similar articles
-
Early postpartum discharge before 48 h: An exhaustive review.J Gynecol Obstet Hum Reprod. 2022 Nov;51(9):102458. doi: 10.1016/j.jogoh.2022.102458. Epub 2022 Aug 13. J Gynecol Obstet Hum Reprod. 2022. PMID: 35973664 Review.
-
Schedules for home visits in the early postpartum period.Cochrane Database Syst Rev. 2013 Jul 23;(7):CD009326. doi: 10.1002/14651858.CD009326.pub2. Cochrane Database Syst Rev. 2013. Update in: Cochrane Database Syst Rev. 2017 Aug 02;8:CD009326. doi: 10.1002/14651858.CD009326.pub3. PMID: 23881661 Updated. Review.
-
Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs.Pediatrics. 2005 Feb;115(2):e139-46. doi: 10.1542/peds.2004-1362. Pediatrics. 2005. PMID: 15687421 Clinical Trial.
-
A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge.Pediatrics. 2000 May;105(5):1058-65. doi: 10.1542/peds.105.5.1058. Pediatrics. 2000. PMID: 10790463 Clinical Trial.
-
Clinical outcomes and maternal perceptions of an updated model of perinatal care.Pediatrics. 1998 Dec;102(6):1437-44. doi: 10.1542/peds.102.6.1437. Pediatrics. 1998. PMID: 9832582
Cited by
-
Length-of-stay after a health facility birth and associated factors: analysis of data from three Sub-Saharan African countries.Ghana Med J. 2022 Jun;56(2):100-109. doi: 10.4314/gmj.v56i2.7. Ghana Med J. 2022. PMID: 37449254 Free PMC article.
-
Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers.Healthcare (Basel). 2023 Mar 17;11(6):878. doi: 10.3390/healthcare11060878. Healthcare (Basel). 2023. PMID: 36981537 Free PMC article.
-
Efficacy of behavioral interventions to improve maternal mental health and breastfeeding outcomes: a systematic review.Int Breastfeed J. 2022 Sep 5;17(1):67. doi: 10.1186/s13006-022-00501-9. Int Breastfeed J. 2022. PMID: 36064573 Free PMC article. Review.
-
Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022.Breastfeed Med. 2022 Mar;17(3):197-206. doi: 10.1089/bfm.2022.29203.aeh. Breastfeed Med. 2022. PMID: 35302875 Free PMC article.
-
Schedules for home visits in the early postpartum period.Cochrane Database Syst Rev. 2021 Jul 21;7(7):CD009326. doi: 10.1002/14651858.CD009326.pub4. Cochrane Database Syst Rev. 2021. PMID: 34286512 Free PMC article.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous