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Unreadiness for Postpartum Discharge Following Healthy Term Pregnancy: Impact on Health Care Use and Outcomes
Abstract Objective To document the association between a lack of readiness, termed “unreadiness,” for postpartum discharge and the health of mothers and their term newborns. Methods Prospective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research n...
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| Published in: | Academic pediatrics 2013, Vol.13 (1), p.27-39 |
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| creator | Bernstein, Henry H., DO Spino, Cathie, DSc Lalama, Christina M., MS Finch, Stacia A., MA Wasserman, Richard C., MD, MPH McCormick, Marie C., MD, ScD |
| description | Abstract Objective To document the association between a lack of readiness, termed “unreadiness,” for postpartum discharge and the health of mothers and their term newborns. Methods Prospective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research network. The association between unreadiness for discharge and health care use, health-related behaviors, and health outcomes was analyzed by the use of bivariate, multivariate linear, and logistic models. Results Sixteen percent of mother-infant dyads were unready for discharge. Unreadiness was significantly associated with maternal and infant health care use and health outcomes but not independently associated with health-related behaviors. In multivariable analyses, after we controlled for important covariates and confounders, unready dyads had more calls to health care providers than ready dyads (13.3% increase for mothers, P = .01; 18.7% increase for infants, P |
| doi_str_mv | 10.1016/j.acap.2012.08.005 |
| format | article |
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Methods Prospective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research network. The association between unreadiness for discharge and health care use, health-related behaviors, and health outcomes was analyzed by the use of bivariate, multivariate linear, and logistic models. Results Sixteen percent of mother-infant dyads were unready for discharge. Unreadiness was significantly associated with maternal and infant health care use and health outcomes but not independently associated with health-related behaviors. In multivariable analyses, after we controlled for important covariates and confounders, unready dyads had more calls to health care providers than ready dyads (13.3% increase for mothers, P = .01; 18.7% increase for infants, P < .01) during the first 2 weeks after discharge. In this same time frame, unready dyads also had more symptom days (8.5% increase for mothers, P < .01; 8.7% increase for infants, P < .01). Unready mothers had lower mean physical (5.0% decrease, P < .01) and mental (4.4% decrease, P < .01) health status scores at 4 weeks after discharge. Conclusions Unreadiness at postpartum discharge was associated with increased health care use and poorer health outcomes in the first 2 to 4 weeks after discharge. Discharge plans should be individualized and jointly tailored to a family's needs rather than to a set timescale.</description><identifier>ISSN: 1876-2859</identifier><identifier>EISSN: 1876-2867</identifier><identifier>DOI: 10.1016/j.acap.2012.08.005</identifier><identifier>PMID: 23098743</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Child Health Services - utilization ; Cohort Studies ; Female ; Health Behavior ; Health Status ; Humans ; Infant, Newborn ; Linear Models ; Logistic Models ; Maternal Health Services - utilization ; Mothers - psychology ; Mothers - statistics & numerical data ; Multivariate Analysis ; Neonatal and Perinatal Medicine ; newborn ; newborn readiness ; nursery discharge ; Patient Discharge ; Pediatrics ; Postpartum Period ; Pregnancy ; Prospective Studies ; Young Adult</subject><ispartof>Academic pediatrics, 2013, Vol.13 (1), p.27-39</ispartof><rights>Academic Pediatric Association</rights><rights>2013 Academic Pediatric Association</rights><rights>Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-cde76744a659bec2b10cba9bf364d552a8e4cc769eab8b9a2c9a53609a57b5b23</citedby><cites>FETCH-LOGICAL-c411t-cde76744a659bec2b10cba9bf364d552a8e4cc769eab8b9a2c9a53609a57b5b23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,4043,27956,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23098743$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bernstein, Henry H., DO</creatorcontrib><creatorcontrib>Spino, Cathie, DSc</creatorcontrib><creatorcontrib>Lalama, Christina M., MS</creatorcontrib><creatorcontrib>Finch, Stacia A., MA</creatorcontrib><creatorcontrib>Wasserman, Richard C., MD, MPH</creatorcontrib><creatorcontrib>McCormick, Marie C., MD, ScD</creatorcontrib><title>Unreadiness for Postpartum Discharge Following Healthy Term Pregnancy: Impact on Health Care Use and Outcomes</title><title>Academic pediatrics</title><addtitle>Acad Pediatr</addtitle><description>Abstract Objective To document the association between a lack of readiness, termed “unreadiness,” for postpartum discharge and the health of mothers and their term newborns. Methods Prospective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research network. The association between unreadiness for discharge and health care use, health-related behaviors, and health outcomes was analyzed by the use of bivariate, multivariate linear, and logistic models. Results Sixteen percent of mother-infant dyads were unready for discharge. Unreadiness was significantly associated with maternal and infant health care use and health outcomes but not independently associated with health-related behaviors. In multivariable analyses, after we controlled for important covariates and confounders, unready dyads had more calls to health care providers than ready dyads (13.3% increase for mothers, P = .01; 18.7% increase for infants, P < .01) during the first 2 weeks after discharge. In this same time frame, unready dyads also had more symptom days (8.5% increase for mothers, P < .01; 8.7% increase for infants, P < .01). Unready mothers had lower mean physical (5.0% decrease, P < .01) and mental (4.4% decrease, P < .01) health status scores at 4 weeks after discharge. Conclusions Unreadiness at postpartum discharge was associated with increased health care use and poorer health outcomes in the first 2 to 4 weeks after discharge. Discharge plans should be individualized and jointly tailored to a family's needs rather than to a set timescale.</description><subject>Adult</subject><subject>Child Health Services - utilization</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Health Behavior</subject><subject>Health Status</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Linear Models</subject><subject>Logistic Models</subject><subject>Maternal Health Services - utilization</subject><subject>Mothers - psychology</subject><subject>Mothers - statistics & numerical data</subject><subject>Multivariate Analysis</subject><subject>Neonatal and Perinatal Medicine</subject><subject>newborn</subject><subject>newborn readiness</subject><subject>nursery discharge</subject><subject>Patient Discharge</subject><subject>Pediatrics</subject><subject>Postpartum Period</subject><subject>Pregnancy</subject><subject>Prospective Studies</subject><subject>Young Adult</subject><issn>1876-2859</issn><issn>1876-2867</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp9kcFu1DAQhi0EoqXwAhyQj1w22E5iOwghVQullSq1Et2zNXFmt14SO9gJaN8eR7v0wIGLx4fv_6X5hpC3nBWccflhX4CFsRCMi4LpgrH6GTnnWsmV0FI9f_rXzRl5ldKeMVlqLV-SM1GyRquqPCfDxkeEznlMiW5DpPchTSPEaR7oF5fsI8Qd0qvQ9-G38zt6jdBPjwf6gHGg9xF3Hrw9fKQ3wwh2osGfCLqGiHSTkILv6N082TBgek1ebKFP-OY0L8jm6uvD-np1e_ftZn15u7IV59PKdqikqiqQddOiFS1ntoWm3Zay6upagMbKWiUbhFa3DQjbQF1Kll_V1q0oL8j7Y-8Yw88Z02SGvAv2PXgMczJcqLJqKqV5RsURtTGkFHFrxugGiAfDmVk0m71ZNJtFs2HaZM059O7UP7cDdk-Rv14z8OkIYN7yl8NoknXoLXYuop1MF9z_-z__E7e9885C_wMPmPZhjj77M9yknDHfl0Mvd-aCMcGquvwDDFOkLw</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Bernstein, Henry H., DO</creator><creator>Spino, Cathie, DSc</creator><creator>Lalama, Christina M., MS</creator><creator>Finch, Stacia A., MA</creator><creator>Wasserman, Richard C., MD, MPH</creator><creator>McCormick, Marie C., MD, ScD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2013</creationdate><title>Unreadiness for Postpartum Discharge Following Healthy Term Pregnancy: Impact on Health Care Use and Outcomes</title><author>Bernstein, Henry H., DO ; Spino, Cathie, DSc ; Lalama, Christina M., MS ; Finch, Stacia A., MA ; Wasserman, Richard C., MD, MPH ; McCormick, Marie C., MD, ScD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-cde76744a659bec2b10cba9bf364d552a8e4cc769eab8b9a2c9a53609a57b5b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Child Health Services - utilization</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Health Behavior</topic><topic>Health Status</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Linear Models</topic><topic>Logistic Models</topic><topic>Maternal Health Services - utilization</topic><topic>Mothers - psychology</topic><topic>Mothers - statistics & numerical data</topic><topic>Multivariate Analysis</topic><topic>Neonatal and Perinatal Medicine</topic><topic>newborn</topic><topic>newborn readiness</topic><topic>nursery discharge</topic><topic>Patient Discharge</topic><topic>Pediatrics</topic><topic>Postpartum Period</topic><topic>Pregnancy</topic><topic>Prospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bernstein, Henry H., DO</creatorcontrib><creatorcontrib>Spino, Cathie, DSc</creatorcontrib><creatorcontrib>Lalama, Christina M., MS</creatorcontrib><creatorcontrib>Finch, Stacia A., MA</creatorcontrib><creatorcontrib>Wasserman, Richard C., MD, MPH</creatorcontrib><creatorcontrib>McCormick, Marie C., MD, ScD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Academic pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bernstein, Henry H., DO</au><au>Spino, Cathie, DSc</au><au>Lalama, Christina M., MS</au><au>Finch, Stacia A., MA</au><au>Wasserman, Richard C., MD, MPH</au><au>McCormick, Marie C., MD, ScD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unreadiness for Postpartum Discharge Following Healthy Term Pregnancy: Impact on Health Care Use and Outcomes</atitle><jtitle>Academic pediatrics</jtitle><addtitle>Acad Pediatr</addtitle><date>2013</date><risdate>2013</risdate><volume>13</volume><issue>1</issue><spage>27</spage><epage>39</epage><pages>27-39</pages><issn>1876-2859</issn><eissn>1876-2867</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract Objective To document the association between a lack of readiness, termed “unreadiness,” for postpartum discharge and the health of mothers and their term newborns. Methods Prospective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research network. The association between unreadiness for discharge and health care use, health-related behaviors, and health outcomes was analyzed by the use of bivariate, multivariate linear, and logistic models. Results Sixteen percent of mother-infant dyads were unready for discharge. Unreadiness was significantly associated with maternal and infant health care use and health outcomes but not independently associated with health-related behaviors. In multivariable analyses, after we controlled for important covariates and confounders, unready dyads had more calls to health care providers than ready dyads (13.3% increase for mothers, P = .01; 18.7% increase for infants, P < .01) during the first 2 weeks after discharge. In this same time frame, unready dyads also had more symptom days (8.5% increase for mothers, P < .01; 8.7% increase for infants, P < .01). Unready mothers had lower mean physical (5.0% decrease, P < .01) and mental (4.4% decrease, P < .01) health status scores at 4 weeks after discharge. Conclusions Unreadiness at postpartum discharge was associated with increased health care use and poorer health outcomes in the first 2 to 4 weeks after discharge. Discharge plans should be individualized and jointly tailored to a family's needs rather than to a set timescale.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23098743</pmid><doi>10.1016/j.acap.2012.08.005</doi><tpages>13</tpages></addata></record> |
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| subjects | Adult Child Health Services - utilization Cohort Studies Female Health Behavior Health Status Humans Infant, Newborn Linear Models Logistic Models Maternal Health Services - utilization Mothers - psychology Mothers - statistics & numerical data Multivariate Analysis Neonatal and Perinatal Medicine newborn newborn readiness nursery discharge Patient Discharge Pediatrics Postpartum Period Pregnancy Prospective Studies Young Adult |
| title | Unreadiness for Postpartum Discharge Following Healthy Term Pregnancy: Impact on Health Care Use and Outcomes |
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