Effect of a reduced postpartum length of stay program on primary care services use by mothers and infants

Objective. To determine the impact of reduced postpartum length of stay (LO S) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for ti me trends. Setting: A managed care plan. Intervention: A reduced obstetrica l LOS program (ROLOS), offering enhanced education and services. Participan ts: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect . Independent Measures: Pre-ROLOS or the post-ROLOS year. Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks p ostpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) an d after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, t here were between 2.37 and 2.72 utilization events per dyad; after, there w ere 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.