Maternal postpartum health care utilization and the effect of Minnesota early discharge legislation

Purpose: To describe maternal postdischarge follow-up and health care utilization in the context of Minnesota's early discharge legislation, which mandates coverage for a home visit for a mother and baby who voluntarily leave the hospital early. Methods: Claims data from a large managed care organization were used to identify 22,944 women giving birth from January 1995 through February 1999. Study variables included home or clinic visits within 1 week of discharge (early follow-up), readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. Results: After enactment of Minnesota's legislation, the percentage of mothers with short stays decreased from 52% to 16% for vaginal births and from 87% to 63% for cesarean births (P = .001). Overall, 33% of mothers with vaginal births and 40% with cesarean births had early home or clinic follow-up (P = .001). Mothers who stayed 0 or 1 hospital days after vaginal births were more likely to have early follow-up than those with longer stays (37% vs 32%, P = .01). However, mothers who stayed 2 or 3 days after cesarean birth were no more likely to have early follow-up than mothers who stayed 4 or more days (39% vs 42%, P = .08). Rates of early follow-up were significantly higher after enactment of Minnesota's legislation, regardless of length of stay. Conclusions: Implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay and an increase in the percentage of mothers who received early follow-up visits. However the majority of mothers with short stays continued to lack early follow-up.