Newborn length of stay, health care utilization, and the effect of Minnesota legislation

Objective: To describe newborn length of stay, post-discharge follow-up, and health care utilization in the context of Minnesota's early discharge legislation. Design and Setting: Retrospective study using claims data from a large managed care organization. Participants: Term newborns born from January 1995 through February 1999 (N = 22944). Outcome Measures: Newborn length of stay, home or clinic visits within 1 week of discharge (early follow-up), immunizations completed by age 3 months, readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. Results: After enactment of Minnesota's early discharge legislation in 1996, the percentage of newborns with short stays (0-1 days after vaginal birth or 2-3 days after cesarean birth) decreased from 52% to 16% for vaginally born infants and from 87% to 63% for cesarean-born infants (P = .001). Although the legislation mandated coverage for home visits after short stays, only 12.4% of short-stay newborns had early home visits. Overall, 50% of infants had early home or clinic follow-up; compared with those who did not receive early follow-up, these infants were more likely to have complete immunizations (adjusted odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.14), urgent care or emergency department visits (adjusted OR, 1.22; 95% CI, 1.07-1.39), and readmissions (adjusted OR, 2.49; 95% CI, 2.02-3.08). Conclusions: Although implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay, very few short-stay infants received the postdischarge care for which coverage was mandated. Our findings indicate, however, that infants at higher risk for adverse outcomes were appropriately identified to receive early follow-up.