Psychosocial Support, Newborn Readmissions, and Postpartum Follow-up

<p><strong>Background.</strong> Women and their infants are being discharged as soon as 24 hours after giving birth without proper follow-up care. The Maternity Department at San Antonio Community Hospital established the Family Care Center (HBFCC) in November 2000 in response to a higher than expected newborn readmission rate, shorter maternity hospitalizations, and a lack of postpartum follow-up. A comprehensive program was offered to support new families in the form of developmental assessment and intervention, breastfeeding, infant and toddler nutrition, health promotion and education, and referrals to appropriate agencies when indicated. In 2004, due to inadequate funding, the hospital reduced the intervention to a postpartum clinic that included limited breastfeeding support 2 weeks following birth.</p> <p><strong>Purpose. </strong>The purpose of this study was to determine if there is a positive relationship between the degree of psychosocial support offered (comprehensive, limited, or none) by healthcare providers and the rate of normal newborn readmissions. In addition, a cost-benefit analysis was performed to compare the costs of the intervention to the costs for normal newborn readmissions to establish whether such interventions are worthwhile from an economic viewpoint.</p> <p><strong>Design and Method.</strong> The study utilized an interrupted time series design with a partial reversal of the intervention. The study included a retrospective analysis of a secondary dataset of normal newborn readmissions at SACH at <em>baseline</em>, 1 year prior to the onset of a <em>comprehensive</em> psychosocial intervention for new mothers and babies (1999-2000), the 4 years during the comprehensive psychosocial intervention (2001- 2004), and 2 years post-intervention during a partial reversal or <em>limited</em> psychosocial intervention (2004-2006). The data were collected in fiscal years from July 1 - June 30 to coincide with the cost-benefit analysis. Participants included normal newborn births or a diagnosis related group (DRG) of 391 froom July 1,1999-June 30, 2006. A one-way ANOVA was conducted to determine if there were significant differences in average costs per patient across all three time periods.</p> <p><strong>Results.</strong>There was a significantly lower readmission rate 1.0% (p < .001) compared to baseline (2.3%), or during the limited psychosocial support intervention time period (2.3%). While there was no significant difference in the average cost per newborn readmitted across the three study time periods, during the comprehensive intervention time period, the average costs of a normal newborn readmission were significantly lower ($4,180,p = .041) for those who received the intervention compared to those who did not ($5,338). The two-way ANOVA comparing the average costs per newborn readmission across all three time periods showed a significant interaction (p = .04) across limited and comprehensive time periods and whether or not the individual received the intervention. The average costs of normal newborn readmissions for those receiving the intervention during the limited time period was $4,845 compared to those not receiving the intervention ($3,785). There was a cost-benefit of $513,540 due to fewer readmissions during the comprehensive psychosocial support time period but it did not exceed the cost of the intervention attributed to care in the first 28 days postpartum ($1,183,600).</p> <p><strong>Significance to Health Education</strong>. With healthcare costs continuing to increase and early discharge programs following delivery a common practice, understanding the potential effects of psychosocial support in a postpartum program is essential. Providing comprehensive follow-up for new mothers in the postpartum period can reduce normal newborn readmissions and potentially lower the average charges for newborn readmissions for those who receive psychosocial support.</p>

Name thesis:degree_name

Doctor of Public Health (DrPH)

Level thesis:degree_level

Dissertation

Year

2008

Author dc:creator

• Barilla, Dora

Contributors dc:contributor

• Helen Hopp Marshak
• Joyce W. Hopp
• S. Eric Anderson

• Public Health Education and Promotion
• Infant, Newborn; Social Support; Postpartum Period; Cost-Benefit Analysis

Statement dc:rights

• This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Language dc:language

English

Repository record dc:identifier

https://scholarsrepository.llu.edu/etd/1160

OAI identifier oai:identifier

oai:scholarsrepository.llu.edu:etd-2680