Abstract

Background. 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.

Purpose. 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.

Design and Method. 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 baseline, 1 year prior to the onset of a comprehensive 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 limited 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.

Results.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).

Significance to Health Education. 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.

School

School of Public Health

First Advisor

Helen Hopp Marshak

Second Advisor

Joyce W. Hopp

Third Advisor

S. Eric Anderson

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2008

Date (Title Page)

6-2008

Language

English

Library of Congress/MESH Subject Headings

Infant, Newborn; Social Support; Postpartum Period; Cost-Benefit Analysis

Type

Dissertation

Page Count

xi; 104

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage 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.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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