Length of Postpartum Hospital Stays and the Health of Mothers and Their Newborns

产后住院时间与母亲及其新生儿的健康

• 批准号: 7219952
• 负责人: WILLIAM N. EVANS
• 金额: $ 11.62万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-15 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7219952
• 关键词: Address; Admission activity; Authorization documentation; Birth; California; Censuses; Cesarean section; Characteristics; Child; Condition; Conflict (Psychology); Consultations; Data; Data Set; Death Records; Event; Grant; Health; Health Professional; Home environment; Hospitalization; Hospitals; Hour; Infant; Insurance Carriers; Laws; Length; Length of Stay; Life; Maryland; Medicaid; Mothers; Neonatal Mortality; Newborn Infant; Numbers; Outcome; Patient Discharge; Patients; Physicians; Policy Maker; Postpartum Period; Protocols documentation; Rate; Records; Research; Research Personnel; Safety; Sampling; Series; Time; Universities; Vagina; Vital Statistics; cost; design; desire; human subject; improved; programs

DESCRIPTION (provided by applicant): Between 1995 and 1997, 32 states passed laws requiring insurance carriers to provide minimum postpartum length of stays and a similar federal law went into effect on January 1, 1998. A number of authors have demonstrated that these laws increased average postpartum hospital length of stay, decreased the fraction of mothers and infants discharged 'early', and increased hospitalization costs. There is however limited evidence about the impact of these laws on the health of the mother and her newborn, and estimates from these studies provide conflicting results. In this application, we outline a research program that uses a restricted-use data set of California births to examine the impact of one of these laws. The California Newborns' and Mothers' Health Act of 1997 (NMHA), which went into effect on August 26,1997, mandated that insurance carriers provide coverage for at least a 48 hour hospital stays for normal deliveries and at least a 96 hour hospital stays for cesarean deliveries. The California law is similar to many other state laws and is nearly identical in scope to the federal law that went into effect in 1998. Both the California and federal laws explicitly excluded Medicaid births from coverage. The data for this project will be administrative records of all mothers and newborns discharged from hospitals in California between January 1, 1995 through the end of 2000, merged with the child's state vital statistics (birth and death) records. We have been granted permission to access this data by the state office responsible for data distribution and our research protocol and data safety plan has been approved by both the California State Committee for the Protection of Human Subjects and the University of Maryland. Using an interrupted time series design, we plan to examine the following questions about the California early discharge law: What was the impact of the NMHA on average postpartum length of stay and the fraction of patients discharged early? How does the program's impact vary by patient and hospital characteristics? Were there spillovers to uncovered groups such as Medicaid patients? Did the law improve health outcomes of mothers and their infants? Did the law alter re-admission rates for mothers and infants? Did the law alter neonatal mortality rates?

描述（由申请人提供）：在1995年至1997年之间，有32个州通过了法律，要求保险公司提供最小的产后长度，并于1998年1月1日生效。许多作者证明，这些法律增加了产后平均住院时间的平均住院时间，减少了母亲和婴儿的早期住院费用，并增加了住院费用。但是，关于这些法律对母亲及其新生儿健康的影响的证据有限，这些研究的估计提供了矛盾的结果。在此应用程序中，我们概述了一项研究计划，该计划使用加利福尼亚出生的限制性数据集来检查其中一项法律的影响。 1997年1997年8月26日生效的1997年加利福尼亚新生儿和母亲的健康法（NMHA）授权保险公司至少为正常送货服务提供至少48小时的住院服务，至少需要96小时的医院住院治疗。加利福尼亚州的法律与许多其他州法律相似，与1998年生效的联邦法律几乎相同。加利福尼亚州和联邦法律都明确将医疗补助的出生排除在覆盖范围之外。该项目的数据将是1995年1月1日至2000年底在加利福尼亚州医院出院的所有母亲和新生儿的行政记录，并与儿童的州生命统计数据（出生和死亡）记录合并。负责数据分配的州办公室已授予我们访问此数据的许可，我们的研究协议和数据安全计划已获得加利福尼亚州人类保护和马里兰州大学的批准。使用中断的时间序列设计，我们计划研究有关加利福尼亚早期出院法的以下问题：NMHA平均产后住院时间的影响是什么，以及早期出院的患者的比例是什么？该计划的影响如何因患者和医院特征而异？是否有溢出到诸如医疗补助患者之类的群体？法律是否改善了母亲及其婴儿的健康状况？法律是否改变了母亲和婴儿的再入院率？法律是否改变了新生儿死亡率？