Length Postpartum Hospital Stays Health Mothers/Newborns

产后住院时间 健康母亲/新生儿

• 批准号: 7081963
• 负责人: WILLIAM N. EVANS
• 金额: $ 11.85万
• 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 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7081963
• 关键词: Medicare /Medicaid; behavioral /social science research tag; cesarean section; clinical research; health care cost /financing; health care policy; health care service evaluation; health insurance; health related legal; health services research tag; health surveys; hospital length of stay; human data; infant mortality; mathematical model; medical records; newborn human (0-6 weeks); outcomes research; postpartum; women' s health

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）：1995 年至 1997 年间，32 个州通过了法律，要求保险公司提供最短产后住院期限，类似的联邦法律于 1998 年 1 月 1 日生效。许多作者已经证明，这些法律增加了产后平均住院时间，减少了母亲和婴儿“提前”出院的比例，并增加了住院费用。然而，关于这些法律对母亲及其新生儿健康影响的证据有限，并且这些研究的估计提供了相互矛盾的结果。在此应用程序中，我们概述了一项研究计划，该计划使用加州出生的限制使用数据集来检查其中一项法律的影响。 1997 年加州新生儿和母亲健康法案 (NMHA) 于 1997 年 8 月 26 日生效，规定保险公司为正常分娩的至少 48 小时住院时间和至少 96 小时住院时间提供保险用于剖腹产。加利福尼亚州法律与许多其他州法律类似，且范围与 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出生排除在承保范围之外。该项目的数据将是 1995 年 1 月 1 日至 2000 年底期间加利福尼亚州医院出院的所有母亲和新生儿的管理记录，并与儿童的州生命统计（出生和死亡）记录合并。我们已获得负责数据分发的州办公室的访问这些数据的许可，并且我们的研究协议和数据安全计划已获得加州人类受试者保护委员会和马里兰大学的批准。我们计划使用间断时间序列设计来研究有关加州提前出院法的以下问题：NMHA 对产后平均住院时间和提前出院患者比例有何影响？该计划的影响如何因患者和医院特征而异？是否会对医疗补助患者等未覆盖群体产生溢出效应？该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重新入院率？该法律是否改变了新生儿死亡率？