Maternity Experiences in a Managed Care Organization

Health Affairs

Volumn 16, Issue 3, 1997, Pages 198-208

  Gazmararian, Julie A ^a   Koplan, Jeffrey P ^d   Cogswell, Mary E ^b   Bailey, Cathy M ^d   Davis, Nancy A ^c   Cutler, Charles M ^d  

^a Prudential Ctr for Hlth Care Res   (United States)

^b CENTERS FOR DISEASE CONTROL AND PREVENTION   (United States)

^c PRUDENTIAL FINANCIAL   (United States)

^d NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; ARTICLE; CHI SQUARE DISTRIBUTION; DEMOGRAPHY; FEMALE; HEALTH INSURANCE; HEALTH SERVICE; HEALTH SERVICES RESEARCH; HUMAN; LENGTH OF STAY; MULTIVARIATE ANALYSIS; NEWBORN; PATIENT SATISFACTION; POSTNATAL CARE; PREGNANCY; QUESTIONNAIRE; RISK FACTOR; STANDARD; STATISTICS; UNITED STATES;

ADOLESCENT; ADULT; CHI-SQUARE DISTRIBUTION; DEMOGRAPHY; FEMALE; HEALTH SERVICES RESEARCH; HUMANS; INFANT, NEWBORN; LENGTH OF STAY; MANAGED CARE PROGRAMS; MATERNAL HEALTH SERVICES; MULTIVARIATE ANALYSIS; PATIENT SATISFACTION; POSTNATAL CARE; PREGNANCY; QUESTIONNAIRES; RISK FACTORS; UNITED STATES;

EID: 0346539397     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.3.198     Document Type: Article

References (36)

1. Centers for Disease Control and Prevention, "Trends in Length of Stay for Hospital Deliveries - United States, 1970-1992," Morbidity and Mortality Weekly Report 44, no. 17 (1995): 335-337.
2. Ibid.
3. W. Kessel et al., "Early Discharge: In the End, It Is Judgment," Pediatrics 96, no. 4 (1995): 739-742; S. Charles and B. Prystowsky, "Early Discharge, In the End: Maternal Abuse, Child Neglect, and Physician Harassment," Pediatrics 96, no. 4 (1995): 746-747; L.N. Sinai et al., "Phenylketonuria Screening: Effect of Early Newborn Discharge," Pediatrics 96, no. 4 (1995): 605-608; and D. Coody et al., "Early Hospital Discharge and the Timing of Newborn Metabolic Screening," Clinical Pediatrics 32, no. 8 (1993): 463-466.
4. W. Kessel et al., "Early Discharge: In the End, It Is Judgment," Pediatrics 96, no. 4 (1995): 739-742; S. Charles and B. Prystowsky, "Early Discharge, In the End: Maternal Abuse, Child Neglect, and Physician Harassment," Pediatrics 96, no. 4 (1995): 746-747; L.N. Sinai et al., "Phenylketonuria Screening: Effect of Early Newborn Discharge," Pediatrics 96, no. 4 (1995): 605-608; and D. Coody et al., "Early Hospital Discharge and the Timing of Newborn Metabolic Screening," Clinical Pediatrics 32, no. 8 (1993): 463-466.
5. W. Kessel et al., "Early Discharge: In the End, It Is Judgment," Pediatrics 96, no. 4 (1995): 739-742; S. Charles and B. Prystowsky, "Early Discharge, In the End: Maternal Abuse, Child Neglect, and Physician Harassment," Pediatrics 96, no. 4 (1995): 746-747; L.N. Sinai et al., "Phenylketonuria Screening: Effect of Early Newborn Discharge," Pediatrics 96, no. 4 (1995): 605-608; and D. Coody et al., "Early Hospital Discharge and the Timing of Newborn Metabolic Screening," Clinical Pediatrics 32, no. 8 (1993): 463-466.
6. W. Kessel et al., "Early Discharge: In the End, It Is Judgment," Pediatrics 96, no. 4 (1995): 739-742; S. Charles and B. Prystowsky, "Early Discharge, In the End: Maternal Abuse, Child Neglect, and Physician Harassment," Pediatrics 96, no. 4 (1995): 746-747; L.N. Sinai et al., "Phenylketonuria Screening: Effect of Early Newborn Discharge," Pediatrics 96, no. 4 (1995): 605-608; and D. Coody et al., "Early Hospital Discharge and the Timing of Newborn Metabolic Screening," Clinical Pediatrics 32, no. 8 (1993): 463-466.
7. W.E. Feldman, "Evaluation of an Early Newborn Discharge Program," HMO Practice 7, no. 1 (1993): 48-50; H.L. Britton and J.R. Britton, "Efficacy of Early Newborn Discharge in a Middle-Class Population," American Journal of Disadvantaged Children 138 (1984): 1041-1046; D. Brooten et al., "A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth," Obstetrics and Geology 84, no. 5 (1994): 832-838; D. Foster and L. Schneider, Hospital Length of Stay and Re-Admission Rates for Normal Deliveries and Newborns: Relationship to Hospital, Patient, and Payer Characteristics (Baltimore, Md.: HCIA, Inc., July 1995), 1-12; and I.D. McIntosh, "Hospital Effects of Maternity Early Discharge," Medical Care 22, no. 7 (1984): 611-619.
8. W.E. Feldman, "Evaluation of an Early Newborn Discharge Program," HMO Practice 7, no. 1 (1993): 48-50; H.L. Britton and J.R. Britton, "Efficacy of Early Newborn Discharge in a Middle-Class Population," American Journal of Disadvantaged Children 138 (1984): 1041-1046; D. Brooten et al., "A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth," Obstetrics and Geology 84, no. 5 (1994): 832-838; D. Foster and L. Schneider, Hospital Length of Stay and Re-Admission Rates for Normal Deliveries and Newborns: Relationship to Hospital, Patient, and Payer Characteristics (Baltimore, Md.: HCIA, Inc., July 1995), 1-12; and I.D. McIntosh, "Hospital Effects of Maternity Early Discharge," Medical Care 22, no. 7 (1984): 611-619.
9. W.E. Feldman, "Evaluation of an Early Newborn Discharge Program," HMO Practice 7, no. 1 (1993): 48-50; H.L. Britton and J.R. Britton, "Efficacy of Early Newborn Discharge in a Middle-Class Population," American Journal of Disadvantaged Children 138 (1984): 1041-1046; D. Brooten et al., "A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth," Obstetrics and Geology 84, no. 5 (1994): 832-838; D. Foster and L. Schneider, Hospital Length of Stay and Re-Admission Rates for Normal Deliveries and Newborns: Relationship to Hospital, Patient, and Payer Characteristics (Baltimore, Md.: HCIA, Inc., July 1995), 1-12; and I.D. McIntosh, "Hospital Effects of Maternity Early Discharge," Medical Care 22, no. 7 (1984): 611-619.
10. W.E. Feldman, "Evaluation of an Early Newborn Discharge Program," HMO Practice 7, no. 1 (1993): 48-50; H.L. Britton and J.R. Britton, "Efficacy of Early Newborn Discharge in a Middle-Class Population," American Journal of Disadvantaged Children 138 (1984): 1041-1046; D. Brooten et al., "A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth," Obstetrics and Geology 84, no. 5 (1994): 832-838; D. Foster and L. Schneider, Hospital Length of Stay and Re-Admission Rates for Normal Deliveries and Newborns: Relationship to Hospital, Patient, and Payer Characteristics (Baltimore, Md.: HCIA, Inc., July 1995), 1-12; and I.D. McIntosh, "Hospital Effects of Maternity Early Discharge," Medical Care 22, no. 7 (1984): 611-619.
11. W.E. Feldman, "Evaluation of an Early Newborn Discharge Program," HMO Practice 7, no. 1 (1993): 48-50; H.L. Britton and J.R. Britton, "Efficacy of Early Newborn Discharge in a Middle-Class Population," American Journal of Disadvantaged Children 138 (1984): 1041-1046; D. Brooten et al., "A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth," Obstetrics and Geology 84, no. 5 (1994): 832-838; D. Foster and L. Schneider, Hospital Length of Stay and Re-Admission Rates for Normal Deliveries and Newborns: Relationship to Hospital, Patient, and Payer Characteristics (Baltimore, Md.: HCIA, Inc., July 1995), 1-12; and I.D. McIntosh, "Hospital Effects of Maternity Early Discharge," Medical Care 22, no. 7 (1984): 611-619.
12. C.T. Beck, "Early Postpartum Discharge Programs in the United States: A Literature Review and Critique," Women and Health 17, no. 1 (1991): 125-138; K.F. Norr and K. Nacion, "Outcomes of Postpartum Early Discharge, 1960-1986: A Comparative Review," Birth 14, no. 3 (1987): 135-141; P. Braveman et al., "Early Discharge of Newborns and Mothers: A Critical Review of the Literature," Pediatrics 96, no. 4 (1995): 716-726; and J.R. Britton, H.L. Britton, and S.A. Beebe, "Early Discharge of the Term Newborn: A Continued Dilemma," Pediatrics 94, no. 3 (1994): 291-295.
13. C.T. Beck, "Early Postpartum Discharge Programs in the United States: A Literature Review and Critique," Women and Health 17, no. 1 (1991): 125-138; K.F. Norr and K. Nacion, "Outcomes of Postpartum Early Discharge, 1960-1986: A Comparative Review," Birth 14, no. 3 (1987): 135-141; P. Braveman et al., "Early Discharge of Newborns and Mothers: A Critical Review of the Literature," Pediatrics 96, no. 4 (1995): 716-726; and J.R. Britton, H.L. Britton, and S.A. Beebe, "Early Discharge of the Term Newborn: A Continued Dilemma," Pediatrics 94, no. 3 (1994): 291-295.
14. C.T. Beck, "Early Postpartum Discharge Programs in the United States: A Literature Review and Critique," Women and Health 17, no. 1 (1991): 125-138; K.F. Norr and K. Nacion, "Outcomes of Postpartum Early Discharge, 1960-1986: A Comparative Review," Birth 14, no. 3 (1987): 135-141; P. Braveman et al., "Early Discharge of Newborns and Mothers: A Critical Review of the Literature," Pediatrics 96, no. 4 (1995): 716-726; and J.R. Britton, H.L. Britton, and S.A. Beebe, "Early Discharge of the Term Newborn: A Continued Dilemma," Pediatrics 94, no. 3 (1994): 291-295.
15. C.T. Beck, "Early Postpartum Discharge Programs in the United States: A Literature Review and Critique," Women and Health 17, no. 1 (1991): 125-138; K.F. Norr and K. Nacion, "Outcomes of Postpartum Early Discharge, 1960-1986: A Comparative Review," Birth 14, no. 3 (1987): 135-141; P. Braveman et al., "Early Discharge of Newborns and Mothers: A Critical Review of the Literature," Pediatrics 96, no. 4 (1995): 716-726; and J.R. Britton, H.L. Britton, and S.A. Beebe, "Early Discharge of the Term Newborn: A Continued Dilemma," Pediatrics 94, no. 3 (1994): 291-295.
16. Foster and Schneider, "Hospital Length-of-Stay and Re-Admission Rates;" J.E. Frank et al., "The Risk of Re-Admission and Emergency Room Visits in Newborns with Early Discharge," Pediatric Research 37, no. 1516 (1995): 255A; and J.A. Gazmararian and J.P. Koplan, "Length-of-Stay after Delivery: Managed Care versus Fee-for-Service," Health Affairs (Winter 1996): 74-80.
17. Foster and Schneider, "Hospital Length-of-Stay and Re-Admission Rates;" J.E. Frank et al., "The Risk of Re-Admission and Emergency Room Visits in Newborns with Early Discharge," Pediatric Research 37, no. 1516 (1995): 255A; and J.A. Gazmararian and J.P. Koplan, "Length-of-Stay after Delivery: Managed Care versus Fee-for-Service," Health Affairs (Winter 1996): 74-80.
18. Foster and Schneider, "Hospital Length-of-Stay and Re-Admission Rates;" J.E. Frank et al., "The Risk of Re-Admission and Emergency Room Visits in Newborns with Early Discharge," Pediatric Research 37, no. 1516 (1995): 255A; and J.A. Gazmararian and J.P. Koplan, "Length-of-Stay after Delivery: Managed Care versus Fee-for-Service," Health Affairs (Winter 1996): 74-80.
19. R.J. Melia et al., "Consumers' Views of the Maternity Services: Implications for Change and Quality Assurance," Journal of Public Health and Medicine 13, no. 2 (1991): 120-126; I. Burnell et al., "Patient Preference and Postnatal Hospital Stay," Journal of Obstetrics and Gynecology 3, no. 1 (1982): 43-47; and L.M. Hellman, S.G. Kohl, and J. Palmer, "Early Hospital Discharge in Obstetrics," The Lancet 1 (1962): 227-232.
20. R.J. Melia et al., "Consumers' Views of the Maternity Services: Implications for Change and Quality Assurance," Journal of Public Health and Medicine 13, no. 2 (1991): 120-126; I. Burnell et al., "Patient Preference and Postnatal Hospital Stay," Journal of Obstetrics and Gynecology 3, no. 1 (1982): 43-47; and L.M. Hellman, S.G. Kohl, and J. Palmer, "Early Hospital Discharge in Obstetrics," The Lancet 1 (1962): 227-232.
21. R.J. Melia et al., "Consumers' Views of the Maternity Services: Implications for Change and Quality Assurance," Journal of Public Health and Medicine 13, no. 2 (1991): 120-126; I. Burnell et al., "Patient Preference and Postnatal Hospital Stay," Journal of Obstetrics and Gynecology 3, no. 1 (1982): 43-47; and L.M. Hellman, S.G. Kohl, and J. Palmer, "Early Hospital Discharge in Obstetrics," The Lancet 1 (1962): 227-232.
22. A normal vaginal delivery was defined by International Classification for Diseases, Ninth Revision (ICD-9), codes 650-659 from the claims system. Women who reported a multiple birth, had given their infant up for adoption, or whose infant had died since delivery were not included in the study. Using claims data, we conducted additional analysis comparing respondents with nonrespondents and found no significant differences for mother's age, region, type of plan, and length-of-stay.
23. A copy of the telephone survey is available from the authors. Please send written requests to Julie Gazmararian, Prudential Center for Health Care Research, Suite 820, 2859 Paces Ferry Road, Atlanta, Georgia 30339.
24. D.G. Kleinbaum, L.L. Kupper, and H. Morgenstern, Epidemiologic Research, Principles and Quantitative Methods (New York: Van Nostrand Reinhold, 1982).
25. Multivariate models were adjusted for maternal age, race, region, education, parity, birthweight and gestational age, maternal hospitalization during pregnancy, and hypertension and/or diabetes before or during pregnancy.
26. CDC, "Trends in Length of Stay for Hospital Deliveries;" and Foster and Schneider, "Hospital Length-of-Stay and Re-Admission Rates."
27. CDC, "Trends in Length of Stay for Hospital Deliveries;" and Foster and Schneider, "Hospital Length-of-Stay and Re-Admission Rates."
28. P.K. Patterson, "A Comparison of Postpartum Early and Traditional Discharge Groups," Quality Review Bulletin 13 (1987): 365-371; P. Romito and C. Zalato, "Social History of a Research Project: A Study on Early Post-Partum Discharge," Social Science and Medicine 34, no. 3 (1992): 227-235; U. Waldenstrom, "Early and Late Discharge after Hospital Birth: Father's Involvement in Infant Care," Early Human Development 17 (1988): 19-28; and U. Waldenstrom, C. Sudelin, and G. Lindmark, "Early and Late Discharge after Hospital Birth: Breastfeeding," Acta Paediatr Scand 76 (1987): 727-732.
29. P.K. Patterson, "A Comparison of Postpartum Early and Traditional Discharge Groups," Quality Review Bulletin 13 (1987): 365-371; P. Romito and C. Zalato, "Social History of a Research Project: A Study on Early Post-Partum Discharge," Social Science and Medicine 34, no. 3 (1992): 227-235; U. Waldenstrom, "Early and Late Discharge after Hospital Birth: Father's Involvement in Infant Care," Early Human Development 17 (1988): 19-28; and U. Waldenstrom, C. Sudelin, and G. Lindmark, "Early and Late Discharge after Hospital Birth: Breastfeeding," Acta Paediatr Scand 76 (1987): 727-732.
30. P.K. Patterson, "A Comparison of Postpartum Early and Traditional Discharge Groups," Quality Review Bulletin 13 (1987): 365-371; P. Romito and C. Zalato, "Social History of a Research Project: A Study on Early Post-Partum Discharge," Social Science and Medicine 34, no. 3 (1992): 227-235; U. Waldenstrom, "Early and Late Discharge after Hospital Birth: Father's Involvement in Infant Care," Early Human Development 17 (1988): 19-28; and U. Waldenstrom, C. Sudelin, and G. Lindmark, "Early and Late Discharge after Hospital Birth: Breastfeeding," Acta Paediatr Scand 76 (1987): 727-732.
31. P.K. Patterson, "A Comparison of Postpartum Early and Traditional Discharge Groups," Quality Review Bulletin 13 (1987): 365-371; P. Romito and C. Zalato, "Social History of a Research Project: A Study on Early Post-Partum Discharge," Social Science and Medicine 34, no. 3 (1992): 227-235; U. Waldenstrom, "Early and Late Discharge after Hospital Birth: Father's Involvement in Infant Care," Early Human Development 17 (1988): 19-28; and U. Waldenstrom, C. Sudelin, and G. Lindmark, "Early and Late Discharge after Hospital Birth: Breastfeeding," Acta Paediatr Scand 76 (1987): 727-732.
32. Melia et al., "Consumers' Views of the Maternity Services."
33. R. Casey et al., "Obstetric and Perinatal Events: The Accuracy of Maternal Report," Clinical Pediatrics 31 (1992): 200-204.
34. Committee on Fetus and Newborn, "Hospital Stay for Healthy Term Newborns," Pediatrics 96, no. 4 (1995): 788-790; and American Academy of Pediatrics and American College of Obstetrics and Gynecology, "Postpartum and Follow-Up Care," in Guidelines for Perinatal Care, 3d ed. (Elk Grove Village, Ill.: AAP; and Washington: ACOG, 1992).
35. Committee on Fetus and Newborn, "Hospital Stay for Healthy Term Newborns," Pediatrics 96, no. 4 (1995): 788-790; and American Academy of Pediatrics and American College of Obstetrics and Gynecology, "Postpartum and Follow-Up Care," in Guidelines for Perinatal Care, 3d ed. (Elk Grove Village, Ill.: AAP; and Washington: ACOG, 1992).
36. Casey et al., "Obstetric and Perinatal Events."