Factors predicting hospital readmission of normal newborns.

Unplanned readmission to hospitals of healthy newborns in the first month of life reflects deterioration of newborn health that may be preventable. Hospitals could reduce morbidity and readmission of healthy newborns by changing structures and processes to respond to specific newborn and maternal risk factors. Identification of those factors has the potential to improve the quality of health service delivery for families, making readmission unnecessary in some cases. Widespread concern about the potentially negative effects of early hospital discharge of mothers and babies has drawn national attention to short maternity stays. Relatively little attention, however, has been given to other dimensions of maternal and newborn care which might influence readmission of normal newborns. In a cohort study using a retrospective sample, 29,475 babies born in a multi-hospital health system from July 1997 to December 1999 were followed for 28 days to see which babies were readmitted to hospitals. Independent variables included newborn, maternal and socioeconomic factors, as well as site-related measures of structures and processes over which medical providers had control during the birth admission. Male gender, vaginal delivery, December birth, jaundice in the nursery, treatment with phototherapy in the nursery, younger maternal age, premature rupture of membranes, and site of birth were predictors of rehospitalization within 28 days of birth. Specific policy interventions that address jaundice in the nursery, support to mothers who are inexperienced or who have complications during delivery, and strict adherence to recommended practice guidelines, particularly in the month of December, were tested in simulation models. Interventions that prevent further development of jaundice already evident during the birth admission have the largest potential impact. If policies for healthy term newborns from the American Academy of Pediatrics---particularly minimum criteria for newborn discharge---were enforced, they would significantly reduce estimated risks of readmission. Such policy interventions, based on characteristics of mothers and newborns as well as modifiable structures and processes of provider care, would improve health system quality and achieve a more comprehensive approach to preventing deterioration of health resulting in hospital readmission of normal newborns.Dr.P.H.Health and Environmental SciencesHealth care managementPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/124513/2/3015622.pd