Timely initial well-baby visits reduce hospital readmissions

Last Updated: 2015-02-02

By Will Boggs MD

NEW YORK (Reuters Health) - Newborns who have their first well-baby visit within 72 hours of hospital discharge are less likely to require readmission in the first weeks after birth, researchers report.

"There seems to be a benefit to having an early well child visit," Dr. Paul C. Young, from University of Utah School of Medicine, Salt Lake City, told Reuters Health by email. "I think we need additional research to determine why the rates are so low and what sort of incentives would increase the proportion who have a visit within the recommended time frame."

Current guidelines from the American Academy of Pediatrics (AAP) and Bright Futures recommend initial well-child visits within 48 to 72 hours for newborns whose well-baby nursery stay was less than 48 hours and within 3 to 5 days for those whose stay was 72 hours or less.

Dr. Young and colleagues investigated the frequency of newborns having their first outpatient visit in that time frame, the likelihood of their readmission in the first month of life, and the association between the two.

Of the 50,606 newborns discharged from the well-baby nursery within 48 hours of birth, only 7,638 (15%) had a well-baby visit within the recommended time frame.

Similarly, only 5,920 (20%) of the 29,114 newborns whose well-baby nursery stay was more than 48 hours had a visit within the recommended time frame.

Dr. Young was surprised.

"We had expected closer to 50%," he said. "I was particularly concerned about the low rates for late preterm newborns who had stays of less than 48 hours. The risk of jaundice and excessive weight loss (both potentially treatable) are quite high in this population."

Overall, 1,431 newborns were readmitted within the first month. Readmission rates were significantly lower for those whose first well-baby outpatient visits were within three or five days (15.7 per 1000) than for those with later visits (18.4 per 1000).

Readmission rates were lower in association with earlier well-baby visits for newborns with jaundice as a readmission diagnosis, but not for those readmitted for feeding problems, respiratory distress, rule out sepsis, or other diagnoses.

Among children with shorter well-baby nursery stays, being a firstborn child increased the likelihood of having a timely well-baby visit; the presence of jaundice or feeding problems in the well-baby nursery had no impact; and the requirement for a copay for the well-baby visit decreased its likelihood.

Among babies with longer well-baby nursery stays, jaundice and feeding problems were associated with an increased likelihood of having a visit within five days of discharge, according to the February 2 Pediatrics online report.

How might we improve the rates of timely well-baby visits?

"I don't have a good answer for that," Dr. Young said. "Hopefully our study, which shows a concrete benefit, will have some influence, but as we note in the article, readmission is a rare event for an individual practice, so it may take stronger encouragement from the AAP and from payers who may see the early visit as a potentially cost-effective method of preventing hospital admissions."

Dr. Robin Foster Williams from McMaster University in Hamilton, Ontario has studied the importance of timely well-baby visits. She told Reuters Health by email, "Physicians need to encourage follow-up within 48 hours, and link mothers to community support services (breastfeeding clinics, public health nursing programs and follow-up, telehealth lines) to ensure that mothers and babies are well supported."

"Depending on other risk factors (time in hospital, geography, primary care availability, socioeconomic status), the need for seeing the mother and baby within the first 48 hours may be very important," Dr. Williams concluded.

This is especially important, she said, "given the move over the past 20 years to quick discharge, before feeding has been established and before hyperbilirubinemia, if (it's) going to pose a problem, has evolved."

SOURCE: http://bit.ly/1BX0GbT

Pediatrics 2015.