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Maternal Postpartum Health Care Utilization and the Effect of Minnesota Early Discharge Legislation

From the Regions Family and Community Medicine Residency Program, St. Paul, Minnesota (DM), and HealthPartners Research Foundation, Bloomington, Minnesota (TD)

Correspondence: Corresponding author: Diane Madlon-Kay, MD, MS, 864 Arcade Street, St. Paul, MN 55106 (e-mail: madlo001{at}tc.umn.edu)

Purpose: To describe maternal postdischarge follow-up and health care utilization in the context of Minnesota’s early discharge legislation, which mandates coverage for a home visit for a mother and baby who voluntarily leave the hospital early.

Methods: Claims data from a large managed care organization were used to identify 22,944 women giving birth from January 1995 through February 1999. Study variables included home or clinic visits within 1 week of discharge (early follow-up), readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge.

Results: After enactment of Minnesota’s legislation, the percentage of mothers with short stays decreased from 52% to 16% for vaginal births and from 87% to 63% for cesarean births (P =.001). Overall, 33% of mothers with vaginal births and 40% with cesarean births had early home or clinic follow-up (P =.001). Mothers who stayed 0 or 1 hospital days after vaginal births were more likely to have early follow-up than those with longer stays (37% vs 32%, P =.01). However, mothers who stayed 2 or 3 days after cesarean birth were no more likely to have early follow-up than mothers who stayed 4 or more days (39% vs 42%, P =.08). Rates of early follow-up were significantly higher after enactment of Minnesota’s legislation, regardless of length of stay.

Conclusions: Implementation of Minnesota’s early discharge legislation corresponded with significantly increased lengths of stay and an increase in the percentage of mothers who received early follow-up visits. However the majority of mothers with short stays continued to lack early follow-up.

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