Impact of Short-Stay Legislation of Length of Stay, Cost of Care, and Rehospitalization for Infants Born Vaginally. † 1215

Legislation designed to permit longer post-partum hospitalization of mothers and infants has been enacted at state and national levels. This prospective study was designed to determine how legislation in the State of Ohio permitting 48h postpartum stay would affect duration of infant hospitalization, cost of care, and infant readmission rate. In 1996, 269 infants delivered vaginally were enrolled during 3 month periods before(N=121) and after (N=148) enactment of state legislation (Oct 1996). Eligibility for early infant discharge followed AAP guidelines and included an integrated plan for follow-up with a home nursing visit in 85% of infants discharged ≤48h as well as intensive breast feeding support. Duration of hospitalization and readmission to the ER or hospital were determined from the medical record as well as phone questionnaire. Cost of care was estimated by microcost analysis (CMIS). Duration of infant stay increased from 29±12 to 39±14 hrs pre- and post-legislation, respectively. Maternal and infant cost for vaginal delivery increased from $3593±880 to$4154±1076 (16% increase). Readmission rate to hospital or ER did not differ between the two groups (4.0% vs 5.4%, pre- and post-legislation, respectively). We speculate that implementation of AAP guidelines may have optimized the medical decision for early infant discharge. These preliminary observations suggest that, under such circumstances, legislative mandate may increase cost of hospitalization without altering infant outcome. Supported by the March of Dimes. Figure