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OBJECTIVE: To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life. DESIGN: Retrospective cohort study. SETTING: Metropolitan university hospital and a children's hospital. PATIENTS: Term infants cared for in a single term nursery, before and after implementation of an early discharge program. INTERVENTION: Early discharge program. METHODS: Linking of the birth hospital and the children's hospital records and chart review. OUTCOME MEASURES: Pattern of emergency department visits and rehospitalizations in the first 3 months of life. RESULTS: The early discharge group had a shorter stay, 32 +/- 21 hours (mean +/- SD) than the control group (48 +/- 22 hours). There was no effect of early discharge on mean age at rehospitalization, rehospitalization rate, or reason for rehospitalization. Twenty-eight percent of infants in both study and control groups had at least one emergency department visit by 3 months of age. There was no difference between study and control groups in mean age or frequency of emergency department visits. Maternal age and race had a significant effect on the odds of visiting the emergency department. For any maternal age, nonwhite mothers were more likely to visit the emergency department. CONCLUSIONS: Early discharge of newborn infants to inner city parents can be accomplished without increasing hospital-based resource use in the first 3 months of life provided coordinated postdischarge care and home visiting services are available.

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The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group. During a 7-month period, an estimated 2073 days of hospital care and approximately $2,700,000 in hospital charges were saved, or $10,609 per infant discharged. The cost of instituting and maintaining the program was $120,413, or $468 per infant. Seven visits were made to the emergency department by the study infants during the first 14 days after discharge. One infant was readmitted for a 4-day hospital stay for suspected sepsis. Significantly earlier discharge of high-risk neonates produced a decrease in hospital charges without causing excessive morbidity. The success of the program was coincident and presumed related to the institution of multiple elements focused toward family support through early-discharge planning. The reduction in hospital charges was 30 times higher than program expenses.

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OBJECTIVE: The Medicus Patient Classification System (PCS) and the lameter Acuity Index Method (AIM) are two proprietary scoring systems in common use for stratifying patient populations before making comparisons of the medical care they receive. In this study the validities of these scores were tested when the scores were used to evaluate cost-related elements of high-risk neonatal intensive care. METHODS: A total of 687 surviving inborn infants cared for in a university hospital newborn intensive care unit provided data for these analyses. The infants were stratified into the five diagnosis-related groups (DRGs) for surviving neonates (386, 387, 388, 389, and 390), as determined from their discharge diagnoses. Each infant's summed total of daily PCS scores, a single AIM score, and birth weight were extracted from the hospital's decision-support data files and used as independent variables in regression analyses to determine correlations with lengths of hospital stay, ancillary resource utilizations, and hospital charges. RESULTS: The Medicus scores, which are computed prospectively on a daily basis, when summed retrospectively, correlated highly with lengths of stay, ancillary resource utilization, and associated hospital charges. The lameter scores, which are assigned retrospectively, were far less predictive of these outcome variables and generally worse than birth weight in explaining outcome variances. CONCLUSIONS: Although in common use, the lameter AIM could not be validated as an appropriate method for assessing cost-related outcomes after newborn intensive care. The Medicus PCS produced daily scores that, when summed after patient discharge, correlated highly with the same outcome variables. There is a need to test further these and other proprietary methods now used to compare the cost-related elements of care provided by different hospitals and physicians.

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A computer was programmed to collect, store, analyze, and display blood gas data in a newborn intensive care unit. Data were displayed if they were (1) markedly abnormal or (2) represented a worsening trend. A controlled study demonstrated that, with the display, the markedly abnormal blood gas values were followed by normal values in a shorter period, and fewer worsening trends progressed. However, with the computer-generated display, there were more overcorrections of both the markedly abnormal blood gas values and the detected worsening trends. The occurrence of pneumothoraces was associated with these overcorrected blood gas values. There were no significant differences in duration of supplemental oxygen administration, duration of tracheal intubation, or mortality between the infants cared for during the time of the computer-generated display and those cared for during the control period. This study demonstrates both benefits and risks of computer-generated displays and emphasizes the need for thorough evaluations of such systems.

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