A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge
Abstract
Background Recently enacted federal legislation mandates insurance coverage of at least 48 hours of postpartum hospitalization, but most mothers and newborns in the United States will continue to go home before the third postpartum day. National guidelines recommend a follow-up visit on the third or fourth postpartum day, but scant evidence exists about whether home or clinic visits are more effective. Methods We enrolled 1163 medically and socially low-risk mother-newborn pairs with uncomplicated delivery and randomly assigned them to receive home visits by nurses or pediatric clinic visits by nurse practitioners or physicians on the third or fourth postpartum day. In contrast with the 20-minute pediatric clinic visits, the home visits were longer (median: 70 minutes), included preventive counseling about the home environment, and included a physical examination of the mother. Clinical utilization and costs were studied using computerized databases. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks' postpartum. Results Comparing the 580 pairs in the home visit group and the 583 pairs in the pediatric clinic visit group, no significant differences occurred in clinical outcomes as measured by maternal or newborn rehospitalization within 10 days postpartum, maternal or newborn urgent clinic visits within 10 days postpartum, or breastfeeding discontinuation or maternal depressive symptoms…
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For Lieu 2000, the primary outcome was not pre-defined in the methods.
“The primary outcome was not pre-defined in the methods.”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
For Lieu 2000, many baseline characteristics were unbalanced (race, education, household income, initiated prenatal care in first trimester).
“Many baseline characteristics were unbalanced (race, education, household income, initiated prenatal care in first trimester).”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
For Lieu 2000, declarations of interest were unclear because no information was provided.
“Declarations of interest: unclear by no information”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
For Lieu 2000, other bias was at high risk.
“Many baseline characteristics were unbalanced (race, education, household income, initiated prenatal care in first trimester).”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
For Lieu 2000, selective reporting was at high risk of bias.
“The primary outcome was not pre-defined in the methods.”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
In the comparison of home versus facility postnatal care, the pooled risk ratio for infant hospital readmissions (non-prespecified outcome) was 1.16 (95% CI 0.57 to 2.36), with no statistically significant difference (Z = 0.40, P = 0.69).
“1.16”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
In the comparison of home versus facility postnatal care, the pooled risk ratio for infant emergency health care visits (non-prespecified outcome) was 1.15 (95% CI 0.95 to 1.38), with no statistically significant difference (Z = 1.45, P = 0.15).
“1.15 [0.95 , 1.38]”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
For the outcome infant emergency health care visits, heterogeneity across the three included studies was low (Tau2 = 0.00; Chi2 = 1.04, df = 2, P = 0.59; I2 = 0%).
“Heterogeneity: Tau² = 0.00; | Chi² = 1.04, df = 2 (P = | | 0.59); | I² = 0%”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Lieu 2000
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- Authors
- Lieu, T. A., Braveman, P. A., Escobar, G. J., Fischer, A. F., Jensvold, N. G., & Capra, A. M.
- Affiliations
- Kaiser Permanente (US)
- Walnut Creek, California, and
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2000-05-01
- Volume
- 105
- Issue
- 5
- Pages
- 1058-1065
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2066267123
- Cited by
- 128
- References
- 17
- Citations by year
- 2025: 4 · 2024: 4 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 5 · 2015: 5 · 2014: 8 · 2013: 6 · 2012: 8
- FWCI
- 14.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- postpartum follow-up, home visits, breastfeeding continuation, maternal depressive symptoms, maternal satisfaction
- MeSH terms
- Adult, Ambulatory Care, Costs and Cost Analysis, Female, Follow-Up Studies, Home Care Services, Humans, Length of Stay, Patient Discharge, Postnatal Care, Time Factors, Patient Satisfaction, Outcome Assessment, Health Care
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