The Mother-Friendly Childbirth Initiative
References for Mother-Friendly Childbirth Initiative Step 5:
Collaborating, Communicating, and Post Discharge Followup
(Links are to abstracts of the papers below)
- Godman Brown, S., and Tate Johnson, B. (1998). Enhancing early discharge with home followup: A pilot project. Journal of Obstetric, Gynecological, and Neonatal Nursing, 27 (1), 33-38.
- Mendler, V., Scallen, C., Kovtun, L., Balesky, J., and Lewis, C. (1996). The conception, birth, and infancy of an early discharge program. American Journal of Maternal Child Nursing, 21, 241-246.
Summary/Commentary:
These articles serve as models to services that wish to document that their home visit followup programs are safe, cost efficient and satisfying to healthy mothers with newborns.
Abstracts:
- Godman Brown, S. and Tate Johnson, B. (1998). Enhancing early discharge with home followup: A pilot project. Journal of Obstetric, Gynecological, and Neonatal Nursing, 27 (1), 33-38.
Premise: Home followup care of postpartum mothers and their newborn infants has demonstrated improved health outcome of mother-infant; and, an overall health care cost reduction for both mother and health care provider. These home followups provide an opportunity for prevention, early diagnosis, and treatment of potential health problems that can occur during the six-week transitional period after birth.
Research Question: What is the effectiveness of the postpartum home followup project?
Study Design: A pilot study was instituted to determine if family health and health care costs would obtain optimal outcomes when nursing care is provided in the home during the six week transitional period. A comparative, time series design was utilized incorporating both quantitative (physiologic measurements) and qualitative (interview) in data collection, analysis and findings.
Subjects: The study consisted of 41 mother-infant dyads entering the program based on criteria established prior to the study, with 29 experimental dyads completing the program plus 29 control dyads from the hospital's delivery log serving as the control group.
Data Collection: Data was obtained by the nursing staff from two telephone interviews with the mother and two home-visits that assessed the health status of the mother-infant in the experimental group during the six week transitional period. The control dyads were contacted by telephone after the six-week transitional period and interviewed to ascertain any health problems that may have transpired during the previous six-weeks. The cost of unscheduled health care in both groups was estimated by the hospital accounting department and demonstrated that the control group health care costs were ten times the amount of the experimental group.
Findings: Findings support the importance of offering preventive health care to mother-infant during the six-week transitional period after birth. Experimental mothers kept more of the six week check up appointments (79% vs. 55%) and more experimental infants kept routine followup care (100% vs. 90%).* Unscheduled care was less for both the experimental group mothers (3% vs. 10%) and infants (28% vs. 45%). One control group infant was hospitalized. Costs of non-scheduled health care were $646.00 for the experimental group versus $6,631.00 for the control group. Costs of the experimental group followup were not provided. Experimental group mothers had needs addressed in the areas of food stamps, WIC educational programs, breast feeding support groups, pain reduction, coping with fatigue, newborn care and feeding, and care for jaundice or infection. Because one infant can impact the financial findings dramatically, this study needs to be replicated with a large sample.
Research reviewed by Roxanne Zeto-Brennan, RN, student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Mendler, V., Scallen, C., Kovtun, L., Balesky, J., and Lewis, C. (1996). The conception, birth, and infancy of an early discharge program. American Journal of Maternal Child Nursing, 21, 241-246.
Major Premise: Hospital development, implementation, and management of an early discharge program can offer quality comprehensive postpartum care to new mothers and their infants while utilizing nursing staff and health care funds more cost-effectively.
Research Question: How can a hospital meet the needs of the community, hospital, and nursing staff?
Research Design: A multidisciplinary team undertook a project to develop, implement, and manage an early discharge program. Program design outcome was based on both quantitative and qualitative data consisting of: exploratory studies to ascertain the population (maternal, nursing, medical) interest; and historical studies on early discharge programs and health provider reimbursement issues. Continuous quality monitoring of this program is accomplished by statistical analysis of hospital cost versus reimbursement information; and, surveys to assess satisfaction of participants (maternal, nursing, medical) involved in the program.
Findings: Of the first 250 families in the program 72% breastfed, fewer than half were primipara, no mothers needed rehospitalization and seven infants were rehospitalized for hyperbillirubinemia or fever. The ensuing and ongoing data compilation demonstrated that the hospital had developed, implemented, and effectively managed a program that offers a preventive health care service while utilizing hospital resources more cost-effectively.
Research reviewed by Roxanne Zeto-Brennan, RN, student at Virginia Commonwealth University, School of Nursing, Richmond, VA.