The effect of early neonatal and obstetric discharge was studied using hospital admissions and discharge data in Wisconsin for the period 1989-94. Data for 412,268 neonatal and 360,362 obstetric admissions were analyzed using a stochastic model of discharge patterns and multiple regression techniques. The average length of stay (ALOS) decreased significantly (p <.001) from 2.97 days in 89 to 2.22 days in 94 for newborns, and from 2.61 to 2.07 for mothers. The readmission rates (within 14 days for newborns) decreased significantly (p <.001) from 5.67 to 1.78 while for mothers it increased significantly (p <.01) steadily from.76 to.89 during the same period. The total charges per newborn (charges at birth +expected readmission charges(calculated as readmission rate times the charges during readmission))increased significantly (p <.001)from $1011.24 in`89to 1350.83 in '94 for newborns and from $1570 to $ 2530 for mothers after adjusting for inflation. Quarterly averages of expected readmission charges for urban and rural counties were regressed on ALOS, readmission rates for three major categories, and socio-economic variables. In urban counties, the coefficient of ALOS was found to be negative and highly significant (p-value of.0005). Our analysis indicates that extending ALOS by one additional day is optimal (for minimizing the expected charge of birth) and leads to a saving of$161.68 for each newborn. Readmission charges increase by $966 for jaundice(DRG 391), $2545.62 for newborn with major problems (DRG 389), $4405 for premature infants classified as normal at birth (DRG 388). For obstetric readmissions, the additional charges are $1938.70 for puerperal infection(ICD-9-CL 670) and $2689.50 for complications of surgical wounds(ICD-9-CL 6741-43).
From a review of 500 readmissions at the Childrens' hospital, it was found that the incidence of jaundice is more in the high income group who exclusively breast-fed and the mean onset of jaundice is 2.4 days.
