PubMed · 12676849
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John Ovretveit, David Gustafson. 2003-04-05. Using research to inform quality programmes.. https://doi.org/10.1136/bmj.326.7392.759
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Research into user involvement groups in mental health was conducted to make them more effective. Responses revealed frustration about a lack of real input, use of volunteers, lack of payment and burn-out of activists. The responses also revealed a widespread feeling of 'influence without power'.
OBJECTIVE: To describe newborn length of stay, postdischarge follow-up, and health care utilization in the context of Minnesota's early discharge legislation. DESIGN AND SETTING: Retrospective study using claims data from a large managed care organization. PARTICIPANTS: Term newborns born from January 1995 through February 1999 (N = 22 944). OUTCOME MEASURES: Newborn length of stay, home or clinic visits within 1 week of discharge (early follow-up), immunizations completed by age 3 months, readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Minnesota's early discharge legislation in 1996, the percentage of newborns with short stays (0-1 days after vaginal birth or 2-3 days after cesarean birth) decreased from 52% to 16% for vaginally born infants and from 87% to 63% for cesarean-born infants (P =.001). Although the legislation mandated coverage for home visits after short stays, only 12.4% of short-stay newborns had early home visits. Overall, 50% of infants had early home or clinic follow-up; compared with those who did not receive early follow-up, these infants were more likely to have complete immunizations (adjusted odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.14), urgent care or emergency department visits (adjusted OR, 1.22; 95% CI, 1.07-1.39), and readmissions (adjusted OR, 2.49; 95% CI, 2.02-3.08). CONCLUSIONS: Although implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay, very few short-stay infants received the postdischarge care for which coverage was mandated. Our findings indicate, however, that infants at higher risk for adverse outcomes were appropriately identified to receive early follow-up.