Postpartum Hospital Readmissions and Emergency Department Visits Among High-Risk, Medicaid-Insured Women in New York City.
Postpartum Hospital Readmissions and Emergency Department Visits Among High-Risk, Medicaid-Insured Women in New York City.
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纽约市高危、医疗补助保险女性的产后再入院和急诊就诊情况。
DOI：
10.1089/jwh.2021.0338
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Howell,ElizabethA
中科院分区：
文献类型：
--
作者：
Glazer,KimberlyB;Harrell,Taylor;Balbierz,Amy;Howell,ElizabethA
Objectives：描述纽约市（NYC）高风险、低收入、主要是黑人和拉丁裔妇女产后急诊（艾德）就诊和再入院的发病率和特征。方法：我们对2015年至2016年纽约市医疗补助保险高风险妇女的详细调查和医疗图表数据进行了二次分析。在380名完成基线（产后床边）和产后3周调查的妇女中，我们检查了产后3周内艾德就诊或再入院的发生率。我们使用逻辑回归分析，以检查未调整和调整患者的人口统计学，临床和心理社会特征和产后医院use.Results的几率之间的关联：在总数中，12.8%（n= 48）的妇女报告了艾德访问或产后3周内再入院。在自我认同为黑人与拉丁裔，美国出生与外国出生，英语与西班牙语的女性中，产后医院使用的未经调整的几率更高。与产后医院使用未经调整的几率增加相关的临床和心理社会特征包括剖宫产、妊娠期高血压疾病和阳性抑郁或焦虑筛查，我们发现了产后三周母乳喂养妇女医院使用减少的初步证据。在调整后的analysis.Conclusions中，患有高血压或抑郁/焦虑的女性寻求产后医院护理的几率仍然高出约2.5倍：我们确定了与艾德访视和纽约市产后妇女高危亚组再次入院相关的特征。这些特征，包括抑郁症状和高血压，表明妇女谁可能受益于额外的产后支持，以防止产妇并发症和减少健康差距。
Objectives:To describe the incidence of and characteristics associated with postpartum emergency department (ED) visits and hospital readmissions among high-risk, low-income, predominantly Black and Latina women in New York City (NYC).Methods:We conducted a secondary analysis of detailed survey and medical chart data from an intervention to improve timely postpartum visits among Medicaid-insured, high-risk women in NYC from 2015 to 2016. Among 380 women who completed surveys at baseline (bedside postpartum) and 3 weeks after delivery, we examined the incidence of having an ED visit or readmission within 3 weeks postpartum. We used logistic regression to examine unadjusted and adjusted associations between patient demographic, clinical, and psychosocial characteristics and the odds of postpartum hospital use.Results:In total, 12.8% (n= 48) of women reported an ED visit or readmission within 3 weeks postpartum. Unadjusted odds of postpartum hospital use were higher among women who self-identified as Black versus Latina, U.S. born versus foreign born, and English versus Spanish speaking. Clinical and psychosocial characteristics associated with increased unadjusted odds of postpartum hospital use included cesarean delivery, hypertensive disorders of pregnancy, and positive depression or anxiety screen, and we found preliminary evidence of decreased hospital use among women breastfeeding at three weeks postpartum. The odds of seeking postpartum hospital care remained roughly 2.5 times higher among women with hypertension or depression/anxiety in adjusted analyses.Conclusions:We identified characteristics associated with ED visits and hospital readmissions among a high-risk subset of postpartum women in NYC. These characteristics, including depressive symptoms and hypertension, suggest women who may benefit from additional postpartum support to prevent maternal complications and reduce health disparities.
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