Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data.
Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data.
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DOI：
10.1136/bmjqs-2020-012898
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发表时间：
2022-04
影响因子：
5.4
通讯作者：
Ross, Michael G.
中科院分区：
文献类型：
--
作者：
Sakai-Bizmark, Rie;Kumamaru, Hiraku;Estevez, Dennys;Neman, Sophia;Bedel, Lauren E. M.;Mena, Laurie A.;Marr, Emily H.;Ross, Michael G.
评估无家可归妇女与非无家可归妇女产后住院率的差异。采用分层回归模型对产后妇女的再入院和急诊（艾德）利用进行横断面二次分析，调整了年龄、种族/民族、分娩期间的保险类型、分娩住院时间、产妇合并症指数评分、其他妊娠并发症、新生儿并发症、剖宫产、年份固定效应和出生医院随机效应。纽约全州住院和急诊部门数据库（2009-2014年）。产后无家可归和非无家可归妇女分别为82 820人和1 026 965人。产后再入院（主要结局）和产后艾德访视（次要结局），自分娩住院出院后6周内。无家可归的妇女产后再入院率较低（风险调整率：1.4% vs 1.6%;调整比值比[aOR] 0.87，95%置信区间[CI]：0.75 - 1.00，p= 0.048）和艾德就诊率高于非无家可归妇女（风险调整率：8.1% vs 9.5%; aOR 0.83，95%CI：0.77 - 0.90，p<0.001）。按收入四分位数对非无家可归人口进行的敏感性分析显示，无家可归妇女的住院率明显低于收入最低四分位数的住房妇女。这些结果令人惊讶，因为产后住院率随着收入水平的下降而增加。有两个因素可能导致无家可归妇女的再入院率较低。首先，缺乏交通、支付或儿童保育等障碍可能阻碍了产后住院和急诊护理的获得。其次，鉴于纽约州广泛的安全网，出院规划，如喘息和清醒的生活住房可能提供了获得门诊护理和生活质量，防止不良健康事件。需要使用门诊数据和患者观点进行额外的研究，以认识这些因素如何影响无家可归妇女的产后健康。这些发现可能有助于降低产后住院人群的再入院率。
To assess differences in rates of postpartum hospitalizations among homeless women compared with non-homeless women. Cross-sectional secondary analysis of readmissions and emergency department (ED) utilization among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, cesarean delivery, year fixed effect, and a birth hospital random effect. New York statewide inpatient and emergency department databases (2009–2014). 82,820 and 1,026,965 postpartum homeless and non-homeless women, respectively. Postpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within six weeks after discharge date from delivery hospitalization. Homeless women had lower rates of both postpartum readmissions (risk adjusted rates: 1.4% vs 1.6%; adjusted Odds Ratio [aOR] 0.87, 95% Confidence Interval [CI]: 0.75 to 1.00, p=.048) and ED visits than non-homeless women (risk adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95%CI: 0.77 to 0.90, p<.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalization rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalization rates increasing as income levels decreased. Two factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment, or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognize how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.
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DOI：
10.1177/0884217504266775
发表时间：
2004-07-01
影响因子：
1.8
作者：
Bloom, KC;Bednarzyk, MS;Van Loock, DM
通讯作者：
Van Loock, DM
影响因子：
2.9
作者：
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影响因子：
3.5
作者：
Bennett, Wendy L.;Ennen, Christopher S.;Clark, Jeanne M.
通讯作者：
Clark, Jeanne M.
影响因子：
9.7
作者：
Clark, Robin E.;Weinreb, Linda;Seifert, Robert W.
通讯作者：
Seifert, Robert W.
影响因子：
1.4
作者：
Azim, Katharina A.;MacGillivray, Laurie;Heise, Donalyn
通讯作者：
Heise, Donalyn