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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge.
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A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge.

机译：产后早期出院后的家庭访视和医院团体随访的随机比较。

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OBJECTIVE: Short postpartum stays are common. Current guidelines provide scant guidance on how routine follow-up of newly discharged mother-infant pairs should be performed. We aimed to compare 2 short-term (within 72 hours of discharge) follow-up strategies for low-risk mother-infant pairs with postpartum length of stay (LOS) of <48 hours: home visits by a nurse and hospital-based follow-up anchored in group visits. METHODS: We used a randomized clinical trial design with intention-to-treat analysis in an integrated managed care setting that serves a largely middle class population. Mother-infant pairs that met LOS and risk criteria were randomized to the control arm (hospital-based follow-up) or to the intervention arm (home nurse visit). Clinical utilization and costs were studied using computerized databases and chart review. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks postpartum. RESULTS: During a 17-month period in 1998 to 1999, we enrolled and randomized 1014 mother-infant pairs (506 to the control group and 508 to the intervention group). There were no significant differences between the study groups with respect to maternal age, race, education, household income, parity, previous breastfeeding experience, early initiation of prenatal care, or postpartum LOS. There were no differences with respect to neonatal LOS or Apgar scores. In the control group, 264 mother-infant pairs had an individual visit only, 157 had a group visit only, 64 had both a group and an individual visit, 4 had a home health and a hospital-based follow-up, 13 had no follow-up within 72 hours, and 4 were lost to follow-up. With respect to outcomes within 2 weeks after discharge, there were no significant differences in newborn or maternal hospitalizations or urgent care visits, breastfeeding discontinuation, maternal depressive symptoms, or a combined clinical outcome measure indicating whether a mother-infant pair had any of the above outcomes. However, mothers in the home visit group were more likely than those in the control group to rate multiple aspects of their care as excellent or very good. These included the preventive advice delivered (76% vs 59%) and the skills and abilities of the provider (84% vs 73%). Mothers in the home visit group also gave higher ratings on overall satisfaction with the newborn's posthospital care (71% vs 59%), as well as with their own posthospital care (63% vs 55%). The estimated cost of a postpartum home visit to the mother and the newborn was Dollars 265. In contrast, the cost of the hospital-based group visit was Dollars 22 per mother-infant pair; the cost of an individual 15-minute visit with a registered nurse was Dollars 52; the cost of a 15-minute individual pediatrician visit was Dollars 92; and the cost of a 10-minute visit with an obstetrician was Dollars 92. CONCLUSIONS: For low-risk mothers and newborns in an integrated managed care organization, home visits compared with hospital-based follow-up and group visits were more costly but achieved comparable clinical outcomes and were associated with higher maternal satisfaction. Neither strategy is associated with significantly greater success at increasing continuation of breastfeeding. This study had limited power to identify group differences in rehospitalization and may not be generalizable to higher-risk populations without comparable access to integrated hospital and outpatient care.
机译：目的：产后短暂停留很常见。当前的指南对应如何对新出院的母婴进行例行随访提供了很少的指导。我们的目的是比较两种低风险母婴对（产后住院时间（LOS）<48小时）的短期（出院72小时内）随访策略：护士的家访和医院随访团拜访的特写。方法：我们在为大多数中产阶级人群提供服务的综合管理式护理环境中使用了具有意向性治疗分析的随机临床试验设计。符合LOS和风险标准的母婴对被随机分配到对照组（基于医院的随访）或干预组（家庭护士就诊）。使用计算机数据库和图表审查研究了临床利用率和费用。在产后2周通过电话访谈的方式评估母乳喂养的持续时间，母体抑郁症状和母体满意度。结果：在1998年至1999年的17个月中，我们纳入了1014对母婴并进行了随机分组（对照组为506个，干预组为508个）。研究组之间在产妇年龄，种族，教育程度，家庭收入，均等，既往母乳喂养经历，提早进行产前护理或产后LOS方面无显着差异。新生儿LOS或Apgar评分无差异。在对照组中，只有264对母婴进行了个人探访，仅有157对进行了小组探视，有64对既有小组就诊又有个体探访，有4人进行了家庭保健和医院随访，有13人没有进行随访。 72小时内进行了随访，有4例失访。就出院后两周内的结局而言，新生儿或产妇的住院或紧急护理就诊，停止母乳喂养，产妇抑郁症状或综合临床结局指标（母婴对是否具有上述任何一项）均无显着差异结果。但是，家庭访问组的母亲比对照组的母亲更有可能将其护理的多个方面评为优秀或非常好。其中包括提供的预防性建议（76％比59％）和提供者的技能和能力（84％比73％）。家访组的母亲对新生儿的院后护理（71％比59％）以及自己的院后护理（63％比55％）的总体满意度也更高。产后对母亲和新生儿进行家庭访问的估计费用为265美元。相比之下，基于医院的团体访问的费用为每对母婴22美元;在注册护士的陪同下进行的15分钟个人护理费用为52美元;每次儿科医生的15分钟诊疗费用为92美元;而产科医师每10分钟一次的诊治费用为92美元。结论：对于综合管理式护理组织中的低风险母亲和新生儿，与医院随访和团体诊治相比，家庭诊治成本更高，但实现了可比的临床结果，并与更高的产妇满意度相关。在增加母乳喂养的持续时间方面，这两种策略均未获得明显的更大成功。这项研究确定再住院的群体差异的能力有限，并且如果没有可比的综合医院和门诊治疗机会，可能无法推广到高危人群。

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