Abstract
Objective: The effect of Alberta’s health reform on length of stay for maternity cases and on subsequent mothers’ rehospitalization was examined in the present study.
Methods: The data set included all Alberta acute care hospital separation records from 1991/92 to 1996/97 inclusive. A logistic regression was applied to the data in order to examine the effects of prepartum condition, type of delivery, length of stay, maternal age, and year on the likelihood of readmission.
Results: Health reform proved to be associated with a dramatic decrease in length of stay for maternity cases; from 3.8 to 2.4 days on average. This was accompanied by very little variation in the 90-day readmission rate for mothers over the same time period (notably, a slight decrease). Higher readmission rates were associated with the existence of difficulties during the pregnancy and other prenatal conditions, maternal age, and with the type of delivery. There were no dramatic changes in the rates for prepartum diagnoses, nor for the type of delivery.
Discussion: The data suggest that the reduction in the length of maternity stay has had no discernible negative health effects on new mothers, perhaps because of the home visiting programs that were put in place. Furthermore, there may still be room to improve outcomes by focussing on those with prepartum conditions and cases involving complicated births.
Résumé
Objectif: Cette étude porte sur l’effet de la réforme de la santé en Alberta sur la durée du séjour à l’hôpital après l’accouchement et sur les réhospitalisations subséquentes des mères.
Méthode: Nous avons étudié les données de tous les registres de sortie des hôpitaux albertains de soins actifs, de 1991–1992 à 1996–1997, inclusivement. Nous les avons analysées par régression logistique pour déterminer les effets de diverses variables (état de santé avant l’accouchement, mode d’accouchement, durée du séjour, âge maternel et année) sur la vraisemblance d’une réadmission.
Résultats: La réforme de la santé était associée à une réduction considérable de la durée du séjour à la maternité, qui est passé de 3,8 à 2,4 jours en moyenne. Elle s’est accompagnée d’un très faible écart (en fait, une légère baisse) dans le taux de réadmission des mères dans un délai de 90 jours pendant la même période. Les taux de réadmission élevés étaient associés aux grossesses difficiles et autres troubles prénatals, à l’âge maternel et au mode d’accouchement. Il n’y a pas eu de changements considérables dans les taux associés au diagnostic avant l’accouchement ou au mode d’accouchement.
Discussion: Ces données portent à croire que la réduction de la durée du séjour à la maternité n’a eu aucun effet néfaste évident sur la santé des nouvelles mères, peut-être en raison de la mise en place de programmes de visites à domicile. En outre, il serait encore possible d’améliorer ces résultats en mettant l’accent sur les mères dont la grossesse a été difficile et les naissances avec complications.
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