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Women leaving the hospital against medical advice after delivering a baby should be targeted for more services

Based on a study of three States, one-tenth of 1 percent of women who have just delivered a baby leave the hospital against medical advice. This potentially jeopardizes their health and that of their newborn child. These women typically suffer from psychosocial or medical problems, and should be targeted for additional maternal and/or child services, suggests a new study.

Clinicians should provide emotional support, identify the reasons for early discharge, ensure continuity of post-hospital care, and/or refer them for mental health, social work, substance abuse, or visiting nurse services, suggests Kevin Fiscella, of the University of Rochester School of Medicine and Dentistry.

Researchers used hospital discharge data for women following a live birth in California, Florida, and New York from 1998-2000 to examine risk factors associated with discharge against medical advice. Post-partum discharge against medical advice averaged 0.10 percent. Rates were lowest among women following uncomplicated cesarean and vaginal births (0.07 percent), followed by complicated vaginal birth (0.21 percent), and complicated cesarean birth (0.29 percent).

Women who were more likely to leave the hospital against medical advice were black; had lower income, public health insurance, no health insurance, or greater medical problems (particularly drug abuse or psychotic illness); lived in medium or large metropolitan areas; and were discharged from a hospital in California or New York (compared with Florida). Pressing priorities in the lives of socially disadvantaged patients, such as child care or financial issues, may motivate them to leave earlier than recommended. Also, uninsured patients may not be able to afford hospitalization.

The study was supported by the Agency for Healthcare Research and Quality (HS10910).

See "Post partum discharge against medical advice: Who leaves and does it matter?" by Dr. Fiscella, Sean Meldrum, M.S., and Peter Franks, M.D., in the September 2007 Maternal and Child Health Journal 11, pp. 431-436.

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