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Study OKs Drive-Through Deliveries

"Drive-through deliveries" that send new mothers home from the hospital after just one night do not seriously endanger newborns, according to a study that calls into question laws enacted around the country to restrict the practice.

Health insurance groups uttered a collective I-told-you-so.

"The political system made a judgment about what was preferred care. Now the research is showing there was probably a rush to judgment," said Karen Ignagni, president of the American Association of Health Plans.

The group represents HMOs and other managed care plans that were at the forefront of a cost-cutting movement in the early 1990s to shorten maternity stays for normal births. Eventually, such programs were widely dubbed "drive-through deliveries." Alarmed by horror stories of endangered newborns, dozens of states and Congress adopted laws mostly requiring insurance coverage for at least 48 hours of care after delivery.

However, in this study, Harvard Medical School researchers found that newborns needed the same number of later emergency room visits and hospital readmissions, regardless of whether they had longer stays or shorter ones.

The overnight stay "can be safe, if it's done carefully," said Jeanne Madden, a Harvard health policy specialist who led the study. The one-night stays examined in this study were followed quickly by home medical visits.

The researchers did not look at the health of the mothers, but all of the cases studied involved routine deliveries. The study excluded women who had Caesarean sections or serious complications.

The researchers, who published their findings in Thursday's New England Journal of Medicine, looked at 20,366 new mothers with normal deliveries. The study was funded by government grants and the foundation arm of Harvard Pilgrim Health Care. Harvard Pilgrim's corporate predecessor insured the mothers in the study.

The researchers looked at the early 1990s, when stays were getting shorter; the mid-1990s, when they were shorter for even more women under an early-discharge program run by the HMO; and the late 1990s, when a minimum 48-hour-stay law went into effect in Massachusetts.

During the period studied, newborn visits to emergency rooms kept steady at an average of about 1 percent every three months. Hospital readmissions held at around 1.5 percent. The same pattern held for a more vulnerable group of young, lower-income mothers with less education.

However, under the health plan program of reduced stays, mothers received home medical visits within four days of leaving the hospital.

"It may be if you had a shorter length of stay and no home visits, the vulnerable subgroup would have had worse outcomes," said Kate Pickett, a University of Chicago assistant professor of health studies and obstetrics.

Pickett said the American medical system lacks many of the community-based services that would make up for shorter hospital visits. However, insurance industry groups say the short-stay programs normally called for follow-up home or pediatric care.

Larry Akey, a spokesman for the Health Insurance Association of America, said short-stay programs were designed "not entirely as cost-saving measures, but an opportunity for the mother to get home" faster.

In the study, the rate of routine medical visits for newborns did rise from 33 percent to 45 percent when the health plan reduced stays. But the researchers did not necessarily view this as the result of sicker babies. They suggested that mothers were encouraged to see doctors more often during the program.

There were a couple of other surprises in the study. In an unintended consequence of the state laws, follow-up exams of newborns on days 3 and 4 of life — an especially sensitive time — dropped by 11 percentage points to 53 percent.

Also, covered medical costs decreased just barely, by $90 per delivery, under the health plan's short-stay program. The researchers say hospitals boosted their prices, nearly offsetting any savings.

By Jeff Donn