Preparation for Discharge, Maternal Satisfaction, and Newborn Readmission for Jaundice: Comparing Postpartum Models of Care

Authors

  • Lise Goulet MD, PhD,

    Corresponding author
    1. 1Lise Goulet is a Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, 2Aïssatou Fall is a Doctoral Candidate in Public Health, 3Danielle D’Amour is an Associate Professor at the Faculty of Nursing, and 4Raynald Pineault is an Emeritus Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, University of Montreal, Montreal, Canada.
      Dr. Lise Goulet, MD, PhD, Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, C.P. 6128, Succ. Centre-ville, Montréal, Quebec, Canada H3C 3J7.
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  • 1 Aïssatou Fall MD, MSc,

    1. 1Lise Goulet is a Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, 2Aïssatou Fall is a Doctoral Candidate in Public Health, 3Danielle D’Amour is an Associate Professor at the Faculty of Nursing, and 4Raynald Pineault is an Emeritus Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, University of Montreal, Montreal, Canada.
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  • 2 Danielle D’Amour RN, PhD,

    1. 1Lise Goulet is a Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, 2Aïssatou Fall is a Doctoral Candidate in Public Health, 3Danielle D’Amour is an Associate Professor at the Faculty of Nursing, and 4Raynald Pineault is an Emeritus Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, University of Montreal, Montreal, Canada.
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  • and 3 Raynald Pineault MD, PhD 4

    1. 1Lise Goulet is a Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, 2Aïssatou Fall is a Doctoral Candidate in Public Health, 3Danielle D’Amour is an Associate Professor at the Faculty of Nursing, and 4Raynald Pineault is an Emeritus Professor in the Department of Social and Preventive Medicine of the Faculty of Medicine, University of Montreal, Montreal, Canada.
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  • This study received financial support from several sources: the Canadian Health Services Research Foundation in Ottawa, Canada; the Fonds de recherche en santé du Québec in Québec, Canada; the Quebec Ministry of Health and Social Services and the Agence d’évaluation des technologies et des modes d’intervention en santé in Montréal, Canada; and 2 of the 4 health regions under study in the Province of Québec, Canada.

Dr. Lise Goulet, MD, PhD, Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, C.P. 6128, Succ. Centre-ville, Montréal, Quebec, Canada H3C 3J7.

Abstract

ABSTRACT: Background: Physiological jaundice generally appears between the third and fifth days of life. The danger of hyperbilirubinemia is therefore a major challenge when postpartum hospital stays are short, and part of the responsibility for screening for signs of jaundice is assumed by the mother. The objective of this study was to identify the model of postnatal continuity of care most likely to prepare mothers for discharge, to reduce newborn readmission for jaundice, and to enhance maternal satisfaction. Methods: An epidemiological study was conducted in regions operating under 3 different models of postnatal continuity of care. Eligible mothers were those who had spent less than 60 hours in hospital after an uncomplicated vaginal delivery. Of this group, 70.8 percent participated in telephone interviews conducted 1 month after their deliveries (n = 1,096). Newborns who had presented with signs of jaundice were identified through statements from their mothers. Results: Of the participating newborns, 45.5 percent presented with signs of jaundice, and 3.2 percent were readmitted for jaundice during the first week of life. The follow-up procedures used in regions operating under a community-based model most closely followed the recommendations of health authorities and featured a high level of mothers’ satisfaction. In the region operating under a mixed hospital model, mothers reported signs of jaundice significantly more often, and postdischarge services received by mothers were less effective at allaying their fears compared with other models. Phototherapy was offered in the home only in the region operating under a mixed ambulatory model, and no readmissions for jaundice were recorded in this region. Conclusions: An effective coordination between community-based perinatal services and hospital-linked home phototherapy in the form of an integrated network appears to be an essential condition for improved monitoring of newborns’ health since it fosters a follow-up that is focused not only on jaundice but also on mothers’ and newborns’ needs while reducing the costs generated by newborn readmissions. (BIRTH 34:2 June 2007)

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