Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Abstract

BACKGROUND AND OBJECTIVE: In the first year of life, the rate of rehospitalization for infants has been shown to be between 4.4% and 9.5%. Reducing avoidable health care utilization is a population health priority. The goal of this study was to identify maternal and infant factors associated with rehospitalization and emergency department (ED) utilization in a cohort of newborn Medicaid recipients. METHODS: A longitudinal database was created by linking mother–infant dyads giving birth at a regional perinatal referral center with Delaware state Medicaid data. Multivariable logistic regression and negative binomial regression were used to examine inpatient hospitalization and ED utilization within 6 months after birth. RESULTS: The study cohort included 4112 infants; 452 (11.0%) were rehospitalized, and 1680 (41%) used the ED within 6 months of birth. Variables independently associated with inpatient rehospitalization included NICU admission (odds ratio [OR]: 1.7 [95% confidence interval (CI): 1.3–2.3]), maternal bipolar diagnosis (OR: 1.5 [95% CI: 1.1–2.2]), count of maternal prenatal hospital admissions (OR: 1.3 [95% CI: 1.1–1.5]), and count of maternal ED visits (OR: 1.08 [95% CI: 1.04–1.1]). Black race (incident rate ratio [IRR]: 1.2 [95% CI: 1.1–1.3]), fall birth (IRR: 1.2 [95% CI: 1.01–1.3]), count of maternal ED visits (IRR: 1.1 [95% CI: 1.09–1.12]), number of maternal medications (IRR: 1.02 [95% CI: 1.01–1.03]), and maternal age (IRR: 0.97 [95% CI: 0.96–0.98]) were associated with ED utilization. CONCLUSIONS: In this newborn Medicaid population, multiple maternal factors (including age, race, and mental health diagnoses) were associated with health care utilization in the 6 months after initial hospital discharge. Our data provide potential risk factors for targeted intervention and suggest that maternal factors should be considered in identifying a population at risk for rehospitalization and ED utilization.