Mothers’ health
A researcher looks at hospital readmissions for new moms in rural and urban areas.
One of the lesser-known provisions of the Affordable Care Act is the penalty to hospitals if patients return too often for certain conditions such as heart attack and heart failure, pneumonia, chronic lung disease, hip and knee replacement, and coronary artery bypass graft surgery.
In 2017, the federal government is expected to withhold more than a half a billion dollars in Medicare reimbursement to many of the nation’s hospitals as a wake-up call to stop the revolving door of those patients returning within 30 days of their discharges. But a researcher at the University of Texas Medical Branch at Galveston wondered about another group of patients whose return to the hospital after release is rarely discussed and even less understood: new moms.
In a potentially first-of-its-kind study, Wei-Chen Lee, a research fellow whoholds a Ph.D. from Texas A&M’s School of Public Health, looked at nearly half a million California women whogave birth in 2011 to see if there was a difference in readmission rates for those giving birth in rural hospitals and those in urban ones.
The overall readmission rate for womenwith a vaginal delivery was about 1 percent, or 3,171, and 1.41 percent, or 2,243, women whodelivered by cesarean sections. The reasons for their return to the hospital were not studied but could be due to medical complications or psychological issues such as post-partum depression.
Here is an edited conversation with her about the unique study:
Q: Explain your research and what you discovered.
A: This is a project where I used California discharge data to identify whether a pregnant woman’s decision to have her baby in either a rural or urban hospital has an influence on if they are readmitted after delivery. While we found that the readmission rate was a little bit higher in cesarean deliveries, we still found that regardless of the delivery mode, the rural population who gave birth in rural hospitals had a higher readmission rate compared to the urban population. Q: How much higher? A: Ten percent.
Q: Do you have a theory of what is behind the results?
A: Other studies have found that rural females give birth at a younger age, they have more drinking, smoking problems; they didn’t go for their routine checks. They often had worse prenatal habits, which can lead to problems.
Q: Why look at childbirth as an issue for hospital readmissions?
A: Centers for Medicare and Medicaid Services are interested in readmissions and they want to know if hospitals are providing the highest standards for chronic conditions. But no one has done this. No one has looked at new mothers.
Q: What are the public health implications of your findings?
A: I think it shows the disadvantage of people living in rural areas. They might not have the knowledge to take care of themselves, or they might not have access to doctors and hospitals. For example, the ratio is 35 obstetricians to every 1,000 patients in an urban area but only 2 per 1,000 patients in rural areas. That is a huge gap. Q: What can be done? A: First, I’d like to see case management covering the entire pregnancy through three months after delivery. It’s very similar to the concept found in treatment of chronic conditions. In a pregnancy, you have nine months and then three months after delivery for a total of 12 months to support these patients and encourage them to take care of themselves. It does not have to be a doctor. It could be a community health worker. In rural areas, they can consider telemedicine as an approach because transportation is a big issue. If you know you have to spend four hours on travel to get to a doctor for a checkup, you may think there is no point to go. The third could be to better motivate or empower the women by using their informal network of friends and family. They could help increase knowledge, share information and also promote positive attitudes to coax the expecting mothers to take care of themselves so they will have more confidence to be a mom.