Systematic home visit planning prior to hospital discharge: a propensity-score matched comparative cohort study of over one million mother-infant dyads with one-year follow-up.
Maternal mental health problems are leading causes of morbidity and mortality in high-income countries, yet follow-up after birth remains inconsistent.
Systematic postnatal home visits are recommended but many women do not receive them. clinical and economic impact of a structured scheduling of visits before discharge has not been fully evaluated.
To determine whether systematically arranged postpartum home visits were associated with reduced maternal rehospitalisations for mental health conditions. Secondary objectives included maternal and infant outcomes and healthcare costs within the first year.
We conducted a matched cohort study using national administrative data from 1297,646 low risk mother-infant dyads. In the intervention group, a midwife home visit was scheduled before discharge. Controls were matched on demographic and obstetric variables. The main outcome was maternal rehospitalisation for mental health conditions (ICD-10 codes F30-F45, F48, including depression or anxiety) within one year postpartum, excluding psychoses (F20-F29). Secondary outcomes included all-cause rehospitalisation for mothers and/or infants, use of emergency services, mortality, and overall healthcare costs.
A scheduled home visit occurred in 95 % of cases in the intervention group, compared to 52 % in controls (p < 0.0001). The intervention was associated with fewer maternal mental health-related rehospitalisations (RR=0.82, p < 0.0001) and slightly reduced overall rehospitalisation rates for mothers and infants. Mortality was unchanged. Mean healthcare costs were marginally lower in the intervention group.
Systematic discharge planning may improve continuity of care and reduce psychiatric morbidity.
Postpartum home visit scheduling supports better outcomes and may offer modest economic benefits.
Systematic postnatal home visits are recommended but many women do not receive them. clinical and economic impact of a structured scheduling of visits before discharge has not been fully evaluated.
To determine whether systematically arranged postpartum home visits were associated with reduced maternal rehospitalisations for mental health conditions. Secondary objectives included maternal and infant outcomes and healthcare costs within the first year.
We conducted a matched cohort study using national administrative data from 1297,646 low risk mother-infant dyads. In the intervention group, a midwife home visit was scheduled before discharge. Controls were matched on demographic and obstetric variables. The main outcome was maternal rehospitalisation for mental health conditions (ICD-10 codes F30-F45, F48, including depression or anxiety) within one year postpartum, excluding psychoses (F20-F29). Secondary outcomes included all-cause rehospitalisation for mothers and/or infants, use of emergency services, mortality, and overall healthcare costs.
A scheduled home visit occurred in 95 % of cases in the intervention group, compared to 52 % in controls (p < 0.0001). The intervention was associated with fewer maternal mental health-related rehospitalisations (RR=0.82, p < 0.0001) and slightly reduced overall rehospitalisation rates for mothers and infants. Mortality was unchanged. Mean healthcare costs were marginally lower in the intervention group.
Systematic discharge planning may improve continuity of care and reduce psychiatric morbidity.
Postpartum home visit scheduling supports better outcomes and may offer modest economic benefits.
Authors
Caron Caron, Rousseau Rousseau, Brisacier Brisacier, Akkari Akkari, Haushalter Haushalter, Mondschein Mondschein, Simon-Yeou Simon-Yeou, Thissier Thissier, Courouve Courouve, Gaucher Gaucher
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