The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware
Abstract Background The Baby Friendly Hospital Initiative was created to enhance breastfeeding, although its impact on infant healthcare utilization is unclear. Breast feeding infants are vulnerable to readmission soon after birth secondary to dehydration and hyperbilirubinemia. Breastfeeding can al...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-023-04424-0 |
| _version_ | 1827590359104880640 |
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| author | Cecelia Harrison-Long Mia Papas David A. Paul |
| author_facet | Cecelia Harrison-Long Mia Papas David A. Paul |
| author_sort | Cecelia Harrison-Long |
| collection | DOAJ |
| description | Abstract Background The Baby Friendly Hospital Initiative was created to enhance breastfeeding, although its impact on infant healthcare utilization is unclear. Breast feeding infants are vulnerable to readmission soon after birth secondary to dehydration and hyperbilirubinemia. Breastfeeding can also protect infants from unnecessary health care utilization later in life by preventing infection. The objective of this study was to examine the impact of the Baby Friendly Hospital Initiative on readmissions and emergency department utilization among Medicaid births in Delaware. Methods The study was a quasi-experimental design. Medicaid claims files were used to study births at five hospitals in Delaware born between January 1, 2014, and December 31, 2018, and covered under Medicaid at time of birth. Three hospitals were designated Baby Friendly, two were not and served as controls. Outcomes included Emergency Department (ED) utilization and readmissions within 30 days and one-year of birth hospitalization. Exposure to the Baby Friendly Hospital Initiative was determined by year and hospital of birth. Logistic regression and interrupted time series segmented regression analysis with controls were used to assess the effect of Baby Friendly Hospital Initiative on healthcare utilization. Results In total, 19,695 infants were born at five hospitals with 80% (15,939) born at hospitals that were designated Baby Friendly. ED utilization and readmissions over the 1st year of life for breastfeeding related diagnosis at the Baby Friendly hospitals occurred in 240 (1.5%) and 226 (1.4%) of infants, respectively. Exposure to the Baby Friendly Hospital Initiative was associated with increased odds of all cause 30-day readmission (AOR: 1.15; 95% CI: 1.03–1.28) but not readmissions over the 1st year of life. While 30-day ED visits did not change after BFHI, one-year ED visits were reduced (0.91, 95% CI 0.86–0.97). A significant negative trend was seen over time for ED utilization post BFHI compared to controls (B: -5.90, p < 0.01). Conclusion There was a small observed increase in the odds of all cause 30-day readmissions with no change in one-year readmissions after BFHI in Delaware. Although there were no observed changes in 30-day ED utilization, there was a reduction in one-year ED utilization following the implementation of the Baby Friendly Hospital Initiative in Delaware birth hospitals. Our data help to inform policy and decision making for statewide systems of care that may be used to support breast feeding. |
| first_indexed | 2024-03-09T01:15:46Z |
| format | Article |
| id | doaj.art-922c3f9cb1ae468ea93fca4bdae669ab |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-03-09T01:15:46Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-922c3f9cb1ae468ea93fca4bdae669ab2023-12-10T12:31:57ZengBMCBMC Pediatrics1471-24312023-12-012311610.1186/s12887-023-04424-0The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in DelawareCecelia Harrison-Long0Mia Papas1David A. Paul2Children’s Hospital of Philadelphia, Infection Prevention and ControlReal World Evidence, AstraZenecaDepartment of Pediatrics, Christiana Care Health SystemAbstract Background The Baby Friendly Hospital Initiative was created to enhance breastfeeding, although its impact on infant healthcare utilization is unclear. Breast feeding infants are vulnerable to readmission soon after birth secondary to dehydration and hyperbilirubinemia. Breastfeeding can also protect infants from unnecessary health care utilization later in life by preventing infection. The objective of this study was to examine the impact of the Baby Friendly Hospital Initiative on readmissions and emergency department utilization among Medicaid births in Delaware. Methods The study was a quasi-experimental design. Medicaid claims files were used to study births at five hospitals in Delaware born between January 1, 2014, and December 31, 2018, and covered under Medicaid at time of birth. Three hospitals were designated Baby Friendly, two were not and served as controls. Outcomes included Emergency Department (ED) utilization and readmissions within 30 days and one-year of birth hospitalization. Exposure to the Baby Friendly Hospital Initiative was determined by year and hospital of birth. Logistic regression and interrupted time series segmented regression analysis with controls were used to assess the effect of Baby Friendly Hospital Initiative on healthcare utilization. Results In total, 19,695 infants were born at five hospitals with 80% (15,939) born at hospitals that were designated Baby Friendly. ED utilization and readmissions over the 1st year of life for breastfeeding related diagnosis at the Baby Friendly hospitals occurred in 240 (1.5%) and 226 (1.4%) of infants, respectively. Exposure to the Baby Friendly Hospital Initiative was associated with increased odds of all cause 30-day readmission (AOR: 1.15; 95% CI: 1.03–1.28) but not readmissions over the 1st year of life. While 30-day ED visits did not change after BFHI, one-year ED visits were reduced (0.91, 95% CI 0.86–0.97). A significant negative trend was seen over time for ED utilization post BFHI compared to controls (B: -5.90, p < 0.01). Conclusion There was a small observed increase in the odds of all cause 30-day readmissions with no change in one-year readmissions after BFHI in Delaware. Although there were no observed changes in 30-day ED utilization, there was a reduction in one-year ED utilization following the implementation of the Baby Friendly Hospital Initiative in Delaware birth hospitals. Our data help to inform policy and decision making for statewide systems of care that may be used to support breast feeding.https://doi.org/10.1186/s12887-023-04424-0Breast feedingReadmissionBaby freindly hospital initiative |
| spellingShingle | Cecelia Harrison-Long Mia Papas David A. Paul The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware BMC Pediatrics Breast feeding Readmission Baby freindly hospital initiative |
| title | The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware |
| title_full | The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware |
| title_fullStr | The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware |
| title_full_unstemmed | The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware |
| title_short | The impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by Medicaid in Delaware |
| title_sort | impact of the baby friendly hospital initiative on healthcare utilization among newborns insured by medicaid in delaware |
| topic | Breast feeding Readmission Baby freindly hospital initiative |
| url | https://doi.org/10.1186/s12887-023-04424-0 |
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