PDF(Pubmed)
Abstract：
BACKGROUND: Early post-discharge assessments for newborns are recommended. Virtual care has become more prevalent during the pandemic, providing an opportunity to better understand its impact on the quality of post-discharge newborn care. The objective of this study was to understand whether primary care visit modality (in-person vs. virtual) is associated with early newborn hospital readmissions and emergency department (ED) visits.
METHODS: We conducted a population-based, case-control study using linked health administrative databases between September 1, 2020 and March 31, 2022 in Ontario, Canada. We compared the modality of primary care visits among cases (hospital readmission within 14 days of life) and controls (newborns without a readmission), matched on infant sex, gestational age, and maternal parity. We included an alternative definition of cases as a composite of either a newborn hospital readmission or emergency department (ED) visit or in-hospital death within the first 14 days of life. Conditional logistic regression models were used to model odds ratios (ORs), comparing those exposed to a virtual visit versus in-person visit, adjusting for infant birth weight, birth hospitalization length of stay, neighbourhood level material deprivation, rurality and presence of active maternal comorbidities.
RESULTS: Among 73,324 eligible newborns, 2,220 experienced a hospital readmission within 14 days of life and were matched to 8,880 controls. Jaundice was the primary reason for readmission (75% of readmissions). Compared to newborns who were seen in-person post-discharge, newborns who were seen virtually had higher odds of hospital readmission (adjusted odds ratio [aOR] 1.41 (95% CI 1.09, 1.83); the magnitude of effect was not different using the composite outcome (aOR 1.35, 95% CI 1.05, 1.75).
CONCLUSIONS: Newborns who receive a virtual post-discharge visit are more likely than those who receive an in-person visit to require hospital readmission.
METHODS: We conducted a population-based, case-control study using linked health administrative databases between September 1, 2020 and March 31, 2022 in Ontario, Canada. We compared the modality of primary care visits among cases (hospital readmission within 14 days of life) and controls (newborns without a readmission), matched on infant sex, gestational age, and maternal parity. We included an alternative definition of cases as a composite of either a newborn hospital readmission or emergency department (ED) visit or in-hospital death within the first 14 days of life. Conditional logistic regression models were used to model odds ratios (ORs), comparing those exposed to a virtual visit versus in-person visit, adjusting for infant birth weight, birth hospitalization length of stay, neighbourhood level material deprivation, rurality and presence of active maternal comorbidities.
RESULTS: Among 73,324 eligible newborns, 2,220 experienced a hospital readmission within 14 days of life and were matched to 8,880 controls. Jaundice was the primary reason for readmission (75% of readmissions). Compared to newborns who were seen in-person post-discharge, newborns who were seen virtually had higher odds of hospital readmission (adjusted odds ratio [aOR] 1.41 (95% CI 1.09, 1.83); the magnitude of effect was not different using the composite outcome (aOR 1.35, 95% CI 1.05, 1.75).
CONCLUSIONS: Newborns who receive a virtual post-discharge visit are more likely than those who receive an in-person visit to require hospital readmission.
摘要：
背景：建议对新生儿进行早期出院后评估。虚拟医疗在大流行期间变得更加普遍，提供一个机会，以更好地了解其对出院后新生儿护理质量的影响。这项研究的目的是了解初级保健就诊方式(当面与虚拟)与新生儿早期医院再入院和急诊科(ED)就诊相关。
方法：我们以人群为基础，2020年9月1日至2022年3月31日在安大略省使用链接的卫生管理数据库进行病例对照研究，加拿大。我们比较了病例（出生后14天内再入院）和对照组（未再入院的新生儿）的初级保健就诊方式，匹配婴儿性别，胎龄,和产妇平等。我们将病例的替代定义包括在出生后的头14天内，新生儿再次入院或急诊科（ED）就诊或住院死亡的复合病例。使用条件逻辑回归模型对比值比(OR)进行建模，比较那些暴露于虚拟访问和亲自访问的人，调整婴儿出生体重，出生住院时间，邻里层面的物质剥夺，乡村性和活动性母体合并症的存在。
结果：在73,324名合格新生儿中，2,220人在生命的14天内再次入院，并与8,880名对照组相匹配。黄疸是再入院的主要原因(75%的再入院)。与出院后亲自见到的新生儿相比，实际就诊的新生儿再入院的几率较高(校正后比值比[aOR]1.41(95%CI1.09,1.83);使用复合结局(aOR1.35,95%CI1.05,1.75),效果的大小没有差异.
结论：接受虚拟出院后访视的新生儿比接受面对面访视的新生儿要求再次入院的可能性更大。
方法：我们以人群为基础，2020年9月1日至2022年3月31日在安大略省使用链接的卫生管理数据库进行病例对照研究，加拿大。我们比较了病例（出生后14天内再入院）和对照组（未再入院的新生儿）的初级保健就诊方式，匹配婴儿性别，胎龄,和产妇平等。我们将病例的替代定义包括在出生后的头14天内，新生儿再次入院或急诊科（ED）就诊或住院死亡的复合病例。使用条件逻辑回归模型对比值比(OR)进行建模，比较那些暴露于虚拟访问和亲自访问的人，调整婴儿出生体重，出生住院时间，邻里层面的物质剥夺，乡村性和活动性母体合并症的存在。
结果：在73,324名合格新生儿中，2,220人在生命的14天内再次入院，并与8,880名对照组相匹配。黄疸是再入院的主要原因(75%的再入院)。与出院后亲自见到的新生儿相比，实际就诊的新生儿再入院的几率较高(校正后比值比[aOR]1.41(95%CI1.09,1.83);使用复合结局(aOR1.35,95%CI1.05,1.75),效果的大小没有差异.
结论：接受虚拟出院后访视的新生儿比接受面对面访视的新生儿要求再次入院的可能性更大。
