Recommendations for the timing of the first well-child visit (WCV) after discharge from a well-baby nursery (WBN) suggest that the visit occur within 48 hours of discharge for those with a WBN length of stay of ≤48 hours and within 3 to 5 days for those with a WBN length of stay of >48 hours. The purpose of these early visits is to detect conditions that may cause readmission in the first weeks after birth, but the effectiveness of early visits to accomplish this has not been shown. The objectives of this study were to determine (1) the frequency of early visits and (2) to compare readmission rates for those who had an early visit compared with those who did not.
Using data from a large health care system in Utah, we determined the readmission rates newborns with an estimated gestational age ≥34 weeks and compared the rates for those who had an early WCV with those who did not.
Of 79 720 newborns, 50 606 (63%) were discharged within 48 hours of birth. Of these, 7638 (15%) had a visit within 72 hours of discharge. The readmission rate for newborns who had a visit within the recommended time frame was 15.7 per 1000 compared with 18.4 for those with a later visit (odds ratio 0.85; 95% confidence interval 0.73–0.99)
The frequency of first WCVs that occurred within the recommended time frames was low. Early visits were associated with a 15% reduction in the rate of readmissions.
Comments
Re: Absolute vs. Relative Risks
Conflict of Interest:
None declared
Absolute vs. Relative Risks
In the discussion of their paper "Timing of Initial Well-Child Visit and Readmissions of Newborns", the authors state, "there was a reduction from a readmission rate of 18.4 to 15.7 per 1,000, and absolute risk reduction of 15%." Two paragraphs later, they again write, "An absolute risk reduction of 15% suggests that it would require about 7 early WCVs to eliminate one readmission." However, what the authors' findings show is in fact a relative risk reduction of 15% and an absolute risk reduction of 0.27% (2.7 per 1,000). This translates into a required 371 early WCVs to prevent a single readmission.
Using the corrected number needed to treat (N.N.T.), the benefit of an early WCV (at least in relationship to 30-day readmissions) appears orders of magnitude lower. I will refrain from speculating about how this more accurate presentation of the findings should be interpreted by clinicians, health systems and families, but I do applaud the authors for using evidence to take a critical look at what is accepted standard practice. It is also laudable that they intended to report the absolute risk reduction and N.N.T. since many studies, drug and device advertisements, and news reports stick to reporting relative risks and benefits - which as shown by the mistake here can be quite misleading.
Conflict of Interest:
None declared