Postpartum Acute Care Utilization in a Health Care System in the Southeastern United States

Abstract

Introduction: Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care ("outpatient"), and hospital readmissions, may indicate medical complications and signal unmet health needs. Methods: We estimated the incidence of PACU and examined patterns by sociodemographic factors, pregnancy and birth characteristics, time since discharge from the birth hospitalization, and medical indications. We constructed a retrospective cohort of people aged ≥18 years who delivered ≥1 liveborn infant >20 weeks of gestation from July 1, 2021, to December 31, 2022, using electronic health record data from a quaternary maternity hospital in the Southeastern United States PACU data throughout the health care system were collected through March 31, 2023. We excluded people with a hospital stay >6 days (n = 29). Results: In this cohort of 6,041 birthing people, 11.3% had ≥1 outpatient encounters (range 0-6) and 3.2% had ≥1 hospital readmissions (range 0-4) within 12 weeks of discharge from the birth hospitalization. Median time to first outpatient PACU was 10 days post-discharge and 6 days for first hospital readmission. Among encounters for the top five medical indications, time to first postpartum acute care encounter varied by medical indication (log-rank test of equality over strata Chi-square = 69.93, degrees of freedom = 4, p < 0.0001). Complications specified during the puerperium (n = 234) and hypertension and hypertensive-related conditions complicating the puerperium (n = 87) were the two most frequent indications. Conclusion: These findings can inform efforts to direct health resources to improve postpartum health care and health outcomes.

Keywords: acute care; electronic health record; emergency care; health services; maternal health; postpartum.

FIG. 1.

Time to first postpartum acute care encounter since discharge from the birth hospitalization among the five most frequent medical indications (log-rank test of equality over strata: Chi-square = 69.93, df = 4, p < 0.0001). Medical indications were determined using the final coded diagnosis, the stated diagnoses of the patient reported for billing purposes, extracted from the electronic health record of the birthing person, and categorized using the Clinical Classifications Software Refined (CCSR) system published by Healthcare Cost and Utilization Project.

FIG. 2.

Time to first outpatient postpartum acute care encounter since discharge from the birth hospitalization for the five most frequent medical indications (log-rank test of equality over strata: Chi-square = 68.46, df = 4, p < 0.0001). Medical indications were determined using the final coded diagnosis, the stated diagnoses of the patient reported for billing purposes, extracted from the electronic health record of the birthing person, and categorized using the Clinical Classifications Software Refined (CCSR) system published by Healthcare Cost and Utilization Project.

FIG. 3.

Time to first hospital readmission since discharge from the birth hospitalization for the four most frequent medical indications (log-rank test of equality over strata: Chi-square = 56.34, df = 3, p < 0.0001). Medical indications were determined using the final coded diagnosis, the stated diagnoses of the patient reported for billing purposes, extracted from the electronic health record of the birthing person, and categorized using the Clinical Classifications Software Refined (CCSR) system published by Healthcare Cost and Utilization Project.