(235) Association of unplanned postpartum hospital use with patient-reported outcomes

Postpartum hospital readmission or emergency department use has significant medical, social, and financial consequences, yet little is known about how unplanned hospital use may influence patient-reported outcomes (PROs). We aimed to evaluate whether postpartum hospital use is associated with PROs in the first year postpartum.

Study Design:

This was a secondary analysis of data from a randomized trial of postpartum patient navigation which included patients who were ≥16 years, had public insurance, and were English- or Spanish-speaking. Postpartum hospital use was defined as emergency department visits or hospital readmissions after delivery discharge within 12 weeks postpartum. All postpartum hospital use occurred prior to study visits. Participants completed study visits that included PROs assessing perceived health status at 4-12 weeks and 11-13 months postpartum. Differences in PRO scores by postpartum hospital use were evaluated using bivariable tests.

Results:

Of 405 randomized participants, 18% (n=73) had postpartum hospital use, including 15 readmissions. Participants with and without postpartum hospital use were similar with respect to demographic characteristics (Table 1). At 4-12 weeks postpartum, postpartum hospital use was associated with lower perceived physical health, lower self-efficacy, and greater perceived stress; these findings did not persist at 11-13 months (Table 2). At 11-13 months, participants with postpartum hospital use reported lower perceived informational support (i.e. availability of helpful information). No differences were seen at either time in perceived mental health, patient activation, knowledge of postpartum risks, postpartum care satisfaction, breastfeeding self-efficacy, postpartum preparedness, or depressive symptoms.

Conclusion:

Unplanned postpartum hospital use was associated with poorer perceived health, confidence in managing health, and stress at 4-12 weeks postpartum. Low-income patients who experience unplanned postpartum hospital use may benefit from increased support and resources to optimize postpartum health in the early postpartum period.