Evidence map›Paper›PMID 30012645›Full record

ArticleCMAJ open

Effect of an innovative community-based care model, the Monarch Centre, on postpartum length of stay: an interrupted time-series study.

Ghislain Hardy, Jo Ann Colas, Deborah Weiss, David Millar, Alan Forster, Mark Walker, Daniel J Corsi

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.9field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
  3. Minimizing length of hospital stay for women's reproductive care.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 3 countries.

Ghislain HardyDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
Jo Ann ColasDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
Deborah WeissDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
David MillarDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
Alan ForsterDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
Mark WalkerDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
Daniel J CorsiDepartment of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont. dcorsi@ohri.ca.
Ottawa Hospital Research InstituteWalker (United States) · USChildren's Hospital of Eastern Ontario · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundReduction in postpartum length of stay has been advocated within a context of reducing health care system costs and maintaining quality of care. We assessed trends in postpartum length of stay for vaginal and cesarean deliveries at an academic hospital, The Ottawa Hospital, before and after the implementation in 2014 of a novel community-based postpartum outpatient clinic, the Monarch Centre.

methodsThe Monarch Centre model of postpartum care consists of prebooked appointments at the postpartum clinic, scheduled within 48 hours of hospital discharge. Clients receive maternal assessment including mood screening and care, neonatal care, laboratory testing including infant total serum bilirubin level, and breast-feeding assessment and support. Family physicians, lactation consultants and registered nurses are available for consultation at the appointment, and there is coordination with institutional care, community partners and primary care providers. We used interrupted time-series regression models to assess trends in postpartum length of stay at The Ottawa Hospital between January 2012 and December 2016.

resultsThere were 16 023 deliveries with 16 515 babies born over the study period. The mean postpartum length of stay was 46 hours (66 h for cesarean deliveries and 37 h for vaginal deliveries). Eighteen months after implementation of the centre, the average length of stay following a cesarean birth had decreased by 20 hours, a relative reduction of 27% (95% confidence interval [CI] 9.5 to 30.4); for vaginal deliveries, length of stay was reduced by 6 hours, a relative reduction of 18% (95% CI 5.2 to 31.1), and by 12 hours among typical cases (relative reduction 28%, 95% CI 19.2 to 36.6). There was a decrease in the proportion of women with a length of stay exceeding 48 hours after centre implementation. An increase in the rate of 30-day readmission from 1.1% to 1.9% was observed among babies.

interpretationA strong association was found between implementation of a community-based multidisciplinary postpartum clinic and declines in postpartum length of stay. This alternative model of postpartum care is safe, has the potential for reducing provider costs and should be considered for further implementation at provincial and national levels.

Identifiers

PMID30012645
PMCPMC6182112
OpenAlexW2883415570

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.