Evaluation of obstetric early discharge - overview, CHERE Discussion Paper No 9

This paper gives an overview of evaluations of obstetric early discharge schemes at three hospitals in Western Sydney Area Health Service. Satisfaction of early discharge and hospital clients with their postnatal care, the reasons given by eligible women who chose not to participate in the schemes, and cost-effectiveness analyses are presented. It was found that women choosing early discharge were more likely to be satisfied with their postnatal care than were women choosing institutional care. This result is dependent on sufficient support for the women in the home, absence of medical complications, and autonomy over the selection of the type of postnatal care received. Participation in the schemes could be increased through better communication of information and increased provision of help in the home. Both Blacktown and Westmead Early Discharge Schemes currently cost the health care system more than the value of the hospital resources which they release. The value of hospital resources released by the Auburn scheme exceeds its costs, but the difference is slight. All results are sensitive to assumptions made in the analyses. Improvements in cost-effectiveness are possible, but would not necessarily lead to reductions in hospital expenditure, as that would depend on the uses made of released resources. From the perspective of the wider community, all three schemes cost more than the value of resources which are released. At issue, therefore, is whether the increase in client choice which the early discharge schemes bring about is judged worth the additional cost.