Discharge of term infants at <48h. from Women and Infants Hospital of Rhode Island includes coverage by two major insurers of a hospital-based home visit for maternal and neonatal post-partum assessment at 72-96 hrs. From June 1 - Nov. 30, 1996, 1414/2369 patients initially screened were eligible, and 979 had home visits by hospital-based nurses. The program included indigent as well as privately insured patients. The principal reasons for nonparticipation were (1) LOS>48h. (995, or 42% of initial contacts) and (2) parents declined or canceled (283, or 20% of eligible families). The reimbursed cost for a 1.5 hr visit was $100, vs. $585 for an additional day in the hospital. The results for newborns were as follows: Table

Table 1
Full size table

Participation decreased from 47% to 37% of patients initially screened(p<0.05) after state and federal length-of-stay legislation took effect on 9/1/96. The neonatal readmission rate was slightly lower than that of the area's largest private HMO with office-based follow-up (0.9% vs. 1.6%). We conclude that: (1) Term infants discharged at <48h. can be adequately followed by hospital-based home visits. (2) The program provides effective early screening (54 physician communications vs. 9 admissions). (3) The rate of unplanned readmissions or office visits is low (2.9% of patients seen). (4) Follow-up for jaundice appears appropriate (bilirubin measured in 2.6%, with one readmission). (5) The program appears cost effective. Further assessment of outcomes may provide criteria for further improvements in the program.