January 16, 2017
2 min read

Home visiting program reduced infant ED, PCP visits during first year

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Infants of first-time parents who were assigned home visits by a nurse–parent educator team were significantly less likely to visit EDs or their primary care physician during the first year of life, according to recent data.

This finding indicates that universal prevention home visiting models delivered by an educator team may significantly reduce health care use.

“The [Home Visiting Evidence of Effectiveness (HomVEE)] project assesses whether the models meet the evidence criteria required for Affordable Care Act funding and documents that four of the 19 evidence-based home visiting models reduced medical contact within the child’s first year of life,” M. Rebecca Kilburn, PhD, a senior economist at RAND Corporation, and Jill S. Cannon, PhD, a policy researcher and faculty member at Pardee RAND Graduate School, wrote. “Studies have found that these home visiting programs reduced the number of hospitalizations, overnight stays in the hospital, ED visits and visits to the family doctor.”

To determine whether a universal model that included a nurse–parent educator team visiting homes reduced health care facility visits during a child’s first year, the researchers enrolled families of first-time parents living in the Santa Fe, N.M. area into a randomized, clinical, single-site trial of the First Born Program between January 2010 and November 2013. The First Born Program home team included a nurse or health care professional who visited families postpartum and delivered the medical components of the program curriculum and a parent educator who visited families to deliver nonmedical curriculum components.

Kilburn and Cannon randomly assigned families into an intention-to-treat experimental group that received program services (n = 138) and a contamination-adjusted intention-to-treat control group (n = 106). Among the study cohort, nurse–parent educator teams conducted an average of 28 visits by each child’s first birthday, which is 70% of the program’s recommended 40 visits — the average, per the program literature, is 50%. The last home visits occurred when the children were aged between 12 months and 15 months. During this time, 244 primary caregivers were surveyed.

Analysis showed that children who participated in the program were one-third less likely to visit the ED (control group mean = 0.42; treatment group mean= 0.28; P = .02), and 41% less likely to have visited their primary care provider nine or more times in their first year of life (Control group mean = 0.49; treatment group mean = 0.29; P < .001).

“We find evidence that the First Born Program model reduced medical contact in children’s first year of life,” the researchers wrote. “These results demonstrate that it is possible to prevent costly health care use by using a staffing model that does not rely exclusively on nurses, which are scarce in some locations and also cost more than parent educator home visitors.” —by Kate Sherrer

Disclosure: The researcher report no relevant financial disclosures.