1. First-time parents receiving home visits from nurses and trained educators regarding infant health were less likely to take their child to an emergency department (ED) during their first year of life.
2. Benefits of this First Born Program (FBP) were even evident in lower-risk groups, such as households with annual incomes greater than twice the poverty line.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Federal funding for home visit programs for new parents and their children is on the rise. Evidence has suggested that such programs promoting infant health and parent education can decrease the use of both emergency and family medical care. One question regarding delivery is whether these visits must be conducted by health care workers (most commonly nurses) to be effective, or if visits by trained paraprofessionals could have a similar positive impact. To address this question, researchers conducted a randomized controlled trial at one site of the FBP, a home visiting program for parents and their first-born children. Results suggest that home visits reduced the probability of visiting an ED and having an above average number of visits (within the sample) to a health care provider during the child’s first year of life. Such benefits were seen even among lower-risk groups, including mothers with more than a high school education, non-single and non-teenage mothers, and caregivers with a household income >$45,000. Limitations of this study included its inability to evaluate biases within the interviewed sample versus the full, randomized sample, and its reliance on word-of-mouth data. Additionally, only binary outcomes were considered, so it is unclear whether the overall health care burden was impacted by the FBP. Nevertheless, continued federal support and information delivery for home visiting programs employing both nurses and trained paraprofessionals is likely to be beneficial.
Study Author, M. Rebecca Kilburn, PhD talks to 2 Minute Medicine: Senior Economist, RAND Corporation, Santa Monica, California.
“While pediatric professional guidelines have emphasized the role of pediatricians in helping educate parents, the pediatric community is increasingly encouraged to learn about community resources that can supplement pediatricians’ guidance on parenting practices and connect families with services. Home visiting is cited as a type of community resource with a strong evidence base, and American Academy of Pediatrics policy statements recommend home visiting models that use professionals (i.e., nurses) rather than paraprofessionals and models that are targeted at specific populations rather than universal models. This study finds that children in families randomly assigned to a home visiting program had less health care use in their first year, demonstrating that a universal prevention home visiting model delivered by a nurse-parent educator team can reduce infant health care use.”
In-Depth [randomized controlled trial]: Participants included 244 first-born children and their primary caregivers in Santa Fe County, New Mexico. Due to limited funding, this FBP site employed a random lottery for treatment assignment, providing an opportunity to conduct a randomized control trial to investigate the impact of home visiting on health care usage. Although researchers did not have contact with all initially randomized children, they conducted interviews with 88% of families that enrolled in the study. In addition to collecting demographic information, researchers created binary variables to assess ED visits, hospital admissions, medical attention for injuries (all ≥1 vs. 0), and greater than average visits to a primary care provider (≥9 vs. <9) during the first year of life. Analysis was conducted using both intention-to-treat (ITT) and contamination-adjusted ITT (CA-ITT) models. The latter model was useful for this sample, as 21% of those allocated to receive the intervention did not actually receive it. Analysis suggested that the FBP and control groups were comparable across an array of demographic variables including maternal education, household income, and maternal adverse childhood experiences (p > 0.05). FBP children were less likely to have visited an ED (FBP mean = 0.28, control mean = 0.42, CA-ITT p = 0.038) and less likely to have gone to a primary care physician ≥9 times (FBP mean = 0.29, control mean = 0.49, CA-ITT p = 0.001). These benefits remained significant when limited to lower-risk families, such as mothers with more than a high school education (ED: p = 0.049, primary care: p = 0.002) and households with annual incomes >$45,000 (ED: p = 0.028, primary care: p = 0.005).
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