Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care.
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BACKGROUND AND OBJECTIVES: Although nurse home visiting has proven efficacious with small samples, scaling up to community populations with diverse families has not yet proven effective. The Durham Connects program was developed in collaboration with community leaders as a brief, universal, postnatal nurse home visiting intervention designed to screen for risk, provide brief intervention, and connect families with more intensive evidence-based services as needed. This study tested program effectiveness in reducing infant emergency medical care between birth and age 12 months. METHODS: All 4777 resident births in Durham, North Carolina across 18 months were randomly assigned, with even birth date families to intervention and odd birth date families to control. Intervention families were offered 3 to 7 contacts between 3 and 12 weeks after birth to assess family needs and connect parents with community resources to improve infant health and well-being. Hospital records were analyzed by using an intent-to-treat design to evaluate impact among a representative subset of 549 families. RESULTS: After demographic factors (ie, birth risk, Medicaid status, ethnicity, and single parenthood) were covaried, relative to control families, families assigned to intervention had 50% less total emergency medical care use (mean [M] emergency department visits and hospital overnights) (M(intervention) = 0.78 and M(control) = 1.57; P < .001, effect size = 0.28) across the first 12 months of life. CONCLUSIONS: This brief, universal, postnatal nurse home visiting program improves population-level infant health care outcomes for the first 12 months of life. Nurse home visiting can be implemented universally at high fidelity with positive impacts on infant emergency health care that are similar to those of longer, more intensive home visiting programs. This approach offers a novel solution to the paradox of targeting by offering individually tailored intervention while achieving population-level impact.
Emergency Medical Services
Health Impact Assessment
Home Care Services
Published Version (Please cite this version)10.1542/peds.2013-1021M
Publication InfoDodge, Kenneth A; Goodman, Ben; Murphy, Robert A; O'Donnell, Karen Jones; & Sato, Jeannine (2013). Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care. Pediatrics, 132 Suppl 2. pp. S140-S146. 10.1542/peds.2013-1021M. Retrieved from http://hdl.handle.net/10161/15882.
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Pritzker Professor of Early Learning Policy Studies
Kenneth A. Dodge is the Pritzker Professor of Early Learning Policy Studies and Professor of Psychology and Neuroscience at Duke University. He is also the founding and past director of the Center for Child and Family Policy. He is a leading scholar in the development and prevention of aggressive and violent behaviors. His work provides a model for understanding how some young children grow up to engage in aggression and violence and
Ben Goodman, PhD, is a research scientist at the Center for Child and Family Policy (CCFP) and a senior fellow at the Center for Child & Family Health at Duke University. He currently serves as the co-director of the Family Connects home visiting programs at CCFP: Durham Connects. In this capacity, he oversees program evaluation for all communities implementing Family Connects and leads the impact evaluation
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Murphy is a licensed clinical psychologist focused on child traumatic stress, including its treatment and prevention and development and dissemination of evidence-based interventions. He is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Dr. Murphy serves as Executive Director for the Center for Child & Family Health (CCFH), a community and three university partnership (Duke University, the University of North Carolina
My research interests are in early development risk: drug exposure, HIV infection, and iodine deficiency. I have ongoing research in developmental outcomes of children exposed prenatally to drugs and alcohol. They include the Infant Care Project (Pediatrics) and the Family Care Project (Psychiatry). I am co-investigator on a NIDA study of SIDS risk with prenatal cocaine exposure. I am involved at Duke and nationally in the study of the neurodevelopmental effects of pediatric HIV infecti
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