title: Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care.
abstract: OBJECTIVE
  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.
authors.affiliation: Center for Child and Family Policy, 302 Towerview Drive, Duke University, Durham, NC 27708. dodge@duke.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Dodge
authors.forename: W Benjamin
authors.initials: WB
authors.lastname: Goodman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Murphy
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
authors.forename: Jeannine
authors.initials: J
authors.lastname: Sato
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends; D005260:Female; D062489:Health Impact Assessment / Q000379:methods* / Q000639:trends; D006699:Home Care Services / Q000639:trends; D006792:House Calls / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010865:Pilot Projects; D011181:Postnatal Care / Q000379:methods* / Q000639:trends; D011247:Pregnancy; D012307:Risk Factors
keywords: child injuries; home visiting; prevention