Low-Cost RCT Evaluation of a Universal Postnatal Nurse Home Visiting Program

The aim of this low-cost randomized control trial (RCT) is to utilize administrative records to evaluate the population-level impact of a brief, universal, newborn nurse home visiting program to improve mother and child health and well-being.  Durham Connects reaches universally to all families at birth to assess individual family needs, intervene briefly between 3-12 weeks of infant age, and direct matched community resources to families based on self-identified risks and needs. The model is in contrast with programs that rely on targeting families by demographic markers, such as young maternal age or poverty, which may lead to discrepancies between families’ needs and the services provided, decreasing overall program effectiveness (Dodge et al., 2013).

Results from an initial Durham Connects RCT evaluation show highly promising impact on multiple domains of family and child well-being, including significant reductions in infant emergency medical care (Dodge et al., 2013; Dodge et al., 2014). The current proposal seeks to address this limitation by utilizing hospital administrative records to conduct a low-cost evaluation of population-level program impact on mother and child emergency department utilization through child age 24 months for intervention and control group families during the second Durham Connects RCT period. The sample will include approximately 1,100 families.

Empirical analyses will be conducted to examine the following research aims and hypotheses:

1.      Relative to even birth date families (control), odd birth date families (DC eligible) will demonstrate less mother and child utilization of emergency department care, including 1) fewer ER visits; 2) fewer hospital overnights; and 3) less total emergency medical care.

2.     Relative to even birth date families, odd birth date families will demonstrate lower total health care costs for emergency department care, as measured by hospital and physician billing costs.

3.     Effect sizes for DC impact on emergency department utilization and costs will be greater for high-risk families than low-risk families as indicated by: 1) family Medicaid status; 2) mother single parent status.