Abstract
To compare hospital-based utilization for early childhood injuries between program recipients and local-area comparison families following statewide implementation of an evidence-based home visitation program, and to describe site-level program variation. Propensity score matching on baseline characteristics was used to create a retrospective cohort of Nurse-Family Partnership (NFP) clients and local area matched comparison women. The main outcome, a count of injury visit episodes, was enumerated from Medicaid claims for injuries examined in an emergency department or hospital setting during the first 2 years of life of children born to included subjects. Generalized linear models with a Poisson distribution examined the association between injury episode counts and NFP participation, controlling for other non-injury utilization and stratifying by individual agency catchment area in a fixed effects analysis. The children of NFP clients were more likely in aggregate to have higher rates of injury visits in the first 2 years of life than the children of comparison women (415.2/1,000 vs. 364.2/1,000, P < 0.0001). Significantly higher rates of visits among children of NFP clients for superficial injuries (156.6/1,000 vs. 132.6/1,000, P < 0.0001) principally accounted for the attributable difference in injury visit rates between groups. Among more serious injuries, no significant difference in injury visit rates was found between NFP clients and comparison women. The proportion of children with at least one injury visit varied from 14.5 to 42.5% among individual sites. Contrary to prior randomized trial data, no reductions in utilization for serious early childhood injuries were demonstrated following statewide implementation of an evidence-based home visitation program. Significant program variation on outcomes underscores the challenges to successful implementation.
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References
American Academy of Pediatrics. (2009). The role of preschool home-visiting programs in improving children’s developmental and health outcomes. Pediatrics, 123(2), 598–603.
Kitzman, H., Olds, D. L., Henderson, C. R., Jr., Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. Journal of the American Medical Association, 278(8), 644–652.
Olds, D. L. (1992). Home visitation for pregnant women and parents of young children. American Journal of Diseases of Children, 146(6), 704–708.
Olds, D. L., Henderson, C. R., Jr., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78(1), 65–78.
Olds, D. L., Henderson, C. R., Jr., Tatelbaum, R., & Chamberlin, R. (1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77(1), 16–28.
Kitzman, H., Olds, D. L., Sidora, K., Henderson, C. R., Jr., Hanks, C., Cole, R., et al. (2000). Enduring effects of nurse home visitation on maternal life course: A 3-year follow-up of a randomized trial. Journal of the American Medical Association, 283(15), 1983–1989.
Olds, D., Henderson, C. R., Jr., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., et al. (1998). Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. Journal of the American Medical Association, 280(14), 1238–1244.
Olds, D. L., Eckenrode, J., Henderson, C. R., Jr., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 278(8), 637–643.
Olds, D. L., Kitzman, H., Cole, R., Robinson, J., Sidora, K., Luckey, D. W., et al. (2004). Effects of nurse home-visiting on maternal life course and child development: Age 6 follow-up results of a randomized trial. Pediatrics, 114(6), 1550–1559.
Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., et al. (2007). Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial. Pediatrics, 120(4), e832–e845.
Eckenrode, J., Campa, M., Luckey, D. W., Henderson, C. R., Jr., Cole, R., Kitzman, H., et al. (2010). Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Archives of Pediatrics and Adolescent Medicine, 164(1), 9–15.
Stoltzfus, E., & Lynch, K. E. (2009). Home visitation for families with young children (R40705). Washington, DC: Congressional Research Service.
Rubin, D., O’Reilly, A., Luan, X., Dingwei, D., Localio, A. R., & Christian, C. W. (2010). Variation in pregnancy outcomes following statewide implementation of a prenatal home visitation program. Archives of Pediatrics & Adolescent Medicine, 165(3), 198–204.
Rubin, D. (1997). Estimating causal effects from large data sets using propensity scores. Annals of Internal Medicine, 127, 757–763.
D’Agostino, R. (1998). Tutorial in biostatistics. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistical Medicine, 17, 2265–2281.
Kosanke, J., & Bergstralh, E. (2004). gmatch. In M. N. Rochester (Ed.). http://mayoresearch.mayo.edu/mayo/research/biostat/sasmacros.cfm.
Owens, P. L., Zodet, M. W., Berdahl, T., Dougherty, D., McCormick, M. C., & Simpson, L. A. (2008). Annual report of health care for children and youth in the United States: Focus on injury-related emergency department utilization and expenditures. Ambulatory Pediatrics, 8(4), 219–240.
Lestina, D. C., Miller, T. R., & Smith, G. S. (1998). Creating injury episodes using medical claims data. The Journal of Trauma: Injury, Infection and Critical Care, 45(3), 565–569.
Spady, D., Saunders, D., Schopflocher, D., & Svenson, L. (2004). Patterns of injury in children: A population-based approach. Pediatrics, 113, 522–529.
Wood, J. N., Hall, M., Schilling, S., Keren, R., Mitra, N., & Rubin, D. M. (2010). Disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury. Pediatrics, 126(3), 408–414.
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This project was supported by a grant from the Department of Public Welfare, Commonwealth of Pennsylvania. We thank the Pennsylvania Department of Public Welfare, Pennsylvania Department of Health, and the 24 NFP agencies across Pennsylvania for contributing data for this study.
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Matone, M., O’Reilly, A.L.R., Luan, X. et al. Emergency Department Visits and Hospitalizations for Injuries Among Infants and Children Following Statewide Implementation of a Home Visitation Model. Matern Child Health J 16, 1754–1761 (2012). https://doi.org/10.1007/s10995-011-0921-7
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DOI: https://doi.org/10.1007/s10995-011-0921-7