Home Visiting and Use of Infant Health Care: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES: Evaluations of home visiting models have shown that they can reduce children's health care use in the first year of life. Models that exclusively use nurses as home visitors may cost more and be infeasible given nursing shortages in some locations. The goal of this study was to test whether a universal home visiting model employing a nurse-parent educator team as home visitors reduces health care use in the first year of life. METHODS: This study was a randomized controlled clinical trial of an intensive home visiting program delivered in homes of primary caregivers and their first-born children in Santa Fe, New Mexico. Intention-to-treat and contamination-adjusted intention-to-treat models were estimated, and 244 primary caregivers participated in the survey. RESULTS: In their first year of life, treatment group children were one-third less likely to visit the emergency department (control group mean, M-C = 0.42, treatment group mean, M-T = 0.28, P = .02) and were also 41% less likely to have visited a primary care provider >= d9 times (M-C = 0.49, M-T = 0.29, P < .001). We found no differences between the treatment and control groups for hospitalizations or injuries requiring medical attention. The universal program reduced infant health care use for high-risk and lower-risk families. CONCLUSIONS: Children in families randomly assigned to the 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.