Saving dollars while helping babies

December 19, 2013

DURHAM, N.C. - As healthcare costs continue to balloon, a new Duke study points to a surprising avenue for potential savings: nurse home visits. For every $1 spent on nurse home visiting for newborns, $3 were saved in healthcare costs. The home visiting program more than paid for itself within the infants' first six months of life.

In addition to saving on emergency room care, the program improved health and parenting outcomes. Participating families had lower rates of maternal anxiety and safer home environments than other families, and they showed more positive parenting behaviors, such as comforting or reading to their child. The new research appears online December 19 in the American Journal of Public Health.

"Everyone is concerned about healthcare costs," said lead author Kenneth Dodge, who directs Duke's Center for Child and Family Policy. "Nurse home visiting programs can prevent inappropriate use of emergency medical care for infants. They represent a cost-effective ways to help young families get off to a good start."

The study examined a community-wide home-visiting program for newborns and their families called Durham Connects. The Durham, N.C. program is the first to evaluate the application of a nurse home visiting model to an entire community. In addition to providing health checks and other services, nurses encouraged families to develop strong relationships with pediatricians, and not to visit the emergency room for primary care.

Infants in the study had 59 percent fewer emergency room visits and overnight hospital stays during the first six months of life than a control group of infants.

Compared with estimated costs of $423 per emergency outpatient visit and $3,722 per hospital night cited by this study, the Durham Connects program costs $700 per family. Based on those findings, the authors estimate that for cities of similar size averaging 3,187 births per year, an annual investment of approximately $2.2 million in nurse home visiting would yield community healthcare cost savings of about $6.7 million in the first six months of life, or $3 saved for every $1 spent.

Participating families had higher-quality home environments: Their homes were more likely to be safe, clean and free of hazards, and to include more age-appropriate books and toys. Also, if the parents chose out-of-home child care, they chose higher-quality care.

The new publication is one of two recent studies to examine Durham Connects. A November study in the journal Pediatrics also found positive effects from the nurse home-visiting program.
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Durham Connects was launched by the Duke University Center for Child and Family Policy in cooperation with the Durham County Health Department and the Center for Child & Family Health. It is now operated by the Center for Child & Family Health.

This trial has been registered as the "Durham Connects Evaluation" with ClinicalTrials.gov, NCT01406184, http://www.clinicaltrials.gov. Funding was provided by the Duke Endowment and the Pew Center on the States.

CITATION: "Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home-Visiting," Kenneth A. Dodge, W. Benjamin Goodman, Robert A. Murphy, Karen O'Donnell, Jeannine Sato, Susan Guptill, American Journal of Public Health, December 19, 2013, DOI: 10.2105/AJPH.2013.301361

Duke University

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