Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months
Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months
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DOI：
10.1017/s0954579419000889
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发表时间：
2019-12-01
影响因子：
3.3
通讯作者：
Murphy, Robert A.
中科院分区：
文献类型：
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作者：
Goodman, W. Benjamin;Dodge, Kenneth A.;Murphy, Robert A.
Tom Dishion对预防科学的最重大贡献之一是开发了负担得起的、生态上有效的干预措施，如家庭体检，广泛筛查儿童和家庭风险因素，但将针对家庭的干预措施集中在那些对人口影响最大的人身上。在这种方法的精神下，研究人员检查了一个简短的、普遍的产后家访计划对儿童紧急医疗护理和从出生到24个月的账单费用的影响。家庭联系是一种社区范围的公共卫生干预措施，它将社区服务和资源的识别和协调与简短的产后护士家访结合起来，旨在评估风险、提供支持性指导，并将已确定有风险的家庭与社区资源联系起来。在18个月的时间里，北卡罗来纳州达勒姆县所有4777名居民的家庭根据双数或单数出生日期被随机分配，接受产后护士家访干预或照常服务(对照)。独立地，这些家庭中的549个被随机选择并参与了影响评估研究。对研究目标视而不见的家庭，提供了查阅医院行政记录的书面同意。结果表明，随机分配到Family Connects的儿童在24个月内得到的紧急医疗护理总量显著减少(减少37%)，几乎所有的亚组都观察到了结果。对账单记录的检查表明，计划成本每增加1美元，总账单成本就会减少3.17美元。总体而言，结果表明，社区范围的产后支持计划可以显著降低24个月内儿童紧急医疗护理的人口比率，同时对社区来说是成本效益的。
One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.