Telehealth in home visiting for new mothers: Are outcomes different if the first visits are in person?

摘要 针对新妈妈的家访方案有广泛的目标，包括改善产妇和 儿童健康、减少虐待儿童和改善儿童发展。超过286,000个家庭 面对逆境每年由19个基于证据的模型在全美提供服务，这些模型 提供支持、教育和与其他服务的连接。在2020年前，只有一小部分访问是 通过远程家访(远程HV；电话或视频会面)提供。冠状病毒病-2019年 (新冠肺炎)大流行需要迅速采用远程高压；到2020年4月初，99%的家访是在 远程高压。在2020年之前，远程HV仅被推荐作为面对面访问的部分替代方案，并且仅 在家庭访客和家人之间的关系建立之后，由于 治疗关系。这种关系是家访计划中的一个关键因素，因为它有助于 作为教育、指导和与家庭合作的基础。关于这一点的证据有限 TeleHV，尽管我们预计继新冠肺炎之后，许多家庭将混合使用面对面访问和TeleHV 由于更大的灵活性和其他优势，限制被取消。我们建议进行二次数据分析，以 利用这一自然实验，确定在建立家庭期间是否亲自到访 在建立这种关系期间，访客与家庭关系与比远程HV更好的结果有关 两性关系。我们还将探索与更好结果相关的家庭特征在以下方面是否存在差异- 个人家访和远程高压，这将有助于我们理解接受和 家庭特征对远距离高压疗效的影响。我们将考虑这两种健康结果(母亲抑郁 症状、母乳喂养、亲密伴侣暴力[IPV])和过程结果(留存、探视、 筛选完成)。我们将从一个大型的循证家访项目--护士家庭中获取数据 伙伴关系(NFP)。NFP在全美大约有260个地点；1000到1600个第一次怀孕- 母亲在怀孕晚期之前每月注册并接受定期探视(频率视情况而定 发育阶段：每周至每月)，从怀孕期间到孩子两岁生日。 NFP全国服务办公室在入学时和规定的时间点收集所有登记家庭的数据 关于就诊、筛查和结果(包括孕产妇和儿童健康)。我们之前曾合作过 拥有这些数据，并且能够很好地访问和分析这些数据。我们估计的初选样本量 目标是每组3000个家庭。这将允许有足够的权力进行回归分析，控制 家庭、项目地点和社区特征。该项目将提供有关 当面开始家访关系的重要性，而不是通过远程高压。这方面的知识将会有所帮助 家访计划在未来更好地利用远程高压，从而为所服务的家庭带来更好的结果 这些情况，包括减少健康方面的不平等。

Summary Home visiting programs for new mothers have a broad range of goals, including improvements in maternal and child health, reductions in child maltreatment, and improvements in child development. Over 286,000 families facing adversity are served annually by 19 evidence-based models throughout the United States, which provide support, education, and connections to other services. Before 2020, only a small portion of visits were delivered through tele home visiting (teleHV; phone or video encounters). The Coronavirus Disease-2019 (COVID-19) pandemic required rapid adoption of teleHV; by early April 2020, 99% of home visits were by teleHV. Prior to 2020, teleHV was recommended only as a partial replacement for in-person visits and only after a relationship between the home visitor and family was established, because of the importance of the therapeutic relationship. This relationship is a key element across home visiting programs, because it serves as the foundation for teaching, mentoring, and collaborating with the family. There is limited evidence regarding teleHV, although we anticipate many families will use a mix of in-person visits and teleHV after COVID-19 restrictions are lifted due to greater flexibility and other advantages. We propose a secondary data analysis to make use of this natural experiment and determine if in-person visits during the establishment of the home visitor-family relationship is associated with better outcomes than teleHV during the establishment of this relationship. We will also explore if family characteristics associated with better outcomes vary between in- person home visiting and teleHV, which will contribute to our understanding of both acceptance and effectiveness of teleHV by family characteristics. We will consider both health outcomes (maternal depressive symptoms, breastfeeding, intimate partner violence [IPV]) and process outcomes (retention, visit attendance, screening completion). We will obtain data from a large, evidence-based home visiting program, Nurse-Family Partnership (NFP). NFP has approximately 260 sites across the United States; 1000 to 1600 pregnant first- time mothers enroll per month, before their third trimester and receive regular visits (frequency varies by developmental stage: weekly to monthly) from nurses during pregnancy through the child’s second birthday. The NFP National Service Office collects data on all enrolled families both at intake and at defined time points regarding visits, screenings, and outcomes (including maternal and child health). We have previously worked with these data and are well-positioned to access and analyze them. Our estimated sample size for the primary aim is 3000 families per group. This will allow sufficient power to conduct regression analyses, controlling for family, program site, and community characteristics. This project will provide critical new knowledge about the importance of starting the home visiting relationship in person vs. through teleHV. This knowledge will help home visiting programs better utilize teleHV in the future, resulting in better outcomes for the families served in these circumstances, including reductions in health inequities.