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The Impact of Nurse Home-Visiting for Pregnant and Parenting Individuals with Previous Live Births
Gregory J Tung1,2, Venice N Williams3,4, Michael D Knudtson3,4
1Department of Health Systems, Management & Policy, Colorado School of Public Health, 13001 E. 17th Place, MS B119, Aurora, CO, 80045, USA. gregory.tung@cuanschutz.edu.
The Nurse-Family Partnership (NFP) benefits first-time parents and their children; however, its effectiveness for families with previous children (multiparous) is not known. This quasi-experimental study used electronic health record data from three NFP sites affiliated with large health systems to evaluate the impact of NFP on pregnancy, birth, and health care utilization outcomes among multiparous families compared with propensity score-matched Medicaid-insured families who did not receive NFP. The study population included 639 multiparous pregnant individuals enrolled in NFP between 2017 and 2021 and a matched comparison group of 6243 non-NFP Medicaid-insured individuals. No statistical differences were found between groups in preterm birth (OR 1.02, 95% CI [0.99, 1.05], p = 0.166), birth weight > 2500 g (OR 1.02, 95% CI [1.00, 1.05], p = 0.094), gestational hypertension (OR 1.02, 95% CI [1.00, 1.05], p = 0.084), child emergency department visits (OR 1.03, 95% CI [0.97, 1.09], p = 0.329), or hospitalizations for injuries (OR 0.0997, 95% CI [0.99, 1.00], p = 0.0503). NICU length of stay was lower for NFP participants (mean difference - 2.45 days) but did not reach statistical significance (95% CI [- 4.91, 0.02], p = 0.052). NFP participants also had higher odds of receiving long-acting reversible contraception (LARC) (OR 1.04, 95% CI [1.01, 1.08], p = 0.019) though this was not significant after adjusting for multiple comparisons. NFP participants did have significantly higher odds of receiving a postpartum visit within 6 weeks (OR 1.22, 95% CI [1.16, 1.24], p < 0.001) and recommended well-child visits (percentage point increase 6.61, 95% CI [3.36, 9.59], p = 0.001). NFP participation among multiparous families was associated with some health care utilization outcomes. These findings suggest a potential mechanism by which NFP may contribute to long-term maternal and child health improvements and highlight the need for further research to assess its effectiveness in this population.
The Nurse-Family Partnership (NFP) benefits first-time parents and their children; however, its effectiveness for families with previous children (multiparous) is not known. This quasi-experimental study used electronic health record data from three NFP sites affiliated with large health systems to evaluate the impact of NFP on pregnancy, birth, and health care utilization outcomes among multiparous families compared with propensity score-matched Medicaid-insured families who did not receive NFP. The study population included 639 multiparous pregnant individuals enrolled in NFP between 2017 and 2021 and a matched comparison group of 6243 non-NFP Medicaid-insured individuals. No statistical differences were found between groups in preterm birth (OR 1.02, 95% CI [0.99, 1.05], p = 0.166), birth weight > 2500 g (OR 1.02, 95% CI [1.00, 1.05], p = 0.094), gestational hypertension (OR 1.02, 95% CI [1.00, 1.05], p = 0.084), child emergency department visits (OR 1.03, 95% CI [0.97, 1.09], p = 0.329), or hospitalizations for injuries (OR 0.0997, 95% CI [0.99, 1.00], p = 0.0503). NICU length of stay was lower for NFP participants (mean difference - 2.45 days) but did not reach statistical significance (95% CI [- 4.91, 0.02], p = 0.052). NFP participants also had higher odds of receiving long-acting reversible contraception (LARC) (OR 1.04, 95% CI [1.01, 1.08], p = 0.019) though this was not significant after adjusting for multiple comparisons. NFP participants did have significantly higher odds of receiving a postpartum visit within 6 weeks (OR 1.22, 95% CI [1.16, 1.24], p < 0.001) and recommended well-child visits (percentage point increase 6.61, 95% CI [3.36, 9.59], p = 0.001). NFP participation among multiparous families was associated with some health care utilization outcomes. These findings suggest a potential mechanism by which NFP may contribute to long-term maternal and child health improvements and highlight the need for further research to assess its effectiveness in this population.
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