密集护士家庭访问和早期儿童的结果:一个随机临床试验
Katarina Swanson1, Sam Ayers2, Dea Oviedo3
1Harvard PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts.
JAMA pediatrics
|June 16, 2025
概括
在这项大型试验中,像护士家庭伙伴关系 (NFP) 这样的家庭访问计划并没有显著减少早期儿童的不良结果. 需要进一步的研究来评估规模化的家庭访问对儿童健康和发展的影响.
科学领域:
- 公共卫生 公共卫生
- 儿科 儿科 儿科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 建议进行家庭访问计划,以减轻幼儿时期的逆境并提高儿童的健康.
- 这些计划的大规模影响的证据仍在不断发展.
研究的目的:
- 评估护士家庭伙伴关系 (NFP) 家庭访问计划对儿童健康结果和生命前两年的医疗保健利用的影响.
- 评估NFP对不良健康结果,急诊室访问和低收入家庭预防性护理的影响.
主要方法:
- 一项随机临床试验,涉及南卡罗来纳州5670名符合医疗补助计划的孕妇,被分配给NFP或常规护理.
- 从2016-2020年收集的数据,分析重点关注产后两年的结果.
- 使用线性回归来比较群体之间的结果的治疗意图分析.
主要成果:
- 在NFP和常规护理组 (27.3%对26.8%) 之间,综合不良结果 (儿童死亡率,重大伤害,虐待/忽视问题) 没有统计学上显著的差异.
- 在NFP组中观察到急诊室使用率的非显著减少 (相对减少4%),在调整后失去了统计学意义.
- 被分配到NFP并没有显著影响健康儿童访问率或预防性服务采用率.
结论:
- 根据行政数据,通过NFP提供密集的护士家庭访问服务,当在医疗补助人口中大规模提供时,并没有减少早期儿童不良结果的发生率.
- 建议进行进一步的研究,以探索扩大家庭访问计划对其他儿童健康指标的影响,包括长期发育轨迹.
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