Duke study: Home visits to newborns by nurses prevent costly care later

jstancill@newsobserver.comNovember 1, 2013 

— New moms are usually exhausted, uneasy and overwhelmed with feeding and caring for their precious ones. The arrival of a friendly face at the door can seem like a lifeline.

When that visitor is a nurse, all the better.

Even minimal nurse visits to newborn babies’ homes pay dividends later, with a reduction in expensive emergency room experiences, a new Duke University study shows.

The study in the Nov. 1 issue of the journal Pediatrics examined results from a Durham program that provides limited visits by nurses to the homes of newborns. The program, called Durham Connects, costs an average of $700 per family. But in the first year of life, infants served by the program had 50 percent less emergency hospital care, which can cost thousands of dollars.

The new federal health care law provides funding for some home visiting programs, which are becoming more common as a preventive health care strategy.

Home visits from nurses have long been considered a reliable way to ensure a healthy start for mother and parents, but such efforts can be costly. Nurse visiting programs typically target poor families, with multiple contacts over many months. The Durham Connects program is a less expensive version across an entire population, with a few visits from nurses who then link patients to other services in the community.

The Duke study showed that preventive benefits extended to all – the privately insured, those with no insurance and low-income families on Medicaid. For a relatively small investment early in a child’s life, the reward is significant, say study authors Kenneth Dodge, director of Duke’s Center for Child and Family Policy, and Ben Goodman, a Duke research scientist.

“Babies don’t come with instruction manuals, and we like to think of the Durham Connects program as maybe being that instruction manual,” Goodman said.

‘A refresher course’

On Thursday, nurse Paula Wright visited Vinetta Hatley and her 2-week-old daughter, Khloe Bright. A check revealed that little Khloe had climbed back up to her birth weight – a relief to Hatley, who was breastfeeding.

Wright brought Hatley a nursing pillow and a new infant thermometer. The two talked about what to do if Khloe got a fever, Hatley said, and discussed that the hospital shouldn’t be her parents’ first health care stop.

“It was like a refresher course,” said Hatley, who has two other children.

The nurse also instructed Hatley to stop using a small finger brush to wipe away milk residue on the baby’s tongue, because it could be a choking hazard.

Melanie Busbee called Durham Connects before she even met her nurse in the spring of 2012. Struggling with breastfeeding, she asked for help. The program directed her to lactation consultants in Durham and support groups for new moms.

When the nurse arrived, Busbee’s 3-week-old daughter Natalie was crying, the house was a mess and the postpartum emotions were raw.

“She really focused on what I needed as a parent to make sure that I could be the best mother to my child,” said Busbee, a communications specialist at UNC. “It was valuable to me because nobody else was asking me those questions.”

The Duke research team started with all 4,777 babies born in Durham County between July 1, 2009 and Dec. 31, 2010. Children born on even dates were offered the program. The scientists studied the medical records for a random sample of more than 500 families, comparing those who got nurse visits and those who didn’t.

From hospital to home

Nurses visit parents soon after the newborn is home from the hospital. Included in the visits are tips on breastfeeding and child care and screening for postpartum depression. The initial visits usually last more than an hour. The free program provides one to three home visits and follow-up phone calls.

The nurses make sure patients are connected to pediatricians and primary care doctors, and they can recommend parenting classes and other free community resources.

“It’s getting into the home right around the time of birth and helping families to get started off on the right foot and to get set on a trajectory that’s going to promote good outcomes over time,” said Goodman, the Duke researcher.

Focused attention

Pam Dardess said such early care is important for any new mom. Dardess, a health care researcher who has a master’s degree in maternal and child health, benefited from a nurse visit in early 2012 after the birth of her second daughter, Maya.

Dardess had suffered postpartum depression after her first child; because Maya was born four weeks early, she was on edge.

“The way that our lives and communities are structured now, a lot of people aren’t surrounded by their family,” Dardess said. “We don’t have that constant level of support. Having a nurse come in and having someone whose attention is focused on you and your baby and your family unit together, is so incredibly helpful.”

Durham Connects is funded primarily by The Duke Endowment, with additional money from Durham County, smaller foundations and Medicaid reimbursements.

A version of the program will soon be running in rural Eastern North Carolina, in Beaufort, Bertie, Chowan and Hyde counties. It is funded with money from the federal government’s Race to the Top early learning grant competition.

Stancill: 919-829-4559

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