Paul, I. M., Phillips, T. A., Widome, M. D., & Hollenbeak, C. S. (2004).Pediatrics,114(4), 1015-1022.

This study adds to the growing body of evidence supporting the effectiveness of home visits by nurses to childbearing families. Particularly, the study focuses on neonates and their parents in the period immediately after hospital discharge. Although the American Academy of Pediatrics (AAP) recommends that infants released from the hospital less than 48 hours after delivery must be reassessed by a healthcare provider in the subsequent 2 days, only one-quarter to one-half of infants have follow-up care consistent with these recommendations. The American Nurses Association advocates a nurse home visit model of postpartum care versus an initial visit to a physician's office, but little research has focused on the impact of one well-timed nursing postpartum home visit on health outcomes. This study included infants discharged from the newborn nursery at a Pennsylvania medical center in 2000, 2001, and 2002. Because jaundice and dehydration are two harmful, yet preventable, conditions that typically present on the third and fourth day of life, nurse home visits assessed the weight, jaundice, and hydration of term or near-term infants within 48 hours of hospital discharge.

Results indicated that a single nurse home visit reduces hospital readmission by about 90%. Of the 2,641 babies who didn't get a home visit, 2.8% (73) were readmitted within 10 days, and 3.5% (92) went to the emergency room (ER). Among the 326 newborns who were home visited, only 0.6% (2) were readmitted and none ended up in the ER. Further, a cost-effectiveness analysis also revealed that home visits work. The average cost per child of those who received home visits was $109.80 versus $118.70 for those who didn't. Incremental cost effectiveness was $181.72, comparing a home-visit with a no-visit strategy.

I'm sending this study to the president of our local health insurance company. I encourage you to do the same. It's good news that postpartum home visits by nurses are cost effective in reducing the need for subsequent hospital-based services. Let's share the evidence with those who make decisions about care of childbearing families.

Comment by Linda Beth Tiedje