Public Health

Postpartum home nursing visits cost-effective for preventing hospital care

Last Updated: 2004-10-07 15:13:57 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - A home nursing visit a few days after delivery is a cost-effective way to prevent hospital care for neonatal jaundice and dehydration, according to a report in the October issue of Pediatrics.

"The third or fourth day after delivery is the time when babies can get into trouble with jaundice and dehydration and the American Academy of Pediatrics and other groups recommend follow-up on these days," lead author Dr. Ian Paul, from Penn State Children's Hospital in Hershey, Pennsylvania, told Reuters Health.

However, the reality is that infants are often not seen on these days, either "because the pediatrician is unaware of the recommendations, their office is too busy to squeeze in more babies on the appropriate day, or simply because the office is closed," Dr. Paul explained.

"People have been talking about home nursing visits as a way to improve follow-up," Dr. Paul noted, "but few studies have looked at whether such visits improve health outcomes and whether they are cost effective."

To investigate, the researchers analyzed data from all neonates who were born at the Hershey Medical Center between 2000 and 2002. A total of 2967 infants were identified, including 326 who received a home nurse visit and 2641 who did not.

The rate of hospital readmission for jaundice/dehydration in the first 10 days of life was 2.8% for the non-nurse group compared with just 0.6% for the nurse group. The corresponding rates for an ER visit in the first 10 days of life were 3.5% and 0%.

The average cost per child in the non-nurse group was $118.70 compared with $109.80 per child in the nurse group. The cost benefit of the nurse visit strategy is due to the avoidance of an ER visit and hospital admission; while a home nurse visit costs insurers about $85, an ER visit and hospital admission typically cost around $400 and $4000, respectively, the investigators note.

"A home nurse visit provides a bridge over the gap between nursery care and primary care," Dr. Paul said. "Such visits are already standard of care in England, many areas of Canada, and several other countries."

Still, given the retrospective nature of the current study, Dr. Paul believes a prospective study is warranted to verify the cost-effectiveness of this approach.

Pediatrics 2004;114:1015-1022.