In Focus
Effects of Home Visiting and Maternal Mental Health on Use of the Emergency Department among Late Preterm Infants

https://doi.org/10.1111/1552-6909.12538Get rights and content

ABSTRACT

Objective

To describe use of the emergency department (ED) among late preterm versus term infants enrolled in a home visiting program and to determine whether home visiting frequency was associated with outcome differences.

Design

Retrospective, cohort study.

Setting

Regional home visiting program in southwest Ohio from 2007–2010.

Participants

Late preterm and term infants born to mothers enrolled in home visiting. Program eligibility requires ≥ one of four characteristics: unmarried, low income, < 18 years, or suboptimal prenatal care.

Methods

Data were derived from vital statistics, hospital discharges, and home visiting records. Negative binomial regression was used to determine association of ED visits in the first year with late preterm birth and home visit frequency, adjusting for maternal and infant characteristics.

Results

Of 1,804 infants, 9.2% were born during the late preterm period. Thirty‐eight percent of all infants had at least one ED visit, 15.6% had three or more. No significant difference was found between the number of ED visits for late preterm and term infants (39.4% vs. 37.8% with at least one ED visit, p = .69). In multivariable analysis, late preterm birth combined with a maternal mental health diagnosis was associated with an ED incident rate ratio (IRR) of 1.26, p = .03; high frequency of home visits was not significant (IRR = .92, p = .42).

Conclusions

Frequency of home visiting service over the first year of life is not significantly associated with reduced ED visits for infants with at‐risk attributes and born during the late preterm period. Research on how home visiting can address ED use, particularly for those with prematurity and maternal mental health conditions, may strengthen program impact and cost benefits.

Section snippets

Setting and Participants

In this retrospective, cohort study we examined ED use among late preterm and term infants born to at‐risk, first‐time mothers enrolled in a well‐established, regional home visiting program serving southwest Ohio. This community‐based home visiting program, which has to date served more than 19,000 families, comprises 11 local home visiting agencies which adhere to program, training, and evaluation standards established by a central office at Cincinnati Children's Hospital Medical Center

Results

Of the 1,804 infants meeting study inclusion criteria, 9.2% were born late preterm. No significant differences in maternal characteristics were observed among late preterm versus full term infants (56% vs. 52% with maternal age <20 years, p = .34), 96% versus 95% with single marital status (p = .56), and 81% versus 80% insured by Medicaid (p = .96). Forty‐eight percent of the sample enrolled in the home visiting program prenatally. Approximately 17.5% of infants were classified as receiving a

Discussion

The vulnerability of LPIs in terms of mortality, morbidity, and increased health care use in the neonatal period and later in infancy and early childhood, has been established in previous literature (Bird et al., 2010; Engle et al., 2007; Martin et al., 2009; Medoff‐Cooper et al., 2012; Raju et al., 2006). However, a gap remains in the evidence to support models of postdischarge care that may improve outcomes for this population (Premji et al., 2012). The majority of LPIs are not enrolled in

Conclusions

Late preterm infants have been previously shown to be at higher risk for ED use and rehospitalization compared with full‐term infants in the first year of life. This study is one of the first to focus on the utility of a community‐based program to mitigate outcomes in this population. We observed that within a socially at‐risk population of infants enrolled in home visiting, late preterm birth in combination with maternal mental health conditions is associated with more than twofold higher rate

Neera K. Goyal, MD, is an assistant professor in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

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    • Cited by (0)

    Neera K. Goyal, MD, is an assistant professor in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

    Alonzo T. Folger, PhD, is a senior epidemiologist in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

    Eric S. Hall, PhD, is an assistant professor in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

    Robert T. Ammerman, PhD, is a professor in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

    Judith B. Van Ginkel, PhD, is a professor in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

    Rita S. Pickler, RN, PhD, is a professor of nursing in the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

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    Copyright © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.