Problem stabilization in public health nurse home visiting intervention trajectories

Background: Health disparities persist for disadvantaged families, and resources for serving families are diminishing. It is imperative to maximize scarce nursing resources, and optimize client outcomes. Public health nurse (PHN) home visiting programs have been widely employed to improve life course trajectories for disadvantaged families. Home visiting programs are often lengthy, simultaneously addressing multiple problems. A new detailed data source, electronic PHN documentation, enables intervention trajectory research for specific client problems. Following more intensive interventions, a change to surveillance during an episode of care (stabilization) may indicate improvement in the respective problem. The objectives of the study are to describe client characteristics, describe problem-specific intervention patterns over time, and evaluate the effectiveness of intervention patterns. Methods: A retrospective cohort was created using family home visiting records from a local Midwest public health agency over a six year period (2000-2005). There were and average of 6.1 visits and 54.5 interventions per client. The data set consisted of Omaha System interventions and assessments for a total of 1390 clients, primarily mothers and infants. A Cox proportional hazards regression model assessing time to stabilization was fitted, including covariates of age, race/ethnicity, marital status, and baseline ratings for each client. Results: On average, 41% of client problems stabilized, (range 1.4% (caretaking/parenting) to 100% (neglect)). Factors related to stabilization differed by problem. For example, associated with the income problem, each additional mental health symptom resulted in .83 times decrease in likelihood to stabilize and clients stabilized later (p = .03); whereas for abuse, each additional income symptom resulted in .64 times decrease in likelihood to stabilize and clients stabilized later (p = .03). Results for the ten most common problems will be presented. Conclusions: Intervention data from PHN clinical documentation are useful in intervention pattern research. Stabilization, as an intermediate outcome of PHN home visiting care, appears to be meaningful in describing client response to PHN intervention. Complex associations between problems were revealed in this analysis. For example, more mental health symptoms, less adequate income, difficulty maintaining housing and increased abuse were all correlated. Future study will examine associations of multi-problem intervention patterns and outcomes.