Pilot test of a maternal risk index score to assess PHN caseload risk and forecast care needs

Background: High caseloads in public health nurse (PHN) home visiting are associated with reduced efficiency in the delivery of care, and with reactive rather than proactive care. Suggested optimal staffing is 20-30 clients per nurse. Such caseloads ensure client safety and encourage innovative modes of delivery of care. However, there is pressure to increase caseload size due to fiscal constraints. No two clients are alike, and their care needs differ, which poses challenges in caseload management. The purpose of this pilot study was to test a maternal risk index to assess PHN caseload risk and forecast care needs. A maternal risk index for family home visiting has been developed, revised, and validated using PHN family home visiting data from three states. The formula takes into account known maternal risk factors, including number of client problems, baseline knowledge scores, and co-morbidities such as poverty, mental health problems, abuse, and substance use. Methods: A retrospective cohort design and de-identified client assessment were employed to test associations between client risk index scores and actual length of client services at a local public health agency. The data were obtained from public health nurse clinical documentation in an electronic health record. Results: Preliminary results show a positive association between the risk score and duration of care. Final results will be presented iat the conference. Conclusions: A maternal risk index based on PHN assessments provides valuable caseload management information to support optimal client care and outcomes.