Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatrics, 168(9), 800-806.
Model(s) Reviewed:
Nurse-Family Partnership (NFP)®
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | Low | Not established on race or SES; outcome measures not assessable at baseline | None | None | Not assessed in manuscripts reviewed before 2021 |
| Study participants | The sample included pregnant, first-time mothers who were less than 29 weeks pregnant. Women were recruited through an obstetrical clinic if they had no previous live births, no chronic illnesses linked to fetal growth retardation or preterm delivery, and at least two of the following sociodemographic characteristics: unmarried, less than 12 years of education, and unemployed. From June 1990 through August 1991, 1,138 women were randomly assigned to one of four intervention groups (two treatment and two control conditions) after providing informed consent. Of the 1,138 women randomized into the four conditions, all 1,138 were included in the analytic sample to assess maternal mortality. Approximately 89 to 96 percent of women in this sample were African American and 1 to 3 percent were married. The average age was 18 years and the average education level was 10 years. On average, women lived in census tracts with 35 to 39 percent of the population living below the poverty level. This study measures maternal and child mortality outcomes 21 years after randomization. |
|---|---|
| Setting | Memphis, Tennessee |
| Intervention services | The study included two treatment groups. The first treatment group received home visits from a nurse during pregnancy and two postpartum visits (one in the hospital before discharge and another in the home). The treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. On average, the nurses completed 7 home visits during pregnancy and 26 home visits postpartum. Nurses used a detailed protocol for each visit, which focused on health-related behaviors, parenting, education, and employment. |
| Comparison conditions | The study included two comparison groups. The first comparison group received taxicab transportation for prenatal care appointments. The second comparison group received the transportation plus developmental screening and referral to services when the children were 6, 12, and 24 months old. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | National Institute of Drug Abuse (grant 1R01DA021624) |
| Author affiliation | David L. Olds, a study author, is a developer of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Study Registration:
Clinicaltrials.gov Identifier: NCT00708695. Study registration was assessed by HomVEE beginning with the 2014 review.
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | 20 year child mortality rate - all causes (Nurse home visits during pregnancy and infancy vs. developmental screening comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy and infancy vs. developmental screening comparison (Memphis) | 20 years | 708 mother/child dyads | Unadjusted mean = 0.01 | Unadjusted mean = 0.03 | Mean difference = -0.02 | HomVEE calculated = -0.68 | Not statistically significant, p = 0.11 | Negative value is favorable to the intervention.
|
| Moderate | 20 year child mortality rate - preventable cause (Nurse home visits during pregnancy and infancy vs. developmental screening comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy and infancy vs. developmental screening comparison (Memphis) | 20 years | 708 mother/child dyads | Unadjusted mean = 0.00 | Unadjusted mean = 0.02 | Mean difference = -0.02 | Not available | Statistically significant, p = 0.04 | Negative value is favorable to the intervention.
|
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | 21 year maternal mortality rate - all causes (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) | 21 years | 1,138 mother/child dyads | Unadjusted mean = 0.01 | Unadjusted mean = 0.04 | Mean difference = -0.03 | HomVEE calculated = -0.69 | Statistically significant, p = 0.01 | Negative value is favorable to the intervention.
|
| Moderate | 21 year maternal mortality rate - all causes (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) | 21 years | 1,138 mother/child dyads | Unadjusted mean = 0.01 | Unadjusted mean = 0.04 | Mean difference = -0.03 | HomVEE calculated = -0.69 | Statistically significant, p = 0.01 | Negative value is favorable to the intervention.
|
| Moderate | 21 year maternal mortality rate - external cause (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) | 21 years | 1,138 mother/child dyads | Unadjusted mean = 0.00 | Unadjusted mean = 0.02 | Mean difference = -0.01 | HomVEE calculated = -1.22 | Statistically significant, p = 0.02 | Negative value is favorable to the intervention.
|
| Moderate | 21 year maternal mortality rate - external cause (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) | 21 years | 1,138 mother/child dyads | Unadjusted mean = 0.00 | Unadjusted mean = 0.02 | Mean difference = -0.01 | HomVEE calculated = -1.22 | Statistically significant, p = 0.02 | Negative value is favorable to the intervention.
|
| Moderate | 21 year maternal mortality rate - all causes (Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison (Memphis) | 21 years | 910 mother/child dyads | Unadjusted mean = 0.00 | Unadjusted mean = 0.04 | Mean difference = -0.04 | HomVEE calculated = -1.41 | Statistically significant, p = 0.01 | Negative value is favorable to the intervention.
|
| Moderate | 21 year maternal mortality rate - external cause (Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison) | FavorableUnfavorable or ambiguousNo Effect |
Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison (Memphis) | 21 years | 910 mother/child dyads | Unadjusted mean = 0.00 | Unadjusted mean = 0.02 | Mean difference = -0.02 | Not available | Not statistically significant, p = 0.05 | Negative value is favorable to the intervention.
|