Black or African American
52%
McConnell, M. A., Rokicki, S., Ayers, S., Allouch, F., Perreault, N., Gourevitch, R. A., Martin, M. W., Zhou, R., A., Zera, C., Hacker, M. R., Chien, A., Bates, M. A., & Baicker, K. (2022). Effect of an intensive nurse home visiting program on adverse birth outcomes in a Medicaid-eligible population: A randomized clinical trial. JAMA, 328(1), 27–37. https://doi.org/10.1001/jama.2022.9703
Peer Reviewed
Model(s): Nurse-Family Partnership (NFP)®
Study Registration: ClinicalTrials.gov
Study design characteristics contributing to rating
| Design | Attrition | Baseline equivalence | Confounding factors? | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low |
Not assessed for randomized controlled trials with low attrition |
No |
Yes |
Notes from the review of this manuscript
Information on sample sizes and adjusted means for the study’s findings is based on correspondence with the authors.
Child Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Adverse birth outcome composite | Child's birth | High | 0.02 | Not statistically significant, p= ≥0.05 | 4966 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Extremely preterm birth | Child's birth | High | 0.00 | Not statistically significant, p= ≥0.05 | 4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Large for gestational age | Child's birth | High | 0.11 | Not statistically significant, p= ≥0.05 | 4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Mean birth weight (in grams) | Child's birth | High | 0.01 | Not statistically significant, p = 0.67 | 4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Mean gestational age (in weeks) | Child's birth | High | 0.04 | Not statistically significant, p = 0.15 | 4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Neonatal morbidity | Child's birth | High | 0.09 | Not statistically significant, p= ≥0.05 | 4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Overnight NICU stay | Child's birth | High | 0.06 | Not statistically significant, p= ≥0.05 | 4543 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Very low birth weight | Child's birth | High | 0.17 | Not statistically significant, p= ≥0.05 | 4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
Maternal Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Cesarean delivery | Child's birth | High | 0.06 | Not statistically significant, p= ≥0.05 | 4932 mothers | NFP vs. usual care RCT, South Carolina 2016-2021, full sample | |
| Severe maternal morbidity | Child's birth | High | 0.13 | Not statistically significant, p= ≥0.05 | 5158 mothers | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
This study included participants from the following locations:
- South Carolina
Study Participants
Participants could refer themselves to the program or be referred through clinicians, schools, or Medicaid. Eligible participants had to be pregnant (< 28 weeks’ gestation) with no previous live births, income-eligible for Medicaid during pregnancy, and residing in a program-served county in South Carolina. Participants were ineligible if they were age 14 or younger or were incarcerated or in a lockdown facility. They were randomized to either the Nurse-Family Partnership intervention (3,806 participants) or the comparison condition (1,864 participants). Four thousand nine hundred and sixty-six mothers were included in the analyses in this manuscript (3,319 in the intervention group and 1,647 in the comparison group). Participants were in the study from the time of enrollment at pregnancy until the child was 24 months old. Outcomes presented in this manuscript were measured at the child’s birth. In the study, 55 percent of the participants were Black and 35 percent were White, and at enrollment, 82 percent were age 19 or older. Thirty-five percent had a high school diploma or equivalent, whereas 42 percent had some college, a college degree, or postgraduate training.
Setting
The study took place in South Carolina.
Intervention condition
Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.
Comparison Conditions
Participants assigned to the comparison condition were not eligible to receive home visits through Nurse-Family Partnership. They received usual care, including access to all other community and medical services. They were provided with a list of available community resources.
Subgroups examined
• Mother has vulnerability (yes or no) • Race/ethnicity (Black or non-Black)
Funding Sources
This research was supported by the Children’s Trust of South Carolina, Arnold Ventures, The Duke Endowment, BlueCross BlueShield Foundation of South Carolina, and the Abdul Latif Jameel Poverty Action Lab North America Health Care Delivery Initiative.