This program of prenatal and infancy home-visiting by nurses continued to improve the lives of women and children at child age 6 years, 4 years after the program ended.

OBJECTIVE-Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2.METHODS-We conducted a randomized, controlled trial in a public system of obstetric and pediatric care. A total of 743 primarily black women <29 weeks' gestation, with previous live births and at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality.RESULTS-Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with controlgroup counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes.CONCLUSIONS-By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.Address correspondence to David L. Olds, PhD, University of Colorado at Denver and Health Sciences Center, 1825 Marion St, Suite 200, Denver, CO 80218. olds.david@tchden.org. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 March 16. Published in final edited form as:Pediatrics. Home visiting by nurses for low-income, at-risk families has been promoted as a promising strategy for preventing child abuse and neglect, children's mental health problems, 1-3 and infant mortality. 4 Recent evidence suggests that the benefits hoped for from such programs do not hold for all types of home-visiting programs. 5 A program of home visiting by nurses known as the Nurse-Family Partnership (NFP) has produced consistent effects on several aspects of maternal and child heal...

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We found enduring effects of a home visitation program on the lives of black women living in an urban setting. While these results were smaller in magnitude than those achieved in a previous trial with white women living in a semirural setting, the direction of the effects was consistent across the 2 studies.

Nurse home visitation has been an important component of public health for over 100 years. Recent reports of large clinical trials have provided a convincing body of evidence of the cost-effectiveness of home visitation. The findings from these studies have helped to renew policy interest in nurse home visitation as a means of improving health and quality of life for low-income families. Reimplementing home visitation on a large scale, however, will require using nurses with little or no home-visiting experience. Sponsoring organizations must delegate, and nurses from hospitals or clinics must accept, responsibility for both increased autonomy and discretion of home visitors. Case study analysis of observational and interview data from the implementation of a large demonstration home visitation program carried out in a health department in a mid-South city from 1989 to 1994 provides evidence that the bottom-up perspective of Hanf and Toonen (1983) best describes how such programs can be put in place. Nurses with little community experience were able to create appropriate strategies to help families achieve the broad program goals in the context of resource constraints associated with a poverty-level lifestyle and the existing health and human service system. Furthermore, nurses were able to establish an organizational culture and job structure in a city/county health department to support their work.

Objective. To describe the implementation and outcomes of a sustainable Medicare Plan Selection Assistance Program conducted through a partnership between Auburn University Harrison School of Pharmacy (AU) and the Alabama State Health Insurance and Assistance Program (SHIP) since 2013. Methods. The Program's goal is to assist Medicare beneficiaries in Medicare Part D plan selection. Reported outcomes included Medicare beneficiaries' plan cost savings and satisfaction, and pharmacy students' self-reported changes in knowledge and attitudes. Results. Each year, over 80 pharmacy students assisted more than 120 beneficiaries; at least 10 events were held covering 6-10 Alabama counties. On average, Medicare beneficiaries had a projected savings of $278.71 (2013), $1,081.66 (2014), $842.84 (2015), and $1,382.90 (2016) after enrolling in a new plan, and most students reported perceived increased ability to help beneficiaries select the most appropriate Medicare Part D plan.