Evaluating the "right@home" randomized trial of nurse home visiting using linked administrative data at school transition.

INTRODUCTION

Nurse home visiting (NHV) is designed to redress child and maternal health inequities, but long-term evaluation is hampered by sample attrition. Evaluation using administrative data has the potential to overcome attrition through provision of a more complete outcome profile. Australia's "right@home" trial is the only long-running evaluation of NHV designed for a population with universal healthcare.

OBJECTIVES

To investigate the effects of the NHV program on children's health and development outcomes and service use, compared with usual care (comparator), using linked administrative data at school transition.

METHODS

A screening survey identified pregnant women experiencing adversity from antenatal clinics across two states (Victoria, Tasmania). 722 were randomized: 363 to the right@home program (25 visits promoting parenting and home learning environment) and 359 to usual care. At children's first birthdays, 198/237 (83.5%) Tasmanian and 420/485 (86.6%) Victorian parents consented to data linkage with the Tasmanian Kindergarten Development Check (KDC, 4 years) and Victorian School Entrant Health Questionnaire (SEHQ, 5-6 years), respectively. Jurisdictional differences meant measures could not be harmonized, and variables varied in their interpretability. Following best-practice methods for managing missing data, outcomes were compared between groups (intention-to-treat) using regression models adjusted for stratification factors, baseline variables, and nurse/site cluster.

RESULTS

Linked data were obtained for n = 134/237 (56.5%) Tasmanian and n = 252/485 (52.0%) Victorian children. These children had substantially higher prevalence of negative life events and poorer health and development outcomes, and used similar or more services than children state-wide. Compared with usual care, the NHV program increased KDC achievement and SEHQ health service use. There was less evidence for program impacts on SEHQ outcomes.

CONCLUSIONS

Benefits of NHV were evident at school transition for child development outcomes and service use. This adds further evidence for NHV being an important component of universal health services that deliver support responsive to families' needs.

REGISTRATION: ISRCTN89962120.