Bureau of Health Services, Tennessee Department of Health, Cordell Hull Building, 4th Floor, 425 5th Avenue North, Nashville, TN 37243, USA.
Matern Child Health J. 2012 Oct;16(7):1401-12. doi: 10.1007/s10995-011-0905-7.
The objective of this study is to report the findings of a 7-month pilot for an integrated system evaluating a state-wide home visiting program. A cross-sectional study design was used to determine baseline process and outcome measures for Tennessee's home visiting program which provides services to families, from pregnancy through 5-years-old. Baseline process measures included: time to initiate service after referral; frequency, duration and intensity of visits; completion of continuous assessment; and time from identification of a need to referral. The baseline outcome measures included: needs of eligible services (e.g. developmental screenings, WIC); prenatal care utilization; biological risks (prematurity; low birth weight); tobacco use and second-hand smoke exposure; and family planning utilization. During the pilot, 3,794 families were enrolled, representing 68% (± 1.5%) of incoming referrals. Enrollment dropped from 82% (90 days) to 69% (120 days); 52% of the families received a visit every month. Ninety percent of families had at least one full assessment after enrollment; 60% occurred within the first 60 days. Over 92% of outgoing referrals were made within 7 days. Immunization status (70%) is below the state level (80.8%). A quarter of the infants enrolled in the program are low birth weight and premature (state level 9.2%). Current tobacco use by the prenatal population is 16% compared to the state, 19.7%. The HUGS program serves high risk/high need clients and is consistent with other national home visiting models that have shown higher levels of attrition and lower levels of visits than intended by the model.
本研究旨在报告一项为期 7 个月的试点计划的结果，该计划评估了一个全州范围的家庭访视项目的综合系统。采用横断面研究设计，以确定田纳西州家庭访视计划的基线过程和结果衡量标准，该计划为从怀孕到 5 岁的家庭提供服务。基线过程衡量标准包括： referral 后开始服务的时间；访问的频率、持续时间和强度；连续评估的完成情况；以及从识别需求到 referral 的时间。基线结果衡量标准包括：合格服务的需求（例如发育筛查、WIC）；产前护理利用率；生物学风险（早产；低出生体重）；烟草使用和二手烟暴露；以及计划生育利用率。在试点期间，共招募了 3794 个家庭，占传入 referral 的 68%（±1.5%）。 enrolment 率从 82%（90 天）下降到 69%（120 天）；52%的家庭每月接受一次访问。90%的家庭在 enrolment 后至少进行了一次全面评估；60%的评估在头 60 天内进行。超过 92%的 outgoing referral 在 7 天内完成。免疫状况（70%）低于州水平（80.8%）。四分之一的 program 中婴儿低出生体重和早产（州水平 9.2%）。目前产前人群的烟草使用率为 16%，而州水平为 19.7%。HUGS program 服务于高风险/高需求客户，与其他国家家庭访视模式一致，这些模式显示出更高的流失率和低于预期的访问量。
