Meghea C I, Li B, Zhu Q, Raffo J E, Lindsay J K, Moore J S, Roman L A
Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, College of Human Medicine, East Lansing, MI 48824-1316, USA.
Child Care Health Dev. 2013 Jan;39(1):27-35. doi: 10.1111/j.1365-2214.2012.01370.x. Epub 2012 Feb 28.
Home visiting is supported as a way to improve child health and development. Home visiting has been usually provided by nurses or community health workers (CHWs). Few studies compared the child health advantages of a nurse-CHW team approach over nurse prenatal and postnatal home visiting.
A randomized trial was conducted with Medicaid-insured pregnant women in Kent County, Michigan. Pregnant women were assigned to a team intervention including nurse-CHW home visitation, or standard community care (CC) including nurse home visitation. Morbidity was assessed in 530 infants over their first 12 months of life from medical claims and reported by the mother.
There were no differences in overall child health between the nurse-CHW intervention and the CC arm over the first year of life. There were fewer mother-reported asthma/wheezing/croup diagnostics in the team intervention group among infants whose mothers have low psychosocial resources (13% vs. 27%, P = 0.01; adjusted OR = 0.4, P = 0.01). There were no differences in diagnosed asthma/wheezing/croup documented by medical claims. There were no differences in immunizations, hospitalizations and ear infections.
There was no strong evidence that infant health was improved by the addition of CHWs to a programme of CC that included nurse home visitation. Targeting such interventions at common health problems of infancy and childhood or at diagnosed chronic conditions may prove more successful.
家访被认为是改善儿童健康和发育的一种方式。家访通常由护士或社区卫生工作者（CHW）提供。很少有研究比较护士 - CHW团队方式与护士产前和产后家访在儿童健康方面的优势。
在密歇根州肯特县对参加医疗补助计划的孕妇进行了一项随机试验。孕妇被分配到团队干预组，包括护士 - CHW家访，或标准社区护理（CC）组，包括护士家访。通过医疗理赔记录并由母亲报告，对530名婴儿在其生命的前12个月内的发病率进行了评估。
在生命的第一年，护士 - CHW干预组和CC组在儿童总体健康方面没有差异。在母亲心理社会资源较低的婴儿中，团队干预组中母亲报告的哮喘/喘息/哮吼诊断较少（13%对27%，P = 0.01；调整后的OR = 0.4，P = 0.01）。医疗理赔记录的确诊哮喘/喘息/哮吼方面没有差异。在免疫接种、住院和耳部感染方面也没有差异。
没有有力证据表明，在包括护士家访的CC计划中增加CHW能改善婴儿健康。针对婴儿期和儿童期的常见健康问题或已确诊的慢性病进行此类干预可能会更成功。
