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Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1015-1022 (doi:10.1542/peds.2003-0766-L)
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Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration

Ian M. Paul, MD, MSc*,{ddagger}, Troy A. Phillips, MHA§, Mark D. Widome, MD, MPH*, Christopher S. Hollenbeak, PhD{ddagger},||

* Departments of Pediatrics
{ddagger} Health Evaluation Sciences
§ Finance
|| Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

Objectives. (1) To describe the relationship between postnatal home nursing visitation and readmissions and emergency department (ED) visits for neonatal jaundice and dehydration in the first 10 days of life. (2) To evaluate the cost-effectiveness of providing home nursing visits after newborn discharge with specific attention to prevention of jaundice and dehydration that require hospital-based services.

Methods. A retrospective analysis of a financial database allowed for review of the discharge disposition and subsequent care for all neonates who were born at a single center from January 2000 through December 2002. Financial data reflect reimbursement values and costs of care from the payers’ perspective at the single center. We performed a deterministic cost-effectiveness analysis using a decision tree that reflected the costs and probabilities of infants in each particular health state after nursery discharge.

Results. A total of 73 (2.8%) of 2641 newborns who did not receive a home visit were readmitted to the hospital in the first 10 days of life with jaundice and/or dehydration compared with 2 (0.6%) of 326 who did receive a home visit. Similarly, 92 (3.5%) of 2641 newborns who were discharged without subsequent home nursing care had an ED visit for these reasons in the first 10 days of life compared with 0 (0%) of 326 who did have such a visit. Of infants who received a home visit, 324 (99.4%) of 326 did not require subsequent hospital services in this time period compared with 2497 (94.5%) of 2641 of those who did not receive a visit. After nursery discharge, the average cost per child who received a home health visit was $109.80 compared with $118.70 for each newborn who did not receive a visit. The incremental cost-effectiveness ratio of a routine home visit strategy compared with a no visit strategy was –$181.82.

Conclusions. A home nursing visit after newborn nursery discharge is highly cost-effective for reducing the need for subsequent hospital-based services.

Key Words: home visit • nurse • jaundice • dehydration • newborn • cost-effectiveness

Abbreviations: LOS, length of stay • AAP, American Academy of Pediatrics • ED, emergency department • ICER, incremental cost-effectiveness ratio

Accepted Mar 1, 2004.


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