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Olds, D. L., Henderson Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77(1), 16.

Model(s) Reviewed: Nurse-Family Partnership (NFP)®
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
High Randomized controlled trial Low Established on race and SES. None None
Notes:

footnote12

Submitted by user on Fri, 03/15/2019 - 14:29

Olds, Henderson, Tatelbaum and Chamberlin (1986) analyzed other outcomes in the maternal health domain, including participation in childbirth education and number of cigarettes per day, but these are not reported in the <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> table because the sample size used for these outcomes is substantially smaller than the sample on which baseline equivalence was established.

footnote30

Submitted by user on Fri, 03/15/2019 - 14:29

The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.

Study characteristics
Study participants The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. Roughly 42 percent of the sample was married. This study measured the sample in the 32nd week of pregnancy and the time of birth. The study sample included 354 women, 189 in the program group and 165 in the comparison group.
Setting The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents.
Intervention services The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services.
Comparison conditions The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening.
Staff characteristics and training All home visitors were nurses. No other information on training is provided.
Funding sources Bureau of Community Health Services (HHS-MCR-360403-06), the Robert Wood Johnson Foundation (grant 5263), and the W. T. Grant Foundation (grant 0723-80). The serum cotinine assays were carried out in the laboratories of Dr. Helen Van Vunakis at Brandeis University and were partially supported by grant DA 2407 from the Department of Health and Human Services.
Author affiliation David L. Olds, a study author, is a developer of this model.

Findings details

Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Child birth weight (grams)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Birth 308 children Adjusted mean = 3285.00 Adjusted mean = 3262.00 Mean difference = 23.00 Not available Not statistically significant,
p > 0.05
High Length of gestation
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Birth 308 children Adjusted mean = 39.57 Adjusted mean = 39.71 Mean difference = -0.14 Not available Not statistically significant,
p > 0.05
High Percentage low birth rate, (≤ 2,500 grams)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Birth 308 children % (adjusted) = 5.78 Adjusted mean % = 2.61 Mean difference = 3.17 HomeVEE calculated = 0.50 Not statistically significant,
p > 0.05
High Percentage preterm delivery (< 37 weeks)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Birth 308 children % (adjusted) = 6.90 Adjusted mean % = 7.27 Mean difference = -0.37 HomeVEE calculated = -0.03 Not statistically significant,
p > 0.05
Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Number of nutritional supplementation vouchers
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) 32 weeks 288 mothers Mean = 2.18 Mean = 1.56 Mean difference = 0.62 Not available Statistically significant,
p ≤ 0.05
Linkages and referrals
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Number of services known
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) 32 weeks postpartum 294 mothers Mean = 4.91 Mean = 5.47 Mean difference = -0.56 Not available Statistically significant,
p ≤ 0.01
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Average weight gain (pounds)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Prepregnancy to last prenatal visit 289 mothers Mean = 35.71 Mean = 32.78 Mean difference = 2.93 Not available Not statistically significant, p ≥ 0.05
High Bladder infection (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to delivery 306 mothers Mean % = 10.00 Mean % = 6.00 Mean difference = 4.00 HomeVEE calculated = 0.34 Not statistically significant, p ≥ 0.05
High Change in average adequacy of diet (percentage RDA)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to week 32 253 mothers Mean = 4.14 Mean = -0.33 Mean difference = 3.81 Not available Statistically significant,
p ≤ 0.05
High Change in blood pressure
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to last prenatal visit 295 mothers Mean = 7.60 Mean = 7.13 Mean difference = -0.47 Not available Not statistically significant, p ≥ 0.05
High Change in percentage experienced bleeding
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) First to third trimester 295 mothers = 0.00 = 0.05 Mean difference = 5.00 Not available Not statistically significant, p ≥ 0.05

footnote150

Submitted by user on Fri, 03/15/2019 - 14:29

High score equals unfavorable.

High Change in percentage experienced spotting
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) First to third trimester 308 mothers = -0.03 = -0.06 Mean difference = -3.00 HomeVEE calculated = -0.40 Not statistically significant, p ≥ 0.05
High Edema (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to delivery 308 mothers Mean % = 62.00 Mean % = 58.00 Mean difference = 0.04 HomeVEE calculated = 0.10 Not statistically significant, p ≥ 0.05
High Hematocrit (percentage, last before delivery)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to delivery 308 mothers Mean % = 36.76 Mean % = 36.67 Mean difference = 0.09 HomeVEE calculated = 0.00 Not statistically significant, p ≥ 0.05
High Hypertensive disorder of pregnancy (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to delivery 308 mothers Mean % = 4.00 Mean % = 7.00 Mean difference = -3.00 HomeVEE calculated = -0.36 Not statistically significant, p ≥ 0.05
High Kidney infection (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to delivery 306 mothers Mean % = 0.00 Mean % = 3.00 Mean difference = -3.00 Not available Statistically significant,
p ≤ 0.01
High Number alcoholic drinks per week (average change)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to week 32 293 mothers Mean = -0.04 Mean = -0.06 Mean difference = -0.02 Not available Not statistically significant, p ≥ 0.05
High Number of antepartum visits
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) 32 weeks 292 mothers Mean = 10.49 Mean = 10.50 Mean difference = -0.01 Not available Not statistically significant, p ≥ 0.05
High Number of calls to physician/clinic
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) 32 weeks 292 mothers Mean = 1.43 Mean = 1.72 Mean difference = -0.29 Not available Not statistically significant, p ≥ 0.05
High Proteinuria (≥ 2+, percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Elmira) Enrollment to delivery 308 mothers Mean % = 5.00 Mean % = 3.00 Mean difference = 2.00 HomeVEE calculated = 0.32 Not statistically significant, p ≥ 0.05

Outcome measure summary

Child health
Outcome measure Description of measure Data collection method Properties of measure

Child birth weight

The child’s recorded birth weight in grams Review of medical records

Not applicable

Length of gestation

The length of gestation in weeks was estimated using newborn physical and neurologic examinations, (based on the Dubowitz procedure) and ultrasound readings taken before the 28th week of pregnancy. In the absence of examination and ultrasound data, reported last menstrual periods and measurements of uterine size made before 20 weeks were used. For low birth weight infants, gestational age was estimated using the newborn physical examination. Review of medical records

Not applicable

Percentage low birth weight

Percentage of children with birth weight less than or equal to 2,500 grams Review of medical records

Not applicable

Percentage preterm delivery

Percentage of children who were delivered at less than 37 weeks’ gestation Review of medical records

Not applicable

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Number of nutritional supplementation vouchers

The number of WIC vouchers the family received

Parent/caregiver report

Not applicable

Linkages and referrals
Outcome measure Description of measure Data collection method Properties of measure

Number of services known

Numbers of services in the community that mothers knew were available to them. Parent/caregiver report

Not applicable

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Average weight gain

The change in reported weight (pounds) from early to late pregnancy Review of medical records

Not applicable

Bladder infection

Percentage of mothers who had diagnosed bladder infections, including urinary tract infections not identified specifically as kidney infections Review of medical records

Not applicable

Change in average adequacy of diet

The change from early to late pregnancy in the reported average percentage of RDAs consumed by mothers Parent/caregiver report

Not applicable

Change in blood pressure

The change in reported blood pressure (diastolic mm Hg) from early to late pregnancy Review of medical records

Not applicable

Change in percentage experienced bleeding

The percentage change from early to late pregnancy in the proportion of women reporting that they experienced bleeding Review of medical records

Not applicable

Change in percentage experienced spotting

The percentage change from early to late pregnancy in the proportion of women reporting that they experienced spotting Review of medical records

Not applicable

Edema

Percentage of mothers who had an edema Review of medical records

Not applicable

Hematocrit

The percentage of blood volume that is populated by red blood cells as measured prior to delivery Review of medical records

Not applicable

Hypertensive disorder of pregnancy

Percentage of mothers diagnosed with hypertensive disorder of pregnancy Review of medical records

Not applicable

Kidney infection

Percentage of mothers who had diagnosed kidney infections Review of medical records

Not applicable

Number alcoholic drinks per week

The average change from early to late pregnancy in the number of drinks mothers reported consuming per week Parent/caregiver report

Not applicable

Number of antepartum visits

Number of antepartum visits to a physician Parent/caregiver report

Not applicable

Number of calls to physician/clinic

Number of antepartum calls to a physician or clinic Parent/caregiver report

Not applicable

Proteinuria

The proportion of respondents with a score greater than or equal to 2+ on a test assessing the presence of proteins in the mother’s urine. Protein is measured on a 6-point scale, with a range of values from 0 to 4+. Review of medical records

Not applicable