Summary
Background: Public health nurse (PHN) home visiting programs have been widely employed to improve
life course trajectories for high risk mothers. Home visiting programs are often lengthy,
during which PHNs simultaneously address multiple problems using diverse interventions
over several client encounters. To manage PHN caseloads it is critical to understand
the trajectory of client improvement and the optimal duration or services. PHN documentation
data enable intervention trajectory research for specific client problems. A new metric
called problem stabilization is proposed for evaluating interim improvement during
PHN home visiting. Problem stabilization is an intervention pattern for a client problem
that is characterized by co-occurring actions (i.e. teaching, guidance, and counseling;
treatments and procedures; case management; and/or surveillance) during a client encounter;
followed by surveillance actions only for that problem during a subsequent client
encounter. The purpose of the study was to investigate problem stabilization during
home visiting services for high risk mothers.
Methods: A retrospective cohort was created using family home visiting intervention documentation
data from a local Midwest public health agency over a six year period (2000–2005).
The data set consisted of Omaha System interventions for 720 high risk mothers. Analysis
was conducted using descriptive statistics and Kaplan Meier curves.
Results: On average 30.1% of the time, client problems stabilized before discharge. Stabilization
patterns differed by problem. Time to stabilization was longest for Caretaking/parenting
and Ante-partum/postpartum problems, and shortest for Residence and Mental health
problems.
Conclusions: Problem stabilization, a proposed intermediate outcome of PHN home visiting care,
appears to be meaningful in describing client response to PHN intervention. This metric
is an example of meaningful use of structured clinical electronic health record data
for program evaluation and clinical decision support.
Keywords
Public health nursing - home visiting - standards - interventions - outcomes - methods
- Omaha system
