What would happen if every family with a newborn baby had routine home visits from a nurse during their child's first month of life? Would the infants have fewer visits to urgent care and emergency departments? Would the parents feel more confident and make better choices?

The answers seem obvious and positive. But what about the costs? The cost of such a program might not offset the savings from fewer visits to emergency rooms. A Duke University study has found that the positive results really do hold up, even when costs are considered.

In Durham, North Carolina, theDurham Connects program begins with a visit while a newborn is still in the hospital and continues with one to three nursing visits during the babies' first three to twelve weeks of life.

Duke researchers wanted to determine if free in-home nurse visits could decrease emergency health care service use, and promote positive parenting. And they found the program more than paid for itself within the infants' first six months of life: For every $1 spent on nurse home visits for newborns, $3 were saved in healthcare costs.

While the benefits of positive parenting, better health, and safer home environments may be priceless, the financial savings in ER visits are substantial and calculable.

At the visits, the nurses provided education and counseling on common newborn and infancy concerns such as managing crying, postpartum depression, and feeding. They also assessed the family’s risks, needs, and functioning and determined what, if any, their unique needs were.

If necessary, they referred parents to community resources and agencies for long-term support. If referrals were made, the visiting nurses followed up with the agencies and the families to be sure the connection had happened and was enduring. The nurses’ procedures were vigorously monitored by direct observation and tape recorded family encounters.

The results were compelling and provide a potential model for other communities in the United States.

Sixty-nine percent of families enrolled in the program completed it. The number of emergency room visits for infant illness decreased compared to families who did have home visits, and this positive impact doubled after six months of tracking. There were also fewer overnight hospitalizations for program infants.

When the babies were six months old, the investigators measured the impact of the one-month long intervention by checking hospital records and interviewing the mothers about the number of emergency room and urgent care visits, well-baby checks, and any community resources they had used. They also evaluated parents' parenting behaviors, mental health, and knowledge of childcare.

The program seemed to really make a difference. Mothers enrolled in Durham Connects showed more positive parenting behaviors than those mothers not receiving nurse visits who served as controls. The homes of parents in the program were safer for their infants, and their out-of-home childcare choices were more appropriate.

The Connect mothers also reported fewer mental health concerns than mothers who had not had nurse visits. The quality of fathers’ involvement with their infants was also better.

While the benefits of positive parenting, better health, and safer home environments may be priceless, the financial savings in ER visits are substantial and calculable.

The Duke team estimates that the program costs came out to $700 per birth. So, for a community like Durham that has an average of 3187 births per year, the cost of the program would amount to $2,230,900, which would yield a community-wide $6.74 million in emergency healthcare savings.

The researchers hope that their data will spur more communities to explore similar options for their families with newborns and young children.

The study appears in the February issue of the American Journal of Public Health.