Abstract：
UNASSIGNED: The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data.
UNASSIGNED: We created a linked cohort of all mothers aged 13-19 using data from health, educational and children\'s social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis.
UNASSIGNED: One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017.
UNASSIGNED: Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren).
UNASSIGNED: The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child\'s second birthday and is combined with usual health and social care. Controls received usual health and social care.
UNASSIGNED: Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth.
UNASSIGNED: Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database.
UNASSIGNED: Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes.
UNASSIGNED: Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results.
UNASSIGNED: This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child.
UNASSIGNED: Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being.
UNASSIGNED: The study is registered as NIHR CRN Portfolio (42900).
UNASSIGNED: This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.
The Family Nurse Partnership is an intensive home visiting service that offers first-time young mothers up to 64 visits with a family nurse from pregnancy to their child’s second birthday. The Family Nurse Partnership aims to improve birth outcomes, child health and development and promote economic self-sufficiency among young mothers. Previous research in England found no differences in birthweight, maternal smoking, repeat pregnancies or accident and emergency attendances between mothers who did or did not take part in the Family Nurse Partnership. However, children in the Family Nurse Partnership group had better measures of development at school age. We aimed to add to the evidence from earlier studies, by using electronic records that are routinely collected as part of health, education and social care services, to compare outcomes for around 26,000 mothers enrolled in the Family Nurse Partnership between 2010 and 2019 with similar mothers who were not enrolled. This study showed that around one in four mothers who were eligible for the programme were enrolled in the Family Nurse Partnership, and family nurses gave priority to mothers who were younger, more deprived or who had other markers of vulnerability (e.g. a history of substance misuse violence, self-harm or mental health conditions). We found no evidence of a difference in indicators of child maltreatment between mothers who were enrolled in the Family Nurse Partnership and those who were not enrolled, but we found weak evidence to suggest that children born to mothers enrolled in the Family Nurse Partnership were more likely to achieve a Good Level of Development at school entry (age 5). We also saw that mothers enrolled in the Family Nurse Partnership were less likely than those who were not enrolled to have their next child within 18 months of their first child. More research is needed to understand which elements of intensive home visiting services work best, for whom and when. This will help inform decisions about whether it is better to offer highly intensive services for a small portion of the target population or to extend and enhance existing universal health visiting services to better support all adolescent mothers.
UNASSIGNED: We created a linked cohort of all mothers aged 13-19 using data from health, educational and children\'s social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis.
UNASSIGNED: One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017.
UNASSIGNED: Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren).
UNASSIGNED: The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child\'s second birthday and is combined with usual health and social care. Controls received usual health and social care.
UNASSIGNED: Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth.
UNASSIGNED: Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database.
UNASSIGNED: Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes.
UNASSIGNED: Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results.
UNASSIGNED: This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child.
UNASSIGNED: Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being.
UNASSIGNED: The study is registered as NIHR CRN Portfolio (42900).
UNASSIGNED: This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.
The Family Nurse Partnership is an intensive home visiting service that offers first-time young mothers up to 64 visits with a family nurse from pregnancy to their child’s second birthday. The Family Nurse Partnership aims to improve birth outcomes, child health and development and promote economic self-sufficiency among young mothers. Previous research in England found no differences in birthweight, maternal smoking, repeat pregnancies or accident and emergency attendances between mothers who did or did not take part in the Family Nurse Partnership. However, children in the Family Nurse Partnership group had better measures of development at school age. We aimed to add to the evidence from earlier studies, by using electronic records that are routinely collected as part of health, education and social care services, to compare outcomes for around 26,000 mothers enrolled in the Family Nurse Partnership between 2010 and 2019 with similar mothers who were not enrolled. This study showed that around one in four mothers who were eligible for the programme were enrolled in the Family Nurse Partnership, and family nurses gave priority to mothers who were younger, more deprived or who had other markers of vulnerability (e.g. a history of substance misuse violence, self-harm or mental health conditions). We found no evidence of a difference in indicators of child maltreatment between mothers who were enrolled in the Family Nurse Partnership and those who were not enrolled, but we found weak evidence to suggest that children born to mothers enrolled in the Family Nurse Partnership were more likely to achieve a Good Level of Development at school entry (age 5). We also saw that mothers enrolled in the Family Nurse Partnership were less likely than those who were not enrolled to have their next child within 18 months of their first child. More research is needed to understand which elements of intensive home visiting services work best, for whom and when. This will help inform decisions about whether it is better to offer highly intensive services for a small portion of the target population or to extend and enhance existing universal health visiting services to better support all adolescent mothers.
摘要：
家庭护士伙伴关系是一项针对青春期母亲的密集家访计划。我们旨在使用国家行政数据评估家庭护士伙伴关系对7岁以下结局的有效性。
■我们使用健康数据创建了一个由所有13-19岁母亲组成的关联队列，教育和儿童的社会护理和定义的母亲加入家庭护士伙伴关系或不使用家庭护士伙伴关系系统数据。倾向评分用于创建匹配的组进行分析。
■2010年至2017年之间，英格兰有一百三十六个地方当局与活跃的家庭护士合作伙伴关系网站。
■末次月经期间13-19岁的母亲在2010年4月至2019年3月期间有活产，生活在家庭护士伙伴关系集水区和他们的长子（ren）。
家庭护士伙伴关系包括家庭护士从怀孕早期到孩子两岁的多达64次家访，并与通常的健康和社会护理相结合。控制通常得到健康和社会护理。
■儿童虐待的指标（因受伤/虐待而入院，转介社会护理服务）；儿童健康和发展（医院利用率和教育）结果以及产妇医院利用率和教育结果，直至出生后7年。
■家庭护士伙伴关系信息系统，医院事件统计，国家学生数据库。
■在110,520名合格的母亲中，25,680人(23.2%)参加了家庭护士伙伴关系。122个站点的入学率各不相同（范围：11-68％）。合格母亲较多的地区入学率较低。13-15岁的母亲入学率更高(52%)，超过18-19岁（21%）。儿童虐待指标：我们没有发现家庭护士伙伴关系与儿童虐待指标之间存在关联的证据，除了家庭护士伙伴关系母亲所生的2岁以下儿童的虐待/伤害相关诊断的计划外入院率增加(6.6%vs.5.7%,相对风险1.15；95%置信区间1.07至1.24)。儿童健康和发育结果：缺乏证据表明，家庭护士伙伴关系母亲所生的孩子更有可能在5岁时达到良好的发育水平（57.5％vs.55.4%,相对风险1.05；95%置信区间1.00至1.09）。产妇结局：有一些证据表明，家庭护士伙伴关系母亲在出生后18个月内不太可能进行后续分娩(8.4%vs.9.3%,相对风险0.92；95%置信区间0.88至0.97）。年轻和更脆弱的母亲接受更多的访问，更有可能实现忠诚目标。达到保真度目标与一些结果有关。
■干预和常规护理随时间和区域之间的指示和变化的偏差可能会限制我们检测效果的能力。多次测试可能导致虚假，显著的结果。
■这项研究支持对家庭护士伙伴关系的评估结果，显示没有证据表明行政数据中测量的虐待结果受益。在所有测量的结果中，我们发现微弱的证据表明，家庭护士伙伴关系与入学时儿童发育的改善有关，快速重复怀孕的减少和母亲和孩子寻求医疗保健的增加的证据。
■未来的评估应更好地衡量家庭护士伙伴关系干预措施和常规护理，更多关于孕产妇风险因素和与孕产妇健康相关的其他结局的信息.
■该研究注册为NIHRCRNPortfolio（42900）。
■该奖项由美国国立卫生与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：17/99/19）资助，并在《健康与社会护理提供研究》中全文发表。12号11.有关更多奖项信息，请参阅NIHR资助和奖励网站。
家庭护士伙伴关系是一项密集的家访服务，从怀孕到孩子的第二个生日，为第一次年轻的母亲提供多达64次的家庭护士探访。家庭护士伙伴关系旨在改善分娩结果，儿童健康和发展，促进年轻母亲的经济自给自足。先前在英国的研究发现出生体重没有差异，母亲吸烟,参加或未参加家庭护士伙伴关系的母亲之间的重复怀孕或意外和紧急护理。然而,家庭护士伙伴关系组的儿童在学龄期有更好的发展指标.我们旨在增加早期研究的证据，通过使用作为健康的一部分定期收集的电子记录，教育和社会护理服务，比较2010年至2019年期间约26,000名参加家庭护士伙伴关系的母亲与未参加的类似母亲的结局。这项研究表明，有资格参加该计划的母亲中约有四分之一参加了家庭护士伙伴关系，家庭护士优先考虑年轻的母亲，更被剥夺或有其他脆弱性标志的人(例如滥用药物暴力的历史，自我伤害或精神健康状况)。我们没有发现任何证据表明参加家庭护士伙伴关系的母亲和未参加家庭护士伙伴关系的母亲之间的儿童虐待指标存在差异，但我们发现，薄弱的证据表明，在家庭护士伙伴关系中登记的母亲所生的孩子更有可能在入学时（5岁）达到良好的发展水平。我们还看到，参加家庭护士伙伴关系的母亲比没有参加的母亲在第一个孩子的18个月内生育下一个孩子的可能性要小。需要更多的研究来了解密集家访服务的哪些要素效果最好，为谁和何时。这将有助于决定是否更好地为一小部分目标人口提供高度密集的服务，还是扩大和加强现有的全民健康访问服务，以更好地支持所有青春期母亲。
■我们使用健康数据创建了一个由所有13-19岁母亲组成的关联队列，教育和儿童的社会护理和定义的母亲加入家庭护士伙伴关系或不使用家庭护士伙伴关系系统数据。倾向评分用于创建匹配的组进行分析。
■2010年至2017年之间，英格兰有一百三十六个地方当局与活跃的家庭护士合作伙伴关系网站。
■末次月经期间13-19岁的母亲在2010年4月至2019年3月期间有活产，生活在家庭护士伙伴关系集水区和他们的长子（ren）。
家庭护士伙伴关系包括家庭护士从怀孕早期到孩子两岁的多达64次家访，并与通常的健康和社会护理相结合。控制通常得到健康和社会护理。
■儿童虐待的指标（因受伤/虐待而入院，转介社会护理服务）；儿童健康和发展（医院利用率和教育）结果以及产妇医院利用率和教育结果，直至出生后7年。
■家庭护士伙伴关系信息系统，医院事件统计，国家学生数据库。
■在110,520名合格的母亲中，25,680人(23.2%)参加了家庭护士伙伴关系。122个站点的入学率各不相同（范围：11-68％）。合格母亲较多的地区入学率较低。13-15岁的母亲入学率更高(52%)，超过18-19岁（21%）。儿童虐待指标：我们没有发现家庭护士伙伴关系与儿童虐待指标之间存在关联的证据，除了家庭护士伙伴关系母亲所生的2岁以下儿童的虐待/伤害相关诊断的计划外入院率增加(6.6%vs.5.7%,相对风险1.15；95%置信区间1.07至1.24)。儿童健康和发育结果：缺乏证据表明，家庭护士伙伴关系母亲所生的孩子更有可能在5岁时达到良好的发育水平（57.5％vs.55.4%,相对风险1.05；95%置信区间1.00至1.09）。产妇结局：有一些证据表明，家庭护士伙伴关系母亲在出生后18个月内不太可能进行后续分娩(8.4%vs.9.3%,相对风险0.92；95%置信区间0.88至0.97）。年轻和更脆弱的母亲接受更多的访问，更有可能实现忠诚目标。达到保真度目标与一些结果有关。
■干预和常规护理随时间和区域之间的指示和变化的偏差可能会限制我们检测效果的能力。多次测试可能导致虚假，显著的结果。
■这项研究支持对家庭护士伙伴关系的评估结果，显示没有证据表明行政数据中测量的虐待结果受益。在所有测量的结果中，我们发现微弱的证据表明，家庭护士伙伴关系与入学时儿童发育的改善有关，快速重复怀孕的减少和母亲和孩子寻求医疗保健的增加的证据。
■未来的评估应更好地衡量家庭护士伙伴关系干预措施和常规护理，更多关于孕产妇风险因素和与孕产妇健康相关的其他结局的信息.
■该研究注册为NIHRCRNPortfolio（42900）。
■该奖项由美国国立卫生与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：17/99/19）资助，并在《健康与社会护理提供研究》中全文发表。12号11.有关更多奖项信息，请参阅NIHR资助和奖励网站。
家庭护士伙伴关系是一项密集的家访服务，从怀孕到孩子的第二个生日，为第一次年轻的母亲提供多达64次的家庭护士探访。家庭护士伙伴关系旨在改善分娩结果，儿童健康和发展，促进年轻母亲的经济自给自足。先前在英国的研究发现出生体重没有差异，母亲吸烟,参加或未参加家庭护士伙伴关系的母亲之间的重复怀孕或意外和紧急护理。然而,家庭护士伙伴关系组的儿童在学龄期有更好的发展指标.我们旨在增加早期研究的证据，通过使用作为健康的一部分定期收集的电子记录，教育和社会护理服务，比较2010年至2019年期间约26,000名参加家庭护士伙伴关系的母亲与未参加的类似母亲的结局。这项研究表明，有资格参加该计划的母亲中约有四分之一参加了家庭护士伙伴关系，家庭护士优先考虑年轻的母亲，更被剥夺或有其他脆弱性标志的人(例如滥用药物暴力的历史，自我伤害或精神健康状况)。我们没有发现任何证据表明参加家庭护士伙伴关系的母亲和未参加家庭护士伙伴关系的母亲之间的儿童虐待指标存在差异，但我们发现，薄弱的证据表明，在家庭护士伙伴关系中登记的母亲所生的孩子更有可能在入学时（5岁）达到良好的发展水平。我们还看到，参加家庭护士伙伴关系的母亲比没有参加的母亲在第一个孩子的18个月内生育下一个孩子的可能性要小。需要更多的研究来了解密集家访服务的哪些要素效果最好，为谁和何时。这将有助于决定是否更好地为一小部分目标人口提供高度密集的服务，还是扩大和加强现有的全民健康访问服务，以更好地支持所有青春期母亲。
