Adverse pregnancy outcomes are more common in the United States than any other developed country. This is compounded among women living in poverty. The Nurse-Family Partnership (NFP) is a nonprofit organization that arranges for home visits from registered nurses to low-income first-time mothers. The visits begin during pregnancy and continue for two years following birth. The program has served 317,000 families in 41 states. Now researchers at the Colorado School of Public Health are studying the effects of cross-sector collaboration and healthcare systems integration on the program’s impact.
Speaking during a July 8 Systems for Action Research in Progress webinar, Chris Arestides, M.P.H., B.S.N., R.N., manager of healthcare integration and strategic partnerships at the NFP National Service Office, described the program’s reach and impact. Research studies have shown that outcomes include reduced pre-term birth, increased breastfeeding, increased child immunizations, and improved educational and employment outcomes. Her office works to help organizations nationwide replicate the program in new settings. Initially started with grant funding, today half of the sites in 22 states receive Medicaid financing in some form. She noted that NFP only reaches a small percentage of the women and children who could benefit and are eligible for the service.
One of the goals of the ongoing research is to examine the effects of multi-sector financing and delivery strategies in expanding the reach and impact of the NFP program across the United States. As more health systems and managed care organizations focus on social determinants of health, tighter integration with healthcare payers and delivery systems is part of the NFP National Service Office Strategic Plan, she said, so research into best practices and the impact of collaboration will be important going forward.
Greg Tung, Ph.D., M.P.H., a researcher at University of Colorado-Denver, noted that as the NFP program has expanded across the country, there has been an increasing realization that the impact of NFP on clients is strongly influenced by its collaborative relationships with other key partners. This current grant-funded research, he said, is taking a deeper dive into those collaborative relationships. What impact do they have on the clients and populations that NFP serves?
Venice Ng Williams, Ph.D., is a mixed-methods prevention researcher at CU Anschutz's Prevention Research Center for Family & Child Health and Adjunct Instructor in Health Systems, Management & Policy at the Colorado School of Public Health. She described one of the aims of the research as measuring NFP nurse collaboration with other health and social service providers. “We want to see if there are high-quality relationships and communication based on shared goals. Do they share knowledge about roles and responsibilities and respect one another? What is the frequency of communication and is it problem-solving in nature?”
On the structural side, they want to examine whether the NFP nurses and collaborators are sharing physical space, policies, and data, including access to electronic health records. They will also look for differences between healthcare-financed sites and social service-financed sites.
Among the research program’s goals are to better understand the relationship between site-level collaboration and program outcomes and to identify and disseminate best practices of successful collaboration with health systems and social services.
Arestides said part of her role is better understanding how NFP can align and partner at the community level, including with payer and delivery systems. “The shift to value-based payment structures,” she added, “positions us well to engage on new payment opportunities.”
She noted that the nurses have always worked as part of a team in collaboration with other providers and social service groups. Diving deeper into questions about what helps facilitate collaboration will shine a light on organizational practices and impact. “What comes out of the research will inform practice, and research on integrating more deeply into healthcare is critical.”