The objective of this quality evaluation was to evaluate the changes in public health nursing (PHN) interventions after the implementation of an evidence-based family home visiting (eB-fHV) guideline encoded using the Omaha System. Design and sample: This quality improvement evaluation was conducted using a secondary dataset of 27,910 PHN family home visiting interventions from visits to 129 adult clients enrolled in eB-fHV programs in a Midwestern PHN agency. The interventions were documented 12 months before and 14 months after eB-fHV Guideline implementation. The eB-fHV consisted of 94 PHN interventions for 10 Omaha System problems, with electronic health record (eHr) data generated by PHNs during routine clinical documentation. Standard descriptive and inferential statistics were employed in the analysis. Measures: The Omaha System was used to compare PHN practice before and after the guideline implementation. Results: Documentation patterns revealed that PHNs tailored interventions while also shifting toward the use of the eB-fHV guideline interventions. Ten eB-fHV problems accounted for 96.3% of interventions documented before and 98.5% of interventions documented after implementation. The proportion of interventions before and after eB-fHV by problem differed significantly for all problems except Substance use. fewer interventions were provided after eB-fHV for the primary problems of Pregnancy and Postpartum, with a shift to more interventions for caretaking/parenting. Conclusion: The PHN documentation demonstrated an adherence to the eB-fHV guideline, while tailoring the evidence-based interventions differentially by problem. further research is needed to extend this quality improvement approach to other guidelines and populations.

There is research evidence describing quality early intervention programs that can promote positive child health and behavior and enhance parenting behaviors and parent-child interactions. Two of the programs with persuasive research evidence are home visitation and parent training. Despite the evidence, it seems that few of these strategies have been translated to real-world clinical settings. This article reviews an evidence-based practice framework that highlights the influence of the research evidence, patient preferences, provider expertise, setting-specific contextual factors, and important role of a facilitator. Examples from one particular early intervention project that implemented a standardized parent training program via home visiting the families of 2- to 6-year-old children help explicate the facilitators and pitfalls in translating best practices into the real-world settings. Strategies that can lead to successful implementation of early intervention child health and parenting best practices in real-world clinical settings are recommended.

BACKGROUND Patients of low socioeconomic status (SES) are at higher risk than patients of greater means for hospitalization for conditions that can be addressed in the ambulatory setting (Kangovi et al., 2013; 2014). Patients of low SES are twice as likely as those of higher SES to require urgent emergency department (ED) visits, four times more likely to require hospital admission, and more likely to be readmitted post-discharge (Kangovi et al., 2013; 2014; Disano et al., 2010; Shipton, 1996). Furthermore, patients of low SES have been shown to use 45 percent less ambulatory and preventive care than their more affluent counterparts (Kangovi et al., 2013; 2014). This underuse of primary care and overuse of hospital-based or emergency care is costly to the health care system, results in relatively poorer health outcomes for persons with low SES, and exacerbates health disparities (Kangovi et al., 2013; 2014; Gardner et al., 2014). A related fact is that poorly executed care transitions 1 from the hospital to the community are associated with higher costs, increased avoidable hospitalization, re-hospitalization, and poorer health outcomes (