Cost Analysis of the PARENT Trial of Community Health Workers in Early Childhood Preventive Care: A Secondary Analysis of a Cluster-Randomized Clinical Trial.

Importance: The Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT) trial demonstrated increased anticipatory guidance and well child care visit (WCV) attendance but no effect on emergency department (ED) utilization. Objective: To assess whether the PARENT intervention was associated with lower non-WCV costs, and whether the increasing WCV attendance might offset recurring intervention costs. Design, Setting, and Participants: The PARENT cluster-randomized clinical trial was conducted from March 5, 2019, to July 14, 2022. This secondary cost analysis was conducted throughout the trial and continued to November 15, 2024. Participants included 937 enrolled parents with a child younger than 2 years presenting for a WCV at 10 clinics from 2 federally qualified health centers (FQHCs). Data on utilization and estimated cost of care using a unit cost approach were collected. Parents were interviewed at baseline and 6 and 12 months and asked about the number of encounters and the child's diagnosis for subspecialty referrals, urgent care visits, ED visits, and hospitalizations. Intervention: PARENT is a team-based approach to health care that uses a trained community health worker as part of the well child care team to provide preventive care services to children aged 0 to 2 years. Main Outcomes and Measures: The main outcome of this analysis was 2016 unit cost estimates for subspecialty referrals, urgent care visits, ED visits, and hospitalizations by health condition and child's age using data from the US Disease Expenditure Study. Results: Among 937 enrolled PARENT participants, 785 (83.8%) completed the 12-month interview and were included in analyses. Mean (SD) child age at enrollment was 4.4 (4.0) months, and most participants were mothers (868 of 914 with available data [95.4%]) and were Medicaid insured (855 of 914 with available data [93.5%]). The intervention group had statistically significant lower costs than the control group for both subspecialty referrals (-$213; 95% uncertainty interval [UI], -$540 to -$106) and total cost of urgent care visits, ED visits, and hospitalizations (-$70; 95% UI, -$150 to -$13). Based on the mean (SD) volume of newborns across all participating clinics (5.8 [4.1] newborns per week), marginal revenue from increased WCV attendance was greater than annual community health worker salary and benefits costs under select current reimbursements. Conclusions and Relevance: This secondary analysis of a cluster-randomized clinical trial suggests that the cost of the PARENT intervention was offset by savings in non-WCV health care utilization, and revenue for federally qualified health centers from increased WCV attendance could fund ongoing intervention costs. Trial Registration: ClinicalTrials.gov Identifier: NCT03797898.