The Title V Maternal and Child Health Services Block Grant to States Program guidance defines the significance of this goal as follows:
A well-woman or preconception visit provides a critical opportunity to receive recommended clinical preventive services, including screening, counseling, and immunizations, which can lead to appropriate identification, treatment, and prevention of disease to optimize the health of women before, between, and beyond potential pregnancies. For example, screening and management of chronic conditions such as diabetes, and counseling to achieve a healthy weight and smoking cessation, can be advanced within a well woman visit to promote women's health prior to and between pregnancies and improve subsequent maternal and perinatal outcomes. The annual well-woman visit has been endorsed by the American College of Obstetrics and Gynecologists (ACOG). See their updated committee opinion (Number 775; September 2018).
NPM 1 Tools
NEW! The MCH Evidence Center is pleased to share Phase 1 of the MCHbest database: the Bank of Evidence-linked Strategies and Tools.
The database aggregates sample evidence-based/informed strategies that can be used as-is or adapted to develop Evidence-based or informed Strategy Measures (ESMs) for each of the MCH National Performance Measures (NPMs). Use the database along with the ESM Development Guide to work through the entire ESM process.
NEW! Watch a short video (below) discussing state-of-the-art, evidence-based/informed strategies that can be used or adapted as ESMs. Experts in the field discuss approaches, the science, and specific ways that Title V agencies can implement and measure these approaches.
Presented by Arden Handler, University of Illinois at Chicago, School of Public Health
- Evidence Brief (National Center for Education in MCH (NCEMCH) at Georgetown University).
- Environmental Scan (Women's and Children's Health Policy Center (WCHPC) at Johns Hopkins University). This environmental scan identifies compilations of strategies to advance NPM 1. Read more about environmental scans
Summary of the Evidence
Current evidence has not focused on effective strategies to increase well-woman visits overall. Thus, proxy strategies to increase receipt of two preventive services that could be delivered in the context of a well-woman visit – cervical cancer screening and human papillomavirus (HPV) vaccination – have been reviewed. The following trends have emerged from this analysis.7
- There is strong evidence to suggest that patient reminders/invitations are effective, both on their own and in combination with other strategies.
- Other interventions targeting the patient/consumer that appear to be effective are community- based group education and patient navigation.
- Home visits (1-2 total visits) targeting patients/consumers do not appear to be effective.
- On the provider/practice-level, provider reminder/recall systems, provider education, and implementation of a designated clinic/extended hours appear to be effective.
- On the community-level, television media appears to be effective.
- Of interventions targeting payers, expanded insurance coverage appears to be effective.
- Using multicomponent interventions is more effective to increase uptake of other screenings.
- Findings from the literature on components of the well-woman visit can be applied to the implementation of multicomponent interventions that target various audiences.
Access the published evidence.
Evidence Analysis Reports
- NPM 1 Well-Woman Visit: Evidence Review Brief (WCHPC). A three-page summary of report methodologies, results, key findings, and implications.
- NPM 1 Well-Woman Visit: Evidence Review Full Report (WCHPC). A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 1 to serve as the foundation for accountability across all states and jurisdictions. The evidence review uses a structured approach to evaluate the available empirical evidence and to draw conclusions for MCH programs based on the best available evidence. Read about the evidence analysis report methodology | You can also access the full set of Evidence Analysis Reports.
You can access strategies from AMCHP’s Innovation Station that have shown promise in advancing your NPM below. While these strategies may not completely align with your current activities, they can be used to help guide further development and measurement of your ESM.
|Practice Name||Primary Interest||State||Level of Evidence|
|Super Babies Program||Birth Defects Prevention||MN||Emerging|
|Body & Soul: A Faith Based Initiative||Women's Health||FL||Promising|
|Healthy Women, Health Futures||Women's Health||OK||Promising|
|Pathways Community HUB||Access to Health Care||OH||Promising|
|Nurse Family Partnership||Home Visiting||National||Best|
|Perinatal Depression Screening/ Referral||Mental Health||CT||Emerging|
|Welcome Family||Health Promotion||MA||Promising|
Also see Quick Guide to Planning and Implementing Selected Activities to Increase Breast, Cervical, and Colorectal Cancer Screening (National Breast and Cervical Cancer Early Detection Program with the Colorectal Cancer Control Program) for additional interventions.
Domain and National Performance Measure: Percent of women with a past year preventive medical visit
|Strategy [Source]||Evidence-based/-informed Strategy Measure (ESM)|
Work with Medicaid to improve the process of auto-enrollment into additional coverage after Medicaid coverage expires postpartum 
|Medicaid extends automatic eligibility beyond current state standard ; #/% women automatically enrolled in Medicaid postpartum|
|Offer enabling services through community organizations to facilitate access to preventive visits ||#/% of community health centers and family planning clinics agencies offering language and translation services|
|Host a webinar for providers about annual preventive visits and strategies to address missed opportunities ||# of participants attending webinar|
|Convene task force comprised of agencies focused on women’s health||# of task force meetings in past year|
 Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg School of Public Health. Environmental Scans.
 Association of Maternal and Child Health Programs & Johns Hopkins Bloomberg School of Public Health. Taking Action with Evidence: Implementation Roadmap Webinars.
Source: Sample Strategies and Evidence-based/informed Strategy Measures (ESMs) (WCHPC). A list of sample strategies and ESMs for each of the 15 NPMs. Sources are provided at the end of the document.
Related ESMs. Access ESMs being implemented by other states/jurisdictions that may serve as models for future work with NPM 1.
- NPM 1 Transformation Tools (MCH Navigator and National MCH Workforce Development Center). Learning resources, implementation strategies, and links to the evidence base for the competencies needed to carry out NPM 1 activities.
- Taking Action with Evidence Implementation Roadmap (Association of MCH Programs (AMCHP) and WCHPC). Archived webinars and additional learning and implementation resources.
- Historical Resources from the MCH Digital Library (NCEMCH). This bibliography is automatically generated to pull resources from MCHLine, the MCH Library's online catalog of seminal resources, in support of NPM 1. Coming soon.
- Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care.
- Well-Woman Visit: Resource Overview: The American College of Obstetricians and Gynecologists (ACOG) has identified the following resources that may be helpful for ob-gyns, other health care providers, and patients related to the well-woman visit.
- AMCHP Resources:
- Health for Every Mother: A Maternal Health Resource and Planning Guide for States. This guide for Title V programs and their partners provides a synthesis of program and policy recommendations and offers a framework to support states in identifying next steps. Contents include strategies and planning tools for strengthening maternal data systems, increasing the value of an investment in maternal health, enabling healthy living, improving access to care, ensuring high quality health care for women, and ensuring readiness and response to obstetric emergencies.
- Implementation Toolkit for National Performance Measure 1. This toolkit contains examples of state strategies being used to address NPM 1 in Title V programs.