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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 10: Adolescent Well-Visit

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Strategy. Telemedicine

Approach. Promote and support telemedicine in pediatric and family medicine practices.

Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database

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Overview. Telemedicine, sometimes called telehealth, uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services. Services can encompass primary and specialty care, referrals, and remote monitoring of vital signs, and may be provided via videoconference, email, smartphones, wireless tools, or other modalities (ATA). Telemedicine can supplement health care services for patients who would benefit from frequent monitoring or provide services to individuals in areas with limited access to care.

Evidence. Scientifically Supported. There is strong evidence that telemedicine increases access to care (Franek 2012, Brown 2007, Wootton 2012, Clark 2007, McLean 2011*, Eland-de Kok 2011*, Hailey 2008*, IHE-Ohinmaa 2010), especially for individuals with chronic conditions (McLean 2011*, Wootton 2012) and those in rural and other traditionally underserved areas (Kehle 2011, Bashshur 2009, Penate 2012). Telemedicine appears to be an effective way to treat children and adolescents (dos Santos 2014). Telemedicine appears to be a cost effective way to deliver care (Yang 2015*, Jennett 2003*). Once the technology is in place, providing care through telemedicine may be less costly than standard care (Henderson 2013). However, high initial implementation costs and limited payment policies can be barriers to establishing telemedicine programs (Henderson 2013, Brown 2007). Read more in theĀ WWFH database report. Read more about WWFH's evidence ratings. (*Links to citations can be accessed through the WWFH database).

Target Audience. National/Systems.

Outcome. Increased access to care (percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year). Other potential outcomes include: improved mental health, reduced mortality, increased medication adherence, reduced vehicle miles traveled, and reduced emissions.

Examples from the Field. Access descriptions of ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy.. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Promote and support telemedicine in pediatric and family medicine practices,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of providers participating in telemedicine program.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of providers participating in telemedicine program.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of adolescents receiving preventive services via telemedicine.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of adolescents receiving preventive services via telemedicine.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.