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MCHbest. NPM 3: Risk-Appropriate Perinatal Care

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Strategy. Rural Transportation Services

Approach. Establish a transportation system for pregnant women and VLBW neonates requiring higher level care.

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

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Overview. Rural transportation services provide transportation across large areas that have low population densities and lack established public transportation systems. Services may include shared transportation options such as publicly-funded buses and vans running on fixed routes and schedules, more flexible pick-up and drop-off with smaller vehicles (e.g., dial-a-ride and other demand-response programs), or volunteer ridesharing programs (Mattson 2016).

Evidence. Expert Opinion. Rural transportation services are a suggested strategy to increase mobility and access to health care for rural populations (National RTAP, RHIhub-Transportation). Available evidence suggests that such services can increase access to medical services (Yang 2017). However, additional evidence is needed to confirm effects. Read more in the WWFH database report. Read more about WWFH's evidence ratings. (*Links to citations can be accessed through the WWFH database).

Target Audience. Systems.

Outcome. Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU).

Examples from the Field. Access descriptions of ESMs from 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 “Establish a transportation system for pregnant women and VLBW neonates requiring higher level care,” 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 rural hospitals with a transportation service available to transport women and newborns.

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

  • Percent of rural hospitals with a transportation service available to transport women and newborns.

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

  • Number of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU) after utilization of a rural transportation service.

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

  • Percent of very low birth weight (VLBW) infants born in a hospital with a Level III+ Neonatal Intensive Care Unit (NICU) after utilization of a rural transportation service.

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.