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MCHbest. NPM 3: Risk-Appropriate Perinatal Care

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Strategy. Telemedicine

Approach. Support the use of telemedicine to establish need for referral and transfer of high-risk mothers with VLBW neonates.

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). Additional evidence is needed to determine the characteristics of the most successful telemedicine practices (Cochrane-Flodgren 2015, McLean 2011, Farmer 2005, Garcia-Lizana 2010, Hailey 2008). 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 “Support the use of telemedicine to establish need for referral and transfer of high-risk mothers with VLBW neonates,” 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 at hospitals without a level III NICU with access to a telemedicine referral hotline.

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

  • Percent of providers at hospitals without a level III NICU with access to a telemedicine referral hotline.

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

  • Number of telemedicine consults resulting in successful transfer of high-risk women to a hospital with a level III NICU.

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

  • Percent of telemedicine consults resulting in successful transfer of high-risk women to a hospital with a level III NICU.

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.