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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 3: Risk-Appropriate Perinatal Care

MCH Best Logo finger touching the foot of a small newborn in an incubator

Strategy. State Policies/Guidelines

Approach. Strengthen statewide intra-hospital transportation systems for transport of high-risk mothers and newborns.

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Overview. Statewide coordinated strategies have proven effective in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers. Transport procedures often include: (1) network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system and (2) preferential admission of extremely premature infants.1

Evidence. Emerging. Population-based systems interventions alone appeared less effective, so multicomponent approaches are recommended. However, this strategy has proven effective as part of a larger approach. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. State/National.

Outcome. VLBW births at risk-appropriate settings. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently 1 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Strengthen statewide intra-hospital transportation systems for transport of high-risk mothers and newborns,” 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 hospitals in the state participating in the transportation system.

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

  • Percent of hospitals in the state participating in the transportation system.

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

  • Number of high-risk pregnant women transported annually via the transportation system.

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

  • Percent of high-risk pregnant women transported annually via the transportation system.

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.


Reference:

1 Nowakowski, L., Barfield, W. D., Kroelinger, C. D., Lauver, C. B., Lawler, M. H., White, V. A., & Ramos, L. R. (2012). Assessment of state measures of risk-appropriate care for very low birth weight infants and recommendations for enhancing regionalized state systems. Maternal and child health journal16(1), 217-227.

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.