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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: Perinatal Regionalization

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finger touching the foot of a small newborn in an incubatorMulticomponent: Continuing Education of Hospital Providers + State Policies/Guidelines

MCH Strategy. Support establishment of intra-hospital transportation system and develop Continuing Medical Education (CME) module.

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Overview. A multicomponent approach is effective: combining education of obstetric and neonatal medical personnel and implementing an intra-hospital neonatal transport system has been shown to increase the number of very low birth weight (VLBW) babies born at level III risk-appropriate settings.1

Evidence. Moderate Evidence. Interventions implemented at both the hospital and population-based systems levels (e.g., continuing education of hospital providers + State policy/guidelines) appeared most effective in increasing risk-appropriate perinatal care; adding a hospital component to population-based systems interventions appears to support the effectiveness of those interventions, as compared to interventions implemented in population-based systems alone. Access the peer-reviewed evidence for continuing education of hospital providers through the MCH Digital Library. Access the evidence for state policies/guidelines. (Read more about understanding evidence ratings).

Target Audience. Providers + State/National.

Outcome. VLBW births at risk-appropriate settings and maternal transfer to risk-appropriate setting. 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 16 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. There is currently 1 ESM focused on a state system.

Sample ESMs. Using the strategy “Support establishment of intra-hospital transportation system for transport of high-risk mothers and newborns, and develop educational CME module on transport guidelines for healthcare providers,” 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 statewide participating in intra-hospital transportation system that also have 50% compliance in providers completing CME credits.

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

  • Percent of hospitals statewide participating in intra-hospital transportation system for high-risk mothers and newborns that also have 50% compliance in providers completing CME credits.

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

  • Number of providers who appropriately transported high-risk mothers and newborns utilizing the intra-hospital transportation system and guidelines learned from CME.

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

  • Percent of providers who appropriately transported high-risk mothers and newborns utilizing the intra-hospital transportation system and guidelines learned from CME.

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:

1Warner B, Altimier L, Imhoff S. Clinical excellence for high risk neonates: improved perinatal regionalization through coordinated maternal and neonatal transport. Neonatal Intensive Care. 2002;15(6):33-38.

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.