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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. Multicomponent: Access to Providers through Hotline + Continuing Education of Hospital Providers + State Policies/Guidelines

Approach. Support development of a 3-pronged approach by developing a 24-hour hotline, support establishment of intra-hospital transport system, and develop a Continuing Medical Education (CME) module.

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Overview. Telemedicine decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.1

Evidence. Emerging. The evidence of effectiveness for interventions with a patient component is less clear. Access the peer-reviewed evidence for provider hotlines through the MCH Digital Library. Access evidence for continuing education. Access evidence for state policies/guidelines. (Read more about understanding evidence ratings).

Target Audience. Patients + providers + 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 several ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of ESMs related to patient engagement through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM. Access hospital-based ESMs here. Access population-level ESMs here.

Sample ESMs. Using the approach “Support development of a 3-pronged approach in caring for at-risk patients by developing a 24-hour hotline for obstetric and neonatal providers to utilize in centers of level II or lower, support establishment of intra-hospital transport system for high-risk mothers and newborns and develop CME module on transportation guidelines of high-risk mothers and newborns 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 that implement the 3-pronged approach in caring for high-risk patients including developing a 24-hour hotline for obstetric and neonatal providers to utilize in centers of level II or lower, support establishment of intra-hospital transport system for high-risk mothers and newborns and develop educational CME module on transportation guidelines of high-risk mothers and newborns for healthcare providers.

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

  • Percent of hospitals that implement the 3-pronged approach in caring for high-risk patients including developing a 24-hour hotline for obstetric and neonatal providers to utilize in centers of level II or lower, support establishment of intra-hospital transport system for high-risk mothers and newborns and develop educational CME module on transportation guidelines of high-risk mothers and newborns for healthcare providers.

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

  • Number of hospitals that implement the 3-pronged approach in caring for high-risk patients that have improved appropriate levels of care (either internally, or through intra-hospital transport) by 20%.

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

  • Percent of hospitals that implement the 3-pronged approach in caring for high-risk patients that have improved appropriate levels of care (either internally, or through intra-hospital transport) by 20%.

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:

1Kim EW, Teague-Ross TJ, Greenfield WW, Keith Williams D, Kuo D, Hall RW. Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality. J Perinatol. 2013;33(9):725-730.

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.