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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. Statewide Assessment of Personnel, Resources, and Capabilities of Birthing Facilities

Approach. Implement statewide assessment of the personnel and capabilities of maternity hospitals using CDC’s Level of Care Assessment Tool (LOCATe).

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Overview. A verification program could be implemented on a local, regional, or state level. A formal on-site verification process is feasible and informative.

Evidence. Emerging. Studies have shown that LOCATe is a user friendly and standardized approach that states and jurisdictions can use to assess maternal and neonatal care capabilities of facilities.1 (Read more about understanding evidence ratings).

Target Audience. Hospitals.

Outcome. Percent of Very Low Birth Weight (VLBW) infants born in the hospital within a Level III hospital + NICU.

Examples from the Field. Access descriptions of ESMs 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.

Overall, 14 states have implemented LOCATe with varying levels of fidelity.

North Carolina is taking a region specific approach, funding perinatal outreach coordinator in each of 6 regions to implement assessments. Successfully engage implementation strategies. LOCATe process started the conversation among hospitals in the region that kindled interested in improving processes for maternal and infant transfer processes.

Role of Title V. Title V Agencies can fund and manage implementation of maternity facility assessment in partnership with hospitals and perinatal professionals through the following methods:

For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.

Sample ESMs. Using the approach "Define Hospital Levels of Neonatal care and Levels of Maternal Care using AAP and ACOG/SMFM guidelines,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of hospitals involved in assessment process using LOCATe.
  • Number of perinatal coordinators working to implement assessment process.

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

  • Percent of hospitals involved in assessment process using LOCATe.

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

  • Number of hospitals that have participated in the assessment process and have initiated procedures to address issues discovered through the LOCATe tool.

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

  • Percent of hospitals that have participated in the assessment process and have initiated procedures to address issues discovered through the LOCATe tool.

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.


1 Studies include:

Catalano AC, Bennett A, Busacker A, Carr A, Goodman D, Kroelinger C, Okoroh E, Brantley M, Barfield W. Implementing CDC’s Level of Care Assessment Tool (LOCATe): A National Collaboration to Improve Maternal and Child Health. J Womens Health 2018 26(12):1265-69

Zahn CM, Remick A, Catalano A, Goodman D, Kilpatrick SJ, Menard MK.  Levels of Maternal Care Verification Pilot:  Translating Guidance into Practice.  Onstet Gynecol 2018. 132(6): 1401-06.

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.