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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. NPM 6: Developmental Screening

MCHbest Logo toddler and doctor playing with their noses

Strategy. Medical Homes

Approach. Support the implementation of a quality improvement initiative to establish a medical home system of care within pediatric primary care clinics.

Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database

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Overview. Medical homes provide continuous, comprehensive, whole person primary care (NCQA-PCMH, AHRQ-PCMH). In this model of care, primary care providers and their teams coordinate care across the health care system, working with patients to address all their preventive, acute, and chronic health care needs, and arranging care with other qualified health professionals as needed. Medical homes offer enhanced access, including expanded hours and easy communication options for patients. They also practice evidence-based medicine, measure performance, and strive to improve care quality (AHRQ-PCMH).

Evidence. Scientifically Supported. There is strong evidence that medical homes improve quality of health care and access to care (van den Berk-Clark 2017*, Olayiwola 2017, Alexander 2012*, van Walraven 2010*, Rosenthal 2008, Homer 2008, Hoff 2013*), and increase the use of preventive services compared to traditional care (Sinaiko 2017, Olayiwola 2017, Hadland 2014, Jackson 2013, Alexander 2012*). Medical homes increase continuity of care (van Walraven 2010*), use of evidence-based medicine (Homer 2008), and patient and family participation in care (Rosenthal 2008, Homer 2008). Medical homes increase general preventive screenings (Sinaiko 2017). 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 children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year.

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.

Sample ESMs. Using the approach “Support the implementation of a quality improvement initiative to establish a medical home system of care within pediatric primary care clinics,” 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 pediatric primary care clinics participating in medical home quality initiative.

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

  • Percent of pediatric primary care clinics participating in medical home quality initiative.

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

  • Number of parents of children ages 9 through 35 months who report having a medical home for all of their child's needs, including developmental screening.

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

  • Percent of parents of children ages 9 through 35 months who report having a medical home for all of their child's needs, including developmental screening.

Note. When looking at your ESMs, SPMs, or other strategies: (1) move from measuring quantity to quality; (2) move from measuring effort to effect; (3) Quadrant 1 strategies should be used sparingly, when no other data exists; and (4) the most effective measurement combines strategies in all levels, with most in Quadrants 2 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.