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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Provider Education. (National Associations). (13.1)

Approach. Collaborate with national nurse midwifery, and family practice associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and make referrals s to oral health providers for care

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Overview. Provider education is an evidence-based strategy that has shown utility in increasing use of health care other than oral health care by MCH population groups. While limited research has been conducted to verify results with populations in need of oral health care, research conducted to date can serve as a proxy to gauge effect. However, more research is needed to obtain conclusive results.[1] Partnerships among prenatal care associations. (which include obstetric, nurse midwifery, and family practice ) provide an opportunity for these associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and refer pregnant women to oral health providers for care. Examples of preventive oral health care include education, anticipatory guidance, and fluoride varnish application.

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Collaboration (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of national nurse midwifery and family practice associations engaged as partners to promote oral health integration. (Measures breadth of collaboration on oral health integration across healthcare sectors)
  • Number of association members who receive training on oral health risk assessment, preventive care, and referrals. (Measures reach of healthcare provider education)

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

PROCESS MEASURES:

  • Percent of oral health integration training sessions that include interactive skill-building components. (Measures the quality of training approach)
  • Percent of association members who demonstrate proficiency in oral health core competencies after training. (Measures effectiveness of workforce development efforts to develop knowledge of oral health competencies)

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

PROCESS MEASURES:

  • Number of collaborations established between nurse midwifery/family practice groups and dental provider organizations. (Measures breadth of inter-professional partnerships)
  • Number of practice settings that institutionalize oral health risk assessments and referral process. (Measures systematic integration of oral health screening and referral process into existing healthcare practices)

OUTCOME MEASURES:

  • Number of pregnant women receiving oral health services from integrated providers who achieve good oral health. (Measures clinical oral health outcomes of integrated care for pregnant women)
  • Number of pregnant women with a dental home who receive regular oral health care during and after pregnancy. (Measures continuity of oral health care for pregnant women)

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

PROCESS MEASURES:

  • Percent of collaborations established between nurse midwifery/family practice groups and dental provider organizations. (Measures breadth of inter-professional partnerships)
  • Percent of oral health integration resources dedicated to practices serving pregnant women with limited financial resources. (Measures tailoring of support to areas with low income)

OUTCOME MEASURES:

  • Percent of pregnant women with limited financial resources who receive integrated oral health services in maternity care settings. (Measures level of access to integrated maternity and oral health services)
  • Percent reduction in gaps in oral health status and dental care utilization among pregnant women. (Measures impact of oral health care integration among pregnant women)

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.
  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.

References

1 Perkins, R. B., Zisblatt, L., Legler, A., Trucks, E., Hanchate, A., & Gorin, S. S. (2015). Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine, 33(9), 1223-1229.

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.