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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Early Prenatal Care.

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Strategy. Collaboration with Prenatal Care Providers

Approach. Collaborate with prenatal care providers to provide care that includes preconception care, prenatal care, and routine care to birthing persons of advanced maternal age.

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Overview. Women of advanced maternal age need compassionate care. (preconception, prenatal, and routine) that is collaborative, coordinated, and comprehensive. healthcare providers should also collaborate on providing surveillance care to women of advanced maternal age to address potential complications.[1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

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.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

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

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

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 prenatal care providers partnered with Title V engaged in collaborative efforts for advanced maternal age care. (Measures extent of partnership)
  • Number of joint planning sessions to develop tailored care protocols for older pregnant women. (Assesses coordination efforts)

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

PROCESS MEASURES:

  • Percent of providers adopting evidence-based guidelines for pregnancies among older individuals. (Assesses spread of best practices)
  • Percent of planning sessions including representation from those with practical experience in advanced maternal age communities. (Evaluates planning)

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

PROCESS MEASURES:

  • Number of providers partnered with Title V implementing team-based models for advanced maternal age care. (Measures care coordination infrastructure)
  • Number of community organizations collaborating with Title V linked with prenatal partners for wrap-around services. (Shows support system expansion)

OUTCOME MEASURES:

  • Number of individuals of advanced maternal age completing reproductive life plans with care teams. (Assesses preconception health engagement)
  • Number of pregnant women of advanced age receiving education on age-related risk factors. (Demonstrates tailored guidance)

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

PROCESS MEASURES:

  • Percent of providers partnered with Title V implementing team-based models for advanced maternal age care. (Measures care coordination infrastructure)
  • Percent of community organizations collaborating with Title V linked with prenatal partners for wrap-around services. (Shows support system expansion)

OUTCOME MEASURES:

  • Percent of individuals of advanced maternal age completing reproductive life plans with care teams. (Assesses preconception health engagement)
  • Percent of pregnant women of advanced age receiving education on age-related risk factors. (Demonstrates tailored guidance)

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] Carrie M. Dillon, Christopher S. Ennen, Kathleen J. Bailey, Andrew S. Thagard, A Comprehensive Approach to Care of Women of Advanced Maternal Age, Nursing for Women's Health, Volume 23, Issue 2, 2019, Pages 124-134, https://doi.org/10.1016/j.nwh.2019.02.002.

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.