Evidence Tools
MCHbest. Early Prenatal Care.

Overview. A quality improvement initiative, this study evaluated the effectiveness of reducing barriers that delayed early access to early prenatal care in a federally qualified community health center. (FQHC).[1] Utilizing several different mechanisms to learn about the barriers. (focus groups, surveys, etc), the quality improvements included a clinical redesign, presumptive insurance eligibility for patients, extended hours of operation, improved patient communications, and a simplification of prenatal care services and protocols. The LEAN methodology was used in the study design.[1] Redesigning the standard prenatal care guidelines to incorporate virtual care and remote monitoring provides a more flexible and usable approach to prenatal care. The 4-1-4 approach allows for critical touchpoints for services such as depression screening, anticipatory guidance about childbirth and parenting, and addressing emerging patient questions.[2] The MiPath program. (Michigan) allows for a flexible, personalized care coordination plan and stresses the importance of addressing the social and structural determinants of health and connecting individuals earlier in pregnancy to necessary services.[3]

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.
• Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
• 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. 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. 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).