Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Early Prenatal Care.

MCHbest Logo

Strategy. Telehealth and Virtual Care

Approach. Develop and adopt prenatal care telehealth policies to reduce barriers to care among birthing persons.

Return to main MCHbest page >>

Overview. COVID-19 provided a natural experiment to better understand the facilitators and barriers to utilizing telehealth for preconception and perinatal healthcare. Hybrid care models combine both in-person and telehealth visits and have been found to be successful in reducing barriers such as transportation, geographic distance and barriers, childcare, and missed and late appointments.[1, 2, 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.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

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

Intervention Level. Individual/Family-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 agencies developing prenatal care telehealth policies. (Measures policy adoption for telehealth)
  • Number of providers trained on prenatal telehealth procedures. (Assesses workforce preparation for telehealth)

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

PROCESS MEASURES:

  • Percent of prenatal care policies incorporating telehealth access. (Measures integration of telehealth in care policies)
  • Percent of providers demonstrating competency in telehealth delivery after training. (Evaluates effectiveness of provider training)

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

PROCESS MEASURES:

  • Number of patients educated about prenatal telehealth options during intake that report an increase in knowledge and/or skill. (Measures patient education on telehealth)
  • Number of telehealth users reporting high satisfaction with virtual prenatal care providers trained by Title V. (Evaluates quality of telehealth experience)

OUTCOME MEASURES:

  • Number of missed in-person appointments avoided by use of telehealth. (Indicates impact on visit adherence)
  • Number of postpartum complications prevented through telehealth monitoring. (Measures contribution to risk reduction)

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

PROCESS MEASURES:

  • Percent of patients educated about prenatal telehealth options during intake that report an increase in knowledge and/or skill. (Measures patient education on telehealth)
  • Percent of telehealth users reporting high satisfaction with virtual prenatal care providers trained by Title V. (Evaluates quality of telehealth experience)

OUTCOME MEASURES:

  • Percent of missed in-person appointments avoided by use of telehealth. (Indicates impact on visit adherence)
  • Percent of postpartum complications prevented through telehealth monitoring. (Measures contribution to risk reduction)

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] Stanley AY, Wallace JB. Telehealth to Improve Perinatal Care Access. MCN Am J Matern Child Nurs. 2022 Sep-Oct 01;47(5):281-287. doi: 10.1097/NMC.0000000000000841. PMID: 35960218.https://pubmed.ncbi.nlm.nih.gov/35960218.

[2] Madden N, Emeruwa UN, Friedman AM, Aubey JJ, Aziz A, Baptiste CD, Coletta JM, D'Alton ME, Fuchs KM, Goffman D, Gyamfi-Bannerman C, Kondragunta S, Krenitsky N, Miller RS, Nhan-Chang CL, Saint Jean AM, Shukla HP, Simpson LL, Spiegel ES, Yates HS, Zork N, Ona S. Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis. Am J Perinatol. 2020 Aug;37(10):1005-1014. doi: 10.1055/s-0040-1712939. Epub 2020 Jun 9. PMID: 32516816; PMCID: PMC7416212. https://pubmed.ncbi.nlm.nih.gov/32516816/.

[3] Whittington JR, Ramseyer AM, Taylor CB. Telemedicine in Low-Risk Obstetrics. Obstet Gynecol Clin North Am. 2020 Jun;47(2):241-247. doi: 10.1016/j.ogc.2020.02.006. Epub 2020 Apr 29. PMID: 32451015. https://pubmed.ncbi.nlm.nih.gov/32451015/#:~:text=Telemedicine%20has%20been%20used%20to,to%20aid%20in%20smoking%20cessation.

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.