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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
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Strategy. Quality Improvement Initiatives

Approach. Implement quality improvement initiatives in healthcare settings that focus on reducing barriers to care for children and families and ensure timely and efficient healthcare delivery

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Overview. Quality improvement initiatives in healthcare settings can focus on reducing barriers to care by enhancing appointment scheduling processes, reducing wait times, and improving communication with families to ensure timely and efficient healthcare delivery for children in need of care. Suboptimal attendance at well-child care may be due to parents' sense of unmet needs during visits or challenges experienced by families, such as limited transportation, economic hardships, and discrimination.[1] Improving access to preventive and acute care is central to improving health care utilization.[2] Models including group well-child care,[1] walk-in clinics for ill care,[2] screening for social needs,[3] changes to the physical clinic space to make it more inclusive and affirming,[4] training of providers to deliver culturally competent care[4], and a social marketing campaign to improve community outreach[4] were implemented to overcome barriers to care and provide needed services and supports in a welcoming and comfortable environment for children and their families.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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 healthcare organizations that implement quality improvement initiatives focused on reducing barriers to care for children. (Measures adoption of improvement strategy.)
  • Number of quality improvement projects conducted to streamline care processes and reduce wait times for children's health services. (Captures improvement activities.)
  • Number of providers and staff engaged in quality improvement training and implementation efforts. (Assesses workforce engagement in improvement.)

OUTCOME MEASURES:

  • Number of children who receive more timely and efficient care as a result of quality improvement initiatives. (Measures impact on timeliness of care.)
  • Number of missed or delayed child health visits prevented through improved scheduling and reminder systems. (Captures prevention of foregone care.)
  • Number of pediatric patient safety events and care quality deficiencies avoided through targeted improvement efforts. (Indicates care quality and safety impact.)

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

PROCESS MEASURES:

  • Percent of quality improvement initiatives that employ family-centered design principles and involve parents as advisors. (Assesses participatory approach.)
  • Percent of quality improvement interventions that are selected based on analysis of disparities in care access, experiences, and outcomes. (Measures data-driven equity focus.)
  • Percent of providers who demonstrate competency in quality improvement methods and tools through training assessments. (Evaluates workforce capability.)

OUTCOME MEASURES:

  • Percent of children who receive all recommended preventive and chronic care services within established benchmarks after quality improvement implementation. (Measures care reliability.)
  • Percent of parents who report improved access, communication, and coordination in their children's care following quality improvement efforts. (Captures family experience impact.)
  • Percent reduction in disparities in care quality and health outcomes between children from disadvantaged backgrounds and those from more privileged circumstances. (Assesses equity impact.)

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

PROCESS MEASURES:

  • Number of pediatric quality measures and performance targets established to guide improvement efforts and track progress over time. (Captures measurement infrastructure.)
  • Number of collaborative improvement networks formed to accelerate the spread of best practices and innovations across healthcare organizations. (Measures dissemination infrastructure.)
  • Number of policy and payment reforms advocated for and adopted to align incentives with child health care quality and equity goals. (Assesses enabling context for improvement.)

OUTCOME MEASURES:

  • Number of healthcare organizations that achieve sustained improvements in child care access, quality, and efficiency through continuous improvement efforts. (Measures long-term impact.)
  • Number of potentially preventable child hospitalizations and readmissions avoided as a result of more reliable and coordinated care. (Captures health system impact.)
  • Number of children who experience optimal health and developmental outcomes due to consistent receipt of high-quality, timely, and barrier-free care. (Indicates cumulative impact on well-being.)

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

PROCESS MEASURES:

  • Percent of quality improvement teams that are diverse and representative of the communities served. (Assesses inclusive improvement infrastructure.)
  • Percent of quality improvement initiatives that prioritize the needs and perspectives of historically marginalized populations in their design and implementation. (Measures equity-oriented improvement.)
  • Percent of healthcare organizations that allocate resources proportional to the level of disparities and improvement needs in the populations they serve. (Evaluates equitable resource allocation.)

OUTCOME MEASURES:

  • Percent decrease in the gap between actual and equitable utilization of essential child health services across racial, ethnic, and socioeconomic groups. (Measures progress toward care equity.)
  • Percent reduction in potentially avoidable child morbidity and mortality, with accelerated improvement among populations experiencing health inequities. (Captures equity impact on health outcomes.)
  • Percent increase in trust, satisfaction, and shared decision-making in healthcare interactions reported by families from historically disadvantaged communities. (Assesses equity in experience of care.)

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] Fenick, A. M., Leventhal, J. M., Gilliam, W., & Rosenthal, M. S. (2020). A Randomized Controlled Trial of Group Well-Child Care: Improved Attendance and Vaccination Timeliness. Clinical pediatrics, 59(7), 686–691.

[2] Warrick, S., Morehous, J., Samaan, Z. M., Mansour, M., Huentelman, T., Schoettker, P. J., & Iyer, S. (2018). Walk-in Model for Ill Care in an Urban Academic Pediatric Clinic. Academic pediatrics, 18(3), 281–288.

[3] Arbour, M. C., Floyd, B., Morton, S., Hampton, P., Sims, J. M., Doyle, S., Atwood, S., & Sege, R. (2021). Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care. Pediatrics, 148(5), e2021050152.

[4] Hermosillo, D., Cygan, H. R., Lemke, S., McIntosh, E., & Vail, M. (2022). Achieving Health Equity for LGBTQ+ Adolescents. Journal of continuing education in nursing, 53(8), 348–354.

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.