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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. Engage in quality improvement initiatives to strengthen the patient-provider relationship and continuity of care

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Overview. Quality improvement initiatives at the clinic, practice, or healthcare system level can enhance the overall quality of care and improve health outcomes for children and youth. These initiatives, including optimizing community-based referrals,[1] providing early intervention and holistic healthcare,[2] increasing patient empanelment to primary care providers,[3] offering nurse or nurse practitioner-led services such as telephone support using motivational interviewing,[4,5] redirecting of nonurgent patients arriving in the emergency department to their primary care office for a same-day visit[6], and offering full-day continuity clinics,[7] are all focused on establishing and maintaining care with a personal healthcare provider, strengthening the patient-provider relationship, and enhancing continuity of care for children, youth, and their families to ensure positive health outcomes.

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.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

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 pediatric practices patterning wit Title V to implement quality improvement (QI) projects focused on strengthening patient-provider relationships and care continuity. (Measures engagement in relationship-centered QI efforts)
  • Number of providers and staff trained in QI methods and relationship-centered care approaches. (Shows workforce capacity building for patient-centered QI)

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

PROCESS MEASURES:

  • Percent of QI initiatives utilizing validated, patient-centered measures to assess and enhance patient-provider relationships. (Measures use of evidence-based, person-centered QI approaches)
  • Percent of QI teams including meaningful participation from patients, families, and community partners in improvement strategies. (Assesses level of patient and family engagement in QI)

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

PROCESS MEASURES:

  • Number of children and families experiencing improved care coordination and continuity through QI initiatives. (Measures impact on care integration and consistency)
  • Number of pediatric practices demonstrating sustained improvement in patient-provider relationship quality following QI initiatives. (Shows long-term impact of relationship-focused QI)

OUTCOME MEASURES:

  • Number of healthcare organizations demonstrating significant improvement in patient experience and health outcomes through relationship-centered QI initiatives. (Measures organizational impact of QI)
  • Number of communities benefiting from the spread of locally adapted models for strengthening patient-provider partnerships. (Assesses population health impact of QI dissemination)

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

PROCESS MEASURES:

  • Percent of children and families experiencing improved care coordination and continuity through QI initiatives. (Measures impact on care integration and consistency)
  • Percent of pediatric practices demonstrating sustained improvement in patient-provider relationship quality following QI initiatives. (Shows long-term impact of relationship-focused QI)

OUTCOME MEASURES:

  • Percent of healthcare organizations demonstrating significant improvement in patient experience and health outcomes through relationship-centered QI initiatives. (Measures organizational impact of QI)
  • Percent of communities benefiting from the spread of locally adapted models for strengthening patient-provider partnerships. (Assesses population health impact of QI dissemination)

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] Sanderson, D., Braganza, S., Philips, K., Chodon, T., Whiskey, R., Bernard, P., ... & Fiori, K. (2021). Increasing warm handoffs: optimizing community based referrals in primary care using QI methodology. Journal of Primary Care & Community Health, 12, 21501327211023883.

[2] Rickwood, D., Paraskakis, M., Quin, D., Hobbs, N., Ryall, V., Trethowan, J., & McGorry, P. (2019). Australia's innovation in youth mental health care: The headspace centre model. Early intervention in psychiatry, 13(1), 159-166.

[3] Snyder, D. A., Schuller, J., Ameen, Z., Toth, C., & Kemper, A. R. (2022). Improving Patient-Provider Continuity in a Large Urban Academic Primary Care Network. Academic pediatrics, 22(2), 305–312.

[4] Schlottmann, H., Broome, M., Herbst, R., Burkhardt, M. C., & Mescher, A. (2019). Nurse-Led Telephone Follow-Up to Improve Parent Promotion of Healthy Behaviors in Young Children With Motivational Interviewing Techniques. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 33(5), 545–554.

[5] Wall, S., & Medina, R. (2022). Creating an academic-practice partnership in a primary care pediatric clinic. Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 41, 176–180

[6] Wolski, T. P., Jr, Jamerino-Thrush, J., Bigham, M. T., Kline-Krammes, S., Patel, N., Lee, T. J., Pollauf, L. A., Joyce, C. N., Kunka, S., McNinch, N. L., Jacobs, M., & White, P. C. (2022). Redirecting Nonurgent Patients From the Pediatric Emergency Department to Their Pediatrician Office for a Same-Day Visit-A Quality Improvement Initiative. Pediatric emergency care, 38(12), 692–696.

[7] Kiger, M. E., Bautista, E., Bertagnoli, T. M., Hammond, C. E., Meyer, H. S., Varpio, L., & Dong, T. (2021). Defragmenting the Day: The Effect of Full-Day Continuity Clinics on Continuity of Care and Perceptions of Clinic. Teaching and learning in medicine, 33(5), 546–553.

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.