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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
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Strategy. Telemedicine and Telehealth Services

Approach. Utilize telemedicine and telehealth services with children and their families to overcome barriers and improve access to healthcare with a personal provider

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Overview. Telemedicine and telehealth services can help overcome geographical barriers and improve access to healthcare, especially in rural, remote, or medically under resourced areas, for children with and without special healthcare needs. These services can facilitate virtual consultations, follow-up appointments, ongoing care, and specialty care with a personal doctor or nurse.[1,2,3] The COVID-19 pandemic has led to unprecedented use of telehealth and primary care providers reported that telehealth increased access to care and enabled them to provide high-quality care to their patients.[4]

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.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • 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 partnered with Title V offering telemedicine and telehealth services for children and families. (Measures availability of telehealth modalities)
  • Number of providers trained to deliver high-quality, family-centered care through telemedicine platforms. (Shows workforce readiness for telehealth)

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

PROCESS MEASURES:

  • Percent of telemedicine services oversaw by Title V adhering to evidence-based clinical guidelines and quality benchmarks. (Measures quality of telehealth delivery)
  • Percent of telehealth encounters involving meaningful patient and family engagement and shared decision-making. (Assesses patient-centeredness of telehealth visits)

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

PROCESS MEASURES:

  • Number of policies and payment models promoted by Title V established to support sustainable delivery of pediatric telemedicine services. (Assesses enabling conditions for telehealth adoption)
  • Number of cross-sector partnerships developed to integrate telemedicine into the broader ecosystem of child and family services who report high levels of engagement. (Measures care integration for telehealth)

OUTCOME MEASURES:

  • Number of communities experiencing improved pediatric care access and outcomes through widespread availability of telemedicine services. (Measures population health impact of telehealth)
  • Number of healthcare organizations demonstrating cost savings and improved value through strategic deployment of telemedicine capabilities. (Assesses economic impact of telehealth)

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

PROCESS MEASURES:

  • Percent of telemedicine services designed with input from families facing the greatest barriers to accessing care. (Measures participatory design of telehealth initiatives)
  • Percent of telehealth investments allocated to building digital infrastructure in communities with limited resources. (Assesses tailored investment in telehealth)

OUTCOME MEASURES:

  • Percent reduction in differences in care access and outcomes between groups through telemedicine initiatives. (Measures impact on advancing health outcomes through telehealth)
  • Percent of children and families from communities reporting telemedicine services as responsive and meeting their needs. (Assesses community experience in telehealth)

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] Hooshmand, M., & Foronda, C. (2018). Comparison of Telemedicine to Traditional Face-to-Face Care for Children with Special Needs: A Quasiexperimental Study. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 24(6), 433–441.

[2] Mosquera, R. A., Avritscher, E. B. C., Pedroza, C., Lee, K. H., Ramanathan, S., Harris, T. S., Eapen, J. C., Yadav, A., Caldas-Vasquez, M., Poe, M., Martinez Castillo, D. J., Harting, M. T., Ottosen, M. J., Gonzalez, T., & Tyson, J. E. (2021). Telemedicine for Children With Medical Complexity: A Randomized Clinical Trial. Pediatrics, 148(3), e2021050400.

[3] Watson, L., Woods, C. W., Cutler, A., DiPalazzo, J., & Craig, A. K. (2023). Telemedicine Improves Rate of Successful First Visit to NICU Follow-up Clinic. Hospital pediatrics, 13(1), 3–8.

[4] Gilkey, M. B., Kong, W. Y., Huang, Q., Grabert, B. K., Thompson, P., & Brewer, N. T. (2021). Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals. Journal of medical Internet research, 23(9), e31240.

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.