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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Referrals.

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Strategy. Plan-Do-Study-Act

Approach. Develop and adopt effective screening and care methodologies that adapt to patient and provider experiences so that efficient and timely care can be provided to all patients

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Overview. Implementing a Plan-Do-Study-Act cycles can enhance social drivers of health (SDOH) screenings in pediatric practices. The quality improvement initiative, ASHEW project, resulted in significant increases in screening rates and fulfilled referrals.[1]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Screening completion and positive screen follow-up rates
  • Patient/family satisfaction surveys
  • Wait time data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Provider Experience of Care. This strategy improves healthcare professionals' perceptions, feelings, and satisfaction with the work environment and systems they use.
  • 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.

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. Screening (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. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of healthcare teams partnered with Title V adopting PDSA methods to improve screening and care process. (Measures uptake of PDSA approach)
  • Number of PDSA cycles conducted to optimize screening practices based on patient and provider insights. (Assesses frequency of PDSA activities)

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

  • Percent of PDSA initiatives adhering to key principles, including clear aims and measurable metrics. (Measures fidelity of PDSA implementation)
  • Percent of PDSA team members receiving training and protected time for improvement work. (Assesses workforce support for PDSA)

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

  • Number of collaborative improvement networks formed to accelerate spread of effective PDSA practices. (Measures field-building for PDSA)
  • Number of providers experiencing increased job satisfaction through participation in PDSA initiatives. (Assesses workforce engagement impact of PDSA)
  • Number of healthcare organizations achieving reductions in care differences through tailored PDSA methods. (Measures PDSA impact on advancing health outcomes)
  • Number of communities experiencing improved population health outcomes through PDSA-driven innovations. (Assesses population health impact of PDSA spread)

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

  • Percent of PDSA initiatives prioritizing needs of patients that results in satisfaction in services received. (Measures impact of PDSA efforts)
  • Percent of PDSA teams that involve leadership from various groups. (Assesses PDSA team composition)
  • Percent reduction in screening between different groups through PDSA interventions. (Measures PDSA impact on closing health gaps)
  • Percent of patients from various backgrounds reporting PDSA-driven changes as responsive and supportive. (Assesses impact of PDSA improvements)

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] Brennan, L., Evans, M., Michaeli, G., Pandita, P., Patel, S., Powell, K., Putnam-Johnson, H., Chong, A., Stelzner, S., & Casavan, K. (2022). Completion of Social Drivers of Health Screenings in Pediatric Practices Participating in a Quality Improvement Initiative. Journal of developmental and behavioral pediatrics : JDBP, 43(8), 472–479. https://doi.org/10.1097/DBP.0000000000001114

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.