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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. Telehealth and Telemedicine

Approach. Provide timely and user-friendly assessments, screenings, and referrals to patients in under resourced areas or areas with long wait-times

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Overview. Telehealth and telemedicine referral process can substantially improve initial access to CMHCs for children referred from primary care. This was evidenced by a significant increase in completion rates of the CMHC screening visit among intervention participants compared to usual care procedures.[1] Moreover, parents reported higher satisfaction levels with the referral system and overall care received, indicating positive outcomes associated with the intervention.[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:

  • Wait time data
  • Caregiver self-efficacy and competency surveys
  • Patient satisfaction data

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 Care Access for All MCH Populations.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for 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. Consultation (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 providers offering telehealth services for assessments and referrals. (Measures availability of telehealth modalities)
  • Number of patients receiving telehealth-based assessments and referrals. (Assesses reach of telehealth service delivery)

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

  • Percent of telehealth encounters adhering to clinical guidelines and quality standards. (Measures fidelity of telehealth service delivery)
  • Percent of patients receiving appropriate telehealth-based assessments. (Assesses responsiveness of telehealth services)

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

  • Number of patients reporting high satisfaction with telehealth encounters from providers receiving training from Title V. (Measures patient experience of telehealth modalities)
  • Number of workforce training programs developed to ensure quality telehealth implementation that results in an increase in knowledge and/or skill. (Shows capacity-building efforts for telehealth delivery)
  • Number of communities experiencing increased care access through tailored telehealth deployment. (Assesses population health impact of telehealth initiatives)
  • Number of healthcare systems achieving cost savings through strategic use of telehealth modalities. (Shows economic value of telehealth investments)

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

  • Percent of patients reporting high satisfaction with telehealth encounters from providers receiving training from Title V. (Measures patient experience of telehealth modalities)
  • Number of workforce training programs developed to ensure quality telehealth implementation that results in an increase in knowledge and/or skill. (Shows capacity-building efforts for telehealth delivery)
  • Number of communities experiencing increased care access through tailored telehealth deployment. (Assesses population health impact of telehealth initiatives)
  • Number of healthcare systems achieving cost savings through strategic use of telehealth modalities. (Shows economic value of telehealth investments)

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] Coker, T. R., Porras-Javier, L., Zhang, L., Soares, N., Park, C., Patel, A., Tang, L., Chung, P. J., & Zima, B. T. (2019). A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial. Pediatrics, 143(3), e20182738. https://doi.org/10.1542/peds.2018-2738

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.