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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Risk-Appropriate Perinatal Care.

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Strategy. Continuing Education of Hospital Providers

Approach. Develop a continuing medical education. (CME) module on transport guidelines of high-risk pregnant women for obstetric and neonatal healthcare providers

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Overview. Very Low Birth Weight. (VLBW) infants born in level III centers leads to improvement in survival rate and reduction in neurological morbidity. Training hospital providers as part of a comprehensive approach has shown to improve delivery in risk-appropriate settings.[1]

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):

  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
  • Safety of Care. This study promotes avoidance of preventable harm to patients during healthcare delivery.

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. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

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 obstetric and neonatal healthcare providers who completed the CME module on transport guidelines. (Measures reach of the intervention)
  • Number of hospitals that have incorporated the CME module into their staff education requirements. (Assesses organizational adoption)

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

PROCESS MEASURES:

  • Percent of the CME module content that aligns with the latest evidence-based transport guidelines. (Measures adherence to best practices)
  • Percent of hospitals with provider participation in the CME module that have updated their transport protocols. (Assesses translation into practice)

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

PROCESS MEASURES:

  • Number of case studies for simulations included in the CME module to reinforce practical application of transport guidelines. (Evaluates relevant content)
  • Number of regional collaboratives formed to facilitate coordination and communication around maternal transport. (Assesses system integration)

OUTCOME MEASURES:

  • Number of maternal and neonatal complications avoided due to appropriate transport of pregnant women facing higher health risks. (Shows preventive impact)
  • Number of healthcare providers who reported improved communication and coordination with other facilities during transport situations. (Assesses process improvement)

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

PROCESS MEASURES:

  • Percent of rural areas with providers who participated in the CME module on transport guidelines. (Measures access)
  • Percent of the CME module that incorporated input from community partners, including patient supporters. (Evaluates the involvement of multiple perspectives)

OUTCOME MEASURES:

  • Percent reduction in poor outcomes for VLBW infant outcomes between level III and lower-level centers after widespread CME participation. (Measures impact)
  • Percent of healthcare providers who reported increased understanding of social factors influencing transport decisions. (Assesses awareness)

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] American College of Obstetricians and Gynecologists. (2019). Levels of maternal care: obstetric care consensus no, 9. Obstet Gynecol, 134(2), e41-e55. Levels of Maternal Care | ACOG

[2] Victorian Infant Collaborative Study Group (VICSG). Improvement of outcome for infants of birth weight under1000 g. Arch Dis Child. 1991;66:765-769.

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.