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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. State Policies/Guidelines

Approach. Strengthen statewide intra-hospital transportation systems for transport of high-risk mothers and newborns

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Overview. Statewide coordinated strategies have proven effective in reducing non tertiary hospital births and optimizing transport of outborn infants to perinatal centers. Transport procedures often include:. (1) network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system and. (2) preferential admission of extremely premature infants.[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):

  • Safety of Care. This study promotes avoidance of preventable harm to patients during healthcare delivery.
  • Morbidity Reduction. This strategy addresses factors that can decrease the incidence or prevalence of diseases and illnesses.
  • Mortality Prevention. This strategy addresses factors that are associated with preventing death, particularly premature death from preventable causes.

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. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-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 hospitals that have adopted the statewide transportation guidelines and protocols. (Measures implementation progress)
  • Number of healthcare providers trained on the updated transport procedures and centralized referral systems. (Assesses workforce readiness)

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

PROCESS MEASURES:

  • Percent of transport teams that include both obstetric and neonatal specialists for cases facing higher health risks. (Measures multidisciplinary approach)
  • Percent of referring hospitals that received timely consultation and feedback from perinatal centers through the telephone advice system. (Assesses communication effectiveness)

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

PROCESS MEASURES:

  • Number of regional perinatal centers designated to provide telephone advice and coordinate neonatal retrievals. (Measures centralization of expertise)
  • Number of outreach programs conducted to educate lower-level hospitals on the importance of early recognition and transport of cases facing higher health risks. (Assesses knowledge sharing)

OUTCOME MEASURES:

  • Number of maternal and neonatal complications prevented for mitigated due to timely transport to higher level of care. (Shows clinical outcomes)
  • Number of lower-level hospitals that reported increased confidence and competence in managing cases facing higher health risks with support from the transportation system. (Assesses capacity building)

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

PROCESS MEASURES:

  • Percent of rural areas with access to the statewide maternal and neonatal transportation systems. (Measures distribution)
  • Percent of regional perinatal centers designated to provide telephone advice and coordinate neonatal retrievals. (Measures centralization of expertise)

OUTCOME MEASURES:

  • Percent reduction in geographic gaps for maternal and neonatal outcomes after strengthening the transportation systems. (Measures reach)
  • Percent reduction in preventable morbidity and mortality among pregnancies and premature births facing higher health risks, stratified by key characteristics. (Assesses population health outcomes)

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 Nowakowski, L., Barfield, W. D., Kroelinger, C. D., Lauver, C. B., Lawler, M. H., White, V. A., & Ramos, L. R. (2012). Assessment of state measures of risk-appropriate care for very low birth weight infants and recommendations for enhancing regionalized state systems. Maternal and child health journal, 16(1), 217-227.

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.