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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. Multicomponent: Continuing Education of Hospital Providers + State Policies/Guidelines

Approach. Support establishment of an intra-hospital transportation system and develop a Continuing Medical Education. (CME) module on transportation guidelines

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Overview. A multicomponent approach is effective in increasing risk-appropriate perinatal care. An approach that combines the education of obstetric and neonatal medical personnel on transportation guidelines and the implementation of an intra-hospital neonatal transport system for high-risk mothers and newborns has been shown to increase the number of very low birth weight. (VLBW) babies born at level III risk-appropriate settings.[1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some 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. Health Teaching (Education and Promotion) (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 implemented the intra-hospital transportation system and required CME module for providers. (Measures adoption of the multicomponent intervention)
  • Number of maternal and neonatal transports conducted using the new intra-hospital system. (Evaluates utilization of the transportation component)

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

PROCESS MEASURES:

  • Percent of CME module content that aligns with the most current evidence-based transportation guidelines. (Measures educational quality)
  • Percent of participating hospitals that have fully integrated the transportation system and CME requirements into their policies. (Assesses institutionalization)

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

PROCESS MEASURES:

  • Number of quality improvement projects conducted to monitor and enhance the performance of the transportation system and CME program. (Evaluates continuous improvement)
  • Number of cross-functional teams formed (e.g., obstetrics, neonatology, transport) to oversee the implementation and ongoing operations. (Measures interdisciplinary collaboration)

OUTCOME MEASURES:

  • Number of adverse events for near misses avoided during maternal and neonatal transports due to adherence to guidelines and protocols. (Shows safety impact)
  • Number of VLBW newborns who received early interventions (e.g., surfactant, CPAP) during transport, leading to improved outcomes. (Measures clinical effectiveness)

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

PROCESS MEASURES:

  • Percent of rural for critical access hospitals that participated in the CME program and adopted the transportation system. (Measures access)
  • Percent of the CME module and transportation protocols that incorporated appropriate content that matched the key characteristics of the patient. (Evaluates provider competence)

OUTCOME MEASURES:

  • Percent reduction in geographic and racial/ethnic gaps for VLBW births at level III for higher facilities after implementing the multicomponent approach. (Measures health impact)
  • Percent reduction in overall infant mortality and morbidity rates attributable to the improved access to risk-appropriate perinatal care. (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 Warner B, Altimier L, Imhoff S. Clinical excellence for high risk neonates: improved perinatal regionalization through coordinated maternal and neonatal transport. Neonatal Intensive Care. 2002;15(6):33-38.

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.