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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: Access to Providers through Hotline + Continuing Education of Hospital Providers + State Policies/Guidelines

Approach. Support a 3-pronged approach in caring for patients who have additional health needs by developing a 24-hour hotline for providers, supporting the establishment of intra-hospital transport system, and developing a Continuing Medical Education. (CME) module on transportation guidelines

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Overview. A multipronged, provider-focused approach to caring for patients who have additional health needs includes the development of a 24-hour hotline for obstetric and neonatal providers to utilize in centers of level II for lower, the creation of a continuing medical education module on transportation guidelines of high-risk mothers and newborns for healthcare providers, and the establishment of an intra-hospital transport system for high-risk mothers and newborns can be used to improve risk-appropriate perinatal care and decrease statewide infant mortality.[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.
  • 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.

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 hotline consultations that adhered to evidence-based triage protocols and national guidelines for perinatal care involving higher health risks. (Assesses quality of hotline support)
  • Number of CME modules that incorporated relevant content for different populations. (Evaluates educational quality)

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

PROCESS MEASURES:

  • Percent ifCME modules that incorporated relevant content for different populations. (Evaluates educational quality)
  • Percent of intra-hospital transports that followed evidence-based guidelines for maternal and neonatal safety during transfer. (Assesses adherence to best practices)

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

PROCESS MEASURES:

  • Number of perinatal care providers trained in using the hotline, transport system, and applying CME knowledge to cases involving higher health risks. (Shows provider capacity building)
  • Number of existing maternal and child health coalitions that have integrated the multi-pronged approach into their strategic plans. (Assesses integration with broader initiatives)

OUTCOME MEASURES:

  • Number of avoided adverse outcomes attributed to timely hotline consultation and appropriate transport decisions. (Measures clinical impact)
  • Number of quality improvement initiatives implemented based on data and insights gathered from the multi-pronged approach. (Assesses system-level improvements)

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

PROCESS MEASURES:

  • Percent of hotline services and CME content tailored to address specific needs of communities experiencing negative perinatal health outcomes. (Evaluates meeting needs of focus population)
  • Percent of community representatives from populations experiencing challenges involved in designing and evaluating the multi-pronged approach. (Assesses authentic engagement)

OUTCOME MEASURES:

  • Percent increase in timely access to risk-appropriate care for pregnancies involving higher health risks in areas with additional needs compared to baseline. (Assesses improvements in care)
  • Percent of participating healthcare facilities actively using all components of the multi-pronged approach (hotline, CME, and transport system). (Assesses program penetration)

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] Kim EW, Teague-Ross TJ, Greenfield WW, Keith Williams D, Kuo D, Hall RW. Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality. J Perinatol. 2013;33(9):725-730

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.