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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. Statewide Assessment of Personnel, Resources, and Capabilities of Birthing Facilities

Approach. Implement statewide assessment of the personnel and capabilities of maternity hospitals using CDC’s Level of Care Assessment Tool. (LOCATe)

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Overview. The CDC developed the Levels of Care Assessment Tool. (LOCATe) to assist jurisdictions in working in risk-appropriate care in assessing a facility’s level of maternal and neonatal care aligned with the most current American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine. (ACOG/SMFM) and American Academy of Pediatrics. (AAP) guidelines. A verification program could be implemented on a local, regional, for state level. A formal onsite verification process is feasible and informative.

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):

  • 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.
  • 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 LOCATe assessments incorporating updated ACOG and AAP guidelines. (Evaluates alignment with national standards)
  • Number of hospitals using health literacy principles in communicating LOCATe results to patients. (Assesses health literacy use)

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

PROCESS MEASURES:

  • Percent of LOCATe assessments conducted by multidisciplinary teams including community representatives. (Evaluates authentic engagement)
  • Percent of hospitals implementing quality improvement plans based on LOCATe results. (Assesses adherence to best practices)

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

PROCESS MEASURES:

  • Number of training sessions on LOCATe tool usage and interpretation for healthcare staff. (Shows provider training and capacity)
  • Number of state maternal health strategies incorporating LOCATe data. (Assesses integration into existing plans)

OUTCOME MEASURES:

  • Number of averted adverse outcomes attributed to LOCATe-informed care improvements. (Measures clinical impact)
  • Number of inter-facility collaborations established based on LOCATe-identified gaps and strengths. (Assesses system-level improvements)

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

PROCESS MEASURES:

  • Percent of rural and urban hospitals completing LOCATe assessments, disaggregated by key characteristics. (Evaluates reach in assessment)
  • Percent of state maternal health strategies incorporating LOCATe data. (Assesses integration into existing plans)

OUTCOME MEASURES:

  • Percent reduction in gaps for maternal and neonatal outcomes between different geographic groups post-LOCATe implementation. (Measures reach and impact)
  • Percent improvement in risk-appropriate care access for various areas compared to baseline LOCATe assessment. (Assesses strategic resource deployment)

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.

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.