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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. Rural Transportation Services

Approach. Establish specialized transportation systems for pregnant women and VLBW neonates requiring higher level care, including emergency transport services, weather-responsive protocols, and coordination with rural transit systems to ensure timely access to appropriate perinatal facilities

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Overview. Rural transportation services for perinatal care address the unique challenges of providing timely access to specialized facilities across large geographic areas with low population densities. These systems include emergency neonatal transport services, coordination with existing rural transit options, and specialized protocols for high-risk maternal and infant populations.[1] Evidence demonstrates that while geographic and weather conditions can significantly impact transport times, well-planned transport systems can maintain safety and effectiveness despite these challenges.[2] Effective rural perinatal transport systems incorporate weather-responsive planning and infrastructure considerations to ensure reliable access to Level III+ facilities for VLBW infants and high-risk pregnancies.[1,2]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

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. Outreach (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 or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of rural counties for regions that have implemented new transportation services for maternal and neonatal care. (Measures expansion of access) Number of partnerships formed with healthcare facilities, community organizations, and transportation providers to establish the services. (Evaluates collaboration)

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

  • Percent of vehicles used for transportation that are equipped with necessary medical equipment and supplies. (Measures quality of services) Percent of transportation staff and volunteers who completed training on safety protocols and patient care during transport. (Evaluates workforce competency)

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

  • Number of rural healthcare facilities that have integrated the transportation services into their patient care protocols. (Measures system integration) Number of quality improvement initiatives implemented to optimize routes, scheduling, and patient handoffs. (Evaluates continuous improvement) Number of pregnancies and VLBW births facing higher health risks that were able to be managed in appropriate level facilities due to transportation access. (Shows clinical appropriateness) Number of patients who were able to attend all recommended prenatal care visits and post-discharge follow-up appointments using the transportation services. (Assesses care continuity)

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

  • Percent of total transportation service capacity allocated to the most remote rural areas. (Measures resource allocation) Percent of transportation staff and volunteers who completed training to provide respectful, patient-centered care. (Evaluates provider competence) Percent reduction in gaps for maternal and VLBW neonatal outcomes between rural and urban areas after implementing transportation services. (Measures health impact) Percent reduction in preventable maternal and neonatal morbidity and mortality in rural areas served by the transportation program. (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] Mattson J, Peterson D. Measuring benefits of rural and small urban transit in Greater Minnesota. Transportation Research Record (2021).
[2] Bhattacharya S, for Knowledge Development Publishing CI. Impact of weather conditions on neonatal transport in Ontario: A retrospective cohort study. Canadian Journal of Medicine (CJM) (2024).

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.