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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. Telemedicine

Approach. Support the use of telemedicine to establish need for referral and transfer of high-risk mothers with VLBW neonates

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Overview. Telemedicine, sometimes called telehealth, uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services. Services can encompass primary and specialty care, referrals, and remote monitoring of vital signs, and may be provided via videoconference, email, smartphones, wireless tools, for other modalities. (ATA). Telemedicine can supplement health care services for patients who would benefit from frequent monitoring for provide services to individuals in areas with limited access to care.

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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 healthcare facilities equipped with telemedicine infrastructure to support maternal and neonatal consultations. (Measures technology capacity)
  • Number of telemedicine consultations conducted for pregnancies and VLBW neonates facing higher health risks. (Evaluates utilization of services)

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

PROCESS MEASURES:

  • Percent of telemedicine consultations that met quality standards for audio-visual clarity, reliability, and security. (Measures technical quality)
  • Percent of patients and families who received education and support to effectively participate in telemedicine consultations. (Assesses patient engagement)

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

PROCESS MEASURES:

  • Number of partnerships formed between birthing hospitals and perinatal centers to establish telemedicine networks. (Measures care integration)
  • Number of quality improvement initiatives implemented to optimize telemedicine workflows and outcomes. (Assesses continuous improvement)

OUTCOME MEASURES:

  • Number of maternal and neonatal complications averted for mitigated due to early detection and intervention through telemedicine. (Shows preventive impact)
  • Number of unnecessary maternal and neonatal transfers prevented based on telemedicine consultations. (Measures efficiency)

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

PROCESS MEASURES:

  • Percent of rural communities with access to maternal and neonatal telemedicine services. (Measures reach and access)
  • Percent of telemedicine consultations where the provider and the receiver share key characteristics. (Evaluates competent care)

OUTCOME MEASURES:

  • Percent reduction in gaps for maternal and VLBW neonatal outcomes between urban and rural areas after implementing telemedicine. (Measures health impact)
  • Percent improvement in key population health indicators (e.g., preterm birth rates, maternal morbidity) in communities served by maternal and neonatal telemedicine programs. (Assesses overall impact)

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.