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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 and telehealth consultation programs including 24-hour provider consultation hotlines, real-time inter-facility consultations, and direct patient care services to establish need for referral and transfer of high-risk mothers with VLBW neonates and extend quaternary neonatal care to rural communities

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Overview. Telemedicine uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services for perinatal care, including provider-to-provider consultation hotlines and direct patient care services. These programs encompass real-time consultations between facilities, 24-hour hotlines for obstetric and neonatal providers, remote monitoring of vital signs, and teleneonatology services that extend Level IV care to rural areas.[1,2] Evidence demonstrates that telemedicine consultation programs can effectively reduce neonatal mortality rates, increase discharge rates, and help retain over half of patients at local facilities, resulting in significant cost savings.[1,2] Comprehensive telemedicine initiatives that combine provider consultation services with systematic regionalization efforts have been shown to improve perinatal regionalization and reduce statewide infant mortality.[3,4]

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

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

Potential Data Sources. Data to support this strategy can be accessed through:

  • Records of Title V funding for telemedicine infrastructure and programs
  • Data on number and type of telemedicine consultations supported or facilitated by Title V
  • Records of Title V developed or endorsed telemedicine protocols and guidelines

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 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 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?”)

  • 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?”)

  • 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)
  • 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?”)

  • 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)
  • 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.

References

[1] Jagarapu J, Kapadia V, Mir I, et al. TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers. J Telemed Telecare (2024).
[2] Mominkhan DM, Aldahmashi F, Almudeer AH, et al. Implementing telemedicine intervention in neonatal intensive care units: Augmented teleconsultation and real-time monitoring experience. Telemed Rep (2025).
[3] Bronstein JM, Ounpraseuth S, Jonkman J, et al. Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention. Health Serv Res (2011).
[4] Bronstein JM, Ounpraseuth S, Lowery CL. Improving perinatal regionalization: 10 years of experience with an Arkansas initiative. Journal of Perinatology (2020).

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.