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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Home Visiting

Approach. Collaborate with home visiting programs to support mothers in obtaining timely postpartum care

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Overview. Home visiting programs (HVPs)—whether staffed by nurses, midwives, or community health workers—can decrease access barriers and increase the likelihood that new mothers will receive postpartum care.[1,2,3] Trained HVP professionals and paraprofessionals can screen for maternal conditions, help postpartum participants make and attend medical appointments, and provide access to community services.[4,5] However, not all HPVs focus on maternal health care not meet the U.S. Department of Health and Human Services’ criteria as an evidence-based service delivery model.[7] Programs that meet the federal guidelines and include postpartum care as a performance measure are likely to increase the rate of postpartum visit attendance.[8]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings). This strategy is also supported as "Early Childhood Home Visiting Programs" in the What Works for Health database.

Source. Peer-Reviewed Literature and 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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

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 home visiting programs. (HVPs) that include postpartum care support and coordination as a core component of their service delivery model. (Indicates the adoption and implementation of the strategy)
  • Number of HVP staff trained and equipped to provide postpartum care education, screening, referrals, and follow-up. (Shows the workforce capacity and readiness for the strategy)

OUTCOME MEASURES:

  • Number of postpartum individuals in HVPs who attend a postpartum visit within the recommended time frame. (Indicates the effectiveness of the strategy in facilitating timely postpartum care)
  • Number of postpartum conditions, complications, and adverse outcomes identified and addressed through HVP-facilitated postpartum care. (Shows the health impact and early intervention effects of the strategy)

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

PROCESS MEASURES:

  • Percent of HVPs that meet the U.S. Department of Health and Human Services' criteria as an evidence-based service delivery model. (Indicates the quality and fidelity of the strategy)
  • Percent of HVP visits and interactions with postpartum individuals that include postpartum care education, screening, and care coordination that is culturally and linguistically appropriate. (Shows the consistency and intentionality of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum individuals in HVPs who demonstrate increased knowledge, self-efficacy, and activation in managing their postpartum health and care. (Indicates the support and behavior change outcomes of the strategy)
  • Percent reduction in disparities in postpartum care access and utilization among postpartum individuals in HVPs, stratified by race, ethnicity, income, and other equity dimensions. (Shows the health equity impact of the strategy)

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

PROCESS MEASURES:

  • Number of partnerships and referral pathways established between HVPs and healthcare providers, clinics, and community organizations to facilitate seamless postpartum care coordination. (Indicates the care integration and community collaboration approach of the strategy)
  • Number of policies, protocols, and data systems developed to support the effective and efficient inclusion of postpartum care in HVP service delivery. (Shows the infrastructure and enabling environment for the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems, payers, and policymakers that recognize and invest in HVPs as a key strategy for improving postpartum care access, utilization, and outcomes. (Indicates the broad partner buy-in and support for the strategy)
  • Number of communities that experience improved postpartum health and reduced maternal morbidity and mortality through the scaling and sustainment of postpartum care-focused HVPs. (Shows the population-level impact and return on investment of the strategy)

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

PROCESS MEASURES:

  • Percent of HVP funding and resources allocated to address root causes and social determinants of postpartum health inequities, such as economic instability and barriers to healthcare access. (Indicates the upstream and equity-focused investments of the strategy)
  • Percent of HVP performance measures and accountability systems that prioritize postpartum care outcomes, patient-reported experiences, and equity indicators. (Shows the commitment to continuous improvement and equitable results)

OUTCOME MEASURES:

  • Percent reduction in structural and systemic barriers to postpartum care access and utilization, such as transportation, childcare, and language barriers, through the education and systems change efforts of HVPs. (Indicates the social determinants of health and health equity outcomes of the strategy)
  • Percent of overall maternal and child health and well-being indicators that improve at the population level as a result of the holistic, family-centered, and community-driven approach of postpartum care-focused HVPs. (Shows the intergenerational and societal impact of the strategy)

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] Adelson, P., Fleet, J. A., & McKellar, L. (2023). Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia: Women's experiences and birth outcomes. Women and birth : journal of the Australian College of Midwives, 36(1), 80–88. https://doi.org/10.1016/j.wombi.2022.03.004.
[2] Raffo, J. E., Titcombe, C., Henning, S., Meghea, C. I., Strutz, K. L., & Roman, L. A. (2021). Clinical-Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting. Women's health issues : official publication of the Jacobs Institute of Women's Health, 31(6), 532–539. https://doi.org/10.1016/j.whi.2021.06.006.
[3] Pan, Z., Veazie, P., Sandler, M., Dozier, A., Molongo, M., Pulcino, T., Parisi, W., & Eisenberg, K. W. (2020). Perinatal Health Outcomes Following a Community Health Worker-Supported Home-Visiting Program in Rochester, New York, 2015-2018. American journal of public health, 110(7), 1031–1033. https://doi.org/10.2105/AJPH.2020.305655.
[4] Phillips, S. E. K., Celi, A. C., Wehbe, A., Kaduthodil, J., & Zera, C. A. (2023). Mobilizing the fourth trimester to improve population health: interventions for postpartum transitions of care. American journal of obstetrics and gynecology, 229(1), 33–38. https://doi.org/10.1016/j.ajog.2022.12.309.
[5] Rudick S., Fields E., Finnerty P., Voelker S., Lewis E.F., Elliot K. (2020) How Home Visiting Can Support Postpartum Care. Education Development Center. https://main.edc.org/sites/default/files/uploads/HVPostPartumBrief.pdf.
[6] Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial. JAMA pediatrics, 168(9), 800–806. https://doi.org/10.1001/jamapediatrics.2014.472.
[7] Early Childhood Home Visiting Models, Home Visiting Evidence of Effectiveness (HomVEE) review 2023 https://homvee.acf.hhs.gov/sites/default/files/2023-11/homvee-summary-brief-nov2023.pdf.
[8] U.S. Department of Health and Human Services, Administration for Children and Families (2023) Home visiting evidence of effectiveness. https://homvee.acf.hhs.gov.

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.