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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. Patient Navigation

Approach. Support patient navigation programs that include postpartum visit appointment scheduling and patient reminders

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Overview. Patient navigation programs that include appointment scheduling and patient reminders—whether via telephone, text-messaging, or email (patient preference)—can increase postpartum visit attendance rates.[1,2] Trained patient navigators can also provide additional services as needed, including arranging transportation and access to language interpreters. This multi-pronged approach can help decrease system barriers and facilitate postpartum engagement, particularly among women experiencing economic challenges.[1,3] This strategy is a promising approach that is likely to be effective in increasing postpartum visit attendance rates.

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).

Source. Peer-Reviewed Literature

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.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

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. Collaboration (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 healthcare systems, clinics, and practices that implement patient navigation programs for postpartum visit appointment scheduling and reminders. (Measures the adoption and spread of the strategy)
  • Number of patient navigators trained and deployed to provide culturally and linguistically appropriate support for postpartum visit scheduling, reminders, and care coordination. (Assesses the workforce capacity and readiness for the strategy)

OUTCOME MEASURES:

  • Number of postpartum women who attend their scheduled postpartum visits with the support of patient navigation programs. (Measures the effectiveness of the strategy in improving postpartum care utilization)
  • Number of postpartum women who receive timely and comprehensive screening, referrals, and follow-up care for physical, mental, and social needs through patient navigation support. (Measures the impact of the strategy on postpartum care quality and coordination)

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

PROCESS MEASURES:

  • Percent of postpartum women who receive culturally and linguistically appropriate patient navigation support, resources, and education. (Measures the equity and patient-centeredness of the strategy)
  • Percent of patient navigators who demonstrate proficiency in postpartum care knowledge, communication skills, and cultural humility through regular training and assessment. (Assesses the competency and effectiveness of the workforce)

OUTCOME MEASURES:

  • Percent of postpartum women who complete all recommended postpartum visits and follow-up care within the appropriate timeframes with the support of patient navigation programs. (Measures the adherence to care guidelines and care continuity)
  • Percent of postpartum women who report high satisfaction, trust, and care experience with the support and services received through patient navigation programs. (Measures the patient-centeredness and acceptability of the strategy)

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

PROCESS MEASURES:

  • Number of partnerships and referral pathways established between patient navigation programs, healthcare providers, payers, and community-based organizations to support seamless postpartum care coordination. (Measures the multi-sector collaboration and integration approach of the strategy)
  • Number of policies, reimbursement models, and sustainability plans developed to support the long-term implementation and funding of patient navigation programs for postpartum care. (Measures the enabling environment and systems change efforts for the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that demonstrate improved postpartum care quality, outcomes, and patient experience through the integration of patient navigation programs. (Measures the healthcare value and return on investment of the strategy)
  • Number of patient navigators who become recognized as trusted champions, supporters, and leaders for advancing postpartum health and well-being in their communities. (Assesses the workforce support and leadership development outcomes of the strategy)

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

PROCESS MEASURES:

  • Percent of patient navigation program resources and funding allocated to address social determinants of health and upstream barriers to postpartum care access and utilization, such as transportation, childcare, and housing. (Measures the health equity and social needs orientation of the strategy)
  • Percent of patient navigation program performance and accountability measures that prioritize postpartum individuals' self-identified goals, preferences, and measures of success. (Assesses the patient-centered and strengths-based focus of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum individuals, particularly those from communities that have been historically underserved by postpartum care resources, who report feeling respected, supported, and confident in navigating the postpartum care system and achieving their health goals through patient navigation programs. (Measures the agency and autonomy impact of the strategy)
  • Percent reduction in system-level barriers, inequities, and fragmentation experienced by postpartum individuals in accessing and receiving high-quality, coordinated care, as a result of the patient navigation support and education. (Measures the care experience and equity outcomes 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] Strohbach, A., Hu, F., Martinez, N. G., & Yee, L. M. (2019). Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women. Patient education and counseling, 102(4), 753–759. https://doi.org/10.1016/j.pec.2018.10.028.
[2] Yee, L. M., Martinez, N. G., Nguyen, A. T., Hajjar, N., Chen, M. J., & Simon, M. A. (2017). Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic. Obstetrics and gynecology, 129(5), 925–933. https://doi.org/10.1097/AOG.0000000000001977.
[3] 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.

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.