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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. Guideline Adherence Protocol

Approach. Develop or adopt a toolkit or note template for use by providers to help ensure they address all components of a comprehensive postpartum visit

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Overview. Adherence to comprehensive postpartum care guidelines—as recommended by the American College of Obstetricians and Gynecologists and endorsed by multiple health professional organizations—can help ensure consistent quality of care for all postpartum patients.[1] Research findings indicate that the majority of new mothers do not receive all of the recommended components of care, including contraception counseling and screening for depression.[2,3] Tools and note templates that remind providers to address all components of postpartum care. (including physical, social, and psychological well-being) are emerging as effective strategies to improve outcomes.[4,5,6]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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):

  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

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. 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, hospitals, and clinics partnered with Title V that adopt and implement a guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Measures the uptake and spread of the strategy)
  • Number of healthcare providers trained and equipped to use the guideline adherence protocol, toolkit, or note template for conducting comprehensive postpartum visits. (Measures the workforce development and readiness for the strategy)

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

PROCESS MEASURES:

  • Percent of healthcare systems, hospitals, and clinics partnered with Title V that adopt and implement a guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Measures the uptake and spread of the strategy)
  • Percent of healthcare providers trained and equipped to use the guideline adherence protocol, toolkit, or note template for conducting comprehensive postpartum visits. (Measures the workforce development and readiness for the strategy)

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

PROCESS MEASURES:

  • Number of postpartum patients supported by Title V who receive all recommended components of care, such as contraception counseling and depression screening, during their visits conducted using the guideline adherence protocol, toolkit, or note template. (Measures the effectiveness and quality of care outcomes of the strategy)
  • Number of postpartum patients supported by Title V who report improved health, well-being, and satisfaction as a result of receiving comprehensive care during their visits conducted using the guideline adherence protocol, toolkit, or note template. (Assesses the patient-centered outcomes of the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that demonstrate improved maternal health outcomes, patient satisfaction, and cost savings through the widespread adoption and use of the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Measures the healthcare value and return on investment of the strategy)
  • Number of healthcare providers and leaders who become champions, educators, and influencers in promoting and modeling the use of the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Assesses the professional development and support outcomes of the strategy)

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

PROCESS MEASURES:

  • Percent of postpartum patients supported by Title V who receive all recommended components of care, such as contraception counseling and depression screening, during their visits conducted using the guideline adherence protocol, toolkit, or note template. (Measures the effectiveness and quality of care outcomes of the strategy)
  • Percent of postpartum patients supported by Title V who report improved health, well-being, and satisfaction as a result of receiving comprehensive care during their visits conducted using the guideline adherence protocol, toolkit, or note template. (Assesses the patient-centered outcomes of the strategy)

OUTCOME MEASURES:

  • Percent of healthcare systems and payers that demonstrate improved maternal health outcomes, patient satisfaction, and cost savings through the widespread adoption and use of the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Measures the healthcare value and return on investment of the strategy)
  • Percent of healthcare providers and leaders who become champions, educators, and influencers in promoting and modeling the use of the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Assesses the professional development and support 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] ACOG Committee Opinion No. 736: Optimizing Postpartum Care https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care Background Includes strategies to help practitioners increase the rate and comprehensiveness of postpartum visits. Review this list of recommendations.
[2] Interrante, J. D., Admon, L. K., Carroll, C., Henning-Smith, C., Chastain, P., & Kozhimannil, K. B. (2022). Association of Health Insurance, Geography, and Race and Ethnicity with Disparities in Receipt of Recommended Postpartum Care in the US. JAMA health forum, 3(10), e223292.
[3] Geissler, K., Ranchoff, B. L., Cooper, M. I., and Attanasio, L. B. (2020). Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits. JAMA network open, 3(11), e2025095.
[4]Grotell, L. A., Bryson, L., Florence, A. M., & Fogel, J. (2021). Postpartum Note Template Implementation Demonstrates Adherence to Recommended Counseling Guidelines. Journal of medical systems, 45(1), 14. https://doi.org/10.1007/s10916-020-01692-6.
[5] Jones-Beatty, K., Jolles, D., Burd, I., & Thomas, O. (2022). Increasing effective postpartum care in an obstetric clinic using ACOG's postpartum toolkit. Nursing forum, 57(6), 1614–1620. https://doi.org/10.1111/nuf.12831.
[6] Stuebe, A. M., Kendig, S., Suplee, P. D., & D'Oria, R. (2021). Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit. Obstetrics and gynecology, 137(1), 33–40. https://doi.org/10.1097/AOG.0000000000004206.

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.