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. Following 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).
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Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of healthcare systems, hospitals, and clinics 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)
- Number of postpartum patients 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 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)
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Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of postpartum visits conducted using the guideline adherence protocol, toolkit, or note template that cover all recommended components of care, as outlined by professional guidelines and standards. (Measures the fidelity and consistency of the strategy)
- Percent of healthcare providers who demonstrate proficiency and adherence in using the guideline adherence protocol, toolkit, or note template for conducting comprehensive postpartum visits, as assessed through quality audits and performance evaluations. (Measures the provider competency and performance in the strategy)
- Percent of postpartum patients who have all their physical, mental, and social needs addressed and managed during their visits conducted using the guideline adherence protocol, toolkit, or note template, as compared to those receiving usual care. (Measures the comprehensiveness and effectiveness of the strategy)
- Percent of postpartum patients who adhere to recommended follow-up care, referrals, and self-management practices based on the care plan developed during their visits conducted using the guideline adherence protocol, toolkit, or note template. (Measures the patient activation and engagement outcomes of the strategy)
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Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of partnerships and collaborations established among healthcare systems, professional associations, and patient advocacy groups that results in the development, dissemination, and implementation of guideline adherence protocols, toolkits, or note templates for comprehensive postpartum visits. (Measures the outcomes of multi-partner engagement and collective action in the strategy)
- Number of policies, incentives, and accountability mechanisms put in place to support and sustain the adoption and use of the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Measures the enabling environment and systems change efforts for the strategy)
- 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 advocacy outcomes of the strategy)
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Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- Percent of postpartum individuals, families, and community members who are actively engaged and consulted in the development, implementation, and evaluation of the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits. (Measures the patient and community partnership in the strategy)
- Percent of resources and funding invested in ensuring equitable access, utilization, and benefit from the guideline adherence protocol, toolkit, or note template for comprehensive postpartum visits, particularly for populations that have been historically underserved by postpartum care resources. (Measures the health equity and social justice commitment of the strategy)
- Percent of postpartum individuals, especially those from communities that have experienced economic or social marginalization, who report feeling informed, supported, and confident in their postpartum care experiences and decisions as a result of the comprehensive visits conducted using the guideline adherence protocol, toolkit, or note template. (Measures the patient agency and autonomy outcomes of the strategy)
- Percent reduction in missed opportunities, delays, and inequities in addressing postpartum health needs and connecting patients to essential services and resources, as a result of the proactive and comprehensive visits conducted using the guideline adherence protocol, toolkit, or note template. (Measures the care coordination and equity outcomes of the strategy)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- 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.
