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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. Appointment Intervals

Approach. Support flexibility in appointment scheduling that reduces the time interval between birth and postpartum follow-up care

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Overview. Shortening the time interval between birth and a postpartum checkup may help increase attendance rates, prevent hard-to-track women from being lost to follow-up, and monitor health conditions that could worsen in the coming weeks and months. This approach, tested more than once, shows promising results. However, more studies are needed to determine which strategy components are most likely to improve postpartum visit attendance rates.[1,2,3]

Evidence. Mixed Evidence. Strategies with this rating have been tested more than once with results that sometimes trend positive and sometimes show little effect. These strategies still have potential to work; however, further research is needed to understand the components of the strategies that have the most potential in producing consistent positive results. (Clarifying Note: The WWFH database calls this "insufficient 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):

  • 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. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-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 providers partnered with Title V that adopt and implement flexible appointment scheduling practices to reduce the time interval between birth and postpartum follow-up care. (Measures the uptake and spread of the strategy)
  • Number of postpartum follow-up visits completed within the recommended shorter time intervals as a result of the flexible appointment scheduling practices. (Assesses the implementation and adherence to the strategy)

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

PROCESS MEASURES:

  • Percent of healthcare systems, clinics, and providers partnered with Title V that adopt and implement flexible appointment scheduling practices to reduce the time interval between birth and postpartum follow-up care. (Measures the uptake and spread of the strategy)
  • Percent of postpartum follow-up visits completed within the recommended shorter time intervals as a result of the flexible appointment scheduling practices. (Assesses the implementation and adherence to the strategy)

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

PROCESS MEASURES:

  • Number of postpartum patients supported by Title V who receive continuous and coordinated care, including referrals and linkages to support services, as a result of the earlier and more frequent follow-up visits facilitated by the flexible appointment scheduling practices. (Measures the care continuity and comprehensiveness outcomes of the strategy)
  • Number of postpartum patients supported by Title V who report improved access, convenience, and satisfaction with their postpartum care experiences due to the flexible appointment scheduling practices that accommodate their needs and preferences. (Assesses the patient-centered and experience outcomes of the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that demonstrate improved postpartum care quality, patient satisfaction, and cost-effectiveness through the implementation of flexible appointment scheduling practices for earlier and more frequent follow-up visits. (Measures the healthcare value and return on investment of the strategy)
  • Number of communities and populations that experience significant and sustained improvements in postpartum health outcomes, care continuity, and patient experience as a result of the widespread adoption and scale-up of flexible appointment scheduling practices for postpartum follow-up care. (Measures the population health and well-being impact 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 continuous and coordinated care, including referrals and linkages to support services, as a result of the earlier and more frequent follow-up visits facilitated by the flexible appointment scheduling practices. (Measures the care continuity and comprehensiveness outcomes of the strategy)
  • Percent of postpartum patients supported by Title V who report improved access, convenience, and satisfaction with their postpartum care experiences due to the flexible appointment scheduling practices that accommodate their needs and preferences. (Assesses the patient-centered and experience outcomes of the strategy)

OUTCOME MEASURES:

  • Percent of healthcare systems and payers that demonstrate improved postpartum care quality, patient satisfaction, and cost-effectiveness through the implementation of flexible appointment scheduling practices for earlier and more frequent follow-up visits. (Measures the healthcare value and return on investment of the strategy)
  • Percent of communities and populations that experience significant and sustained improvements in postpartum health outcomes, care continuity, and patient experience as a result of the widespread adoption and scale-up of flexible appointment scheduling practices for postpartum follow-up care. (Measures the population health and well-being 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] Masho, S. W., Ihongbe, T. O., Wan, W., Graves, W. C., Karjane, N., Dillon, P., Bazzoli, G., & McGee, E. (2019). Effectiveness of shortened time interval to postpartum visit in improving postpartum attendance: Design and rationale for a randomized controlled trial. Contemporary clinical trials, 81, 40–43. https://doi.org/10.1016/j.cct.2019.04.012].
[2] Pluym, I. D., Tandel, M. D., Kwan, L., Mok, T., Holliman, K., Afshar, Y., & Rao, R. (2021). Randomized control trial of postpartum visits at 2 and 6 weeks. American journal of obstetrics & gynecology MFM, 3(4), 100363. https://doi.org/10.1016/j.ajogmf.2021.100363] Scheduling an earlier postpartum visit might also help prevent hard-to-track women from being lost to follow-up.
[3] Kuster, A., Lee, K. A., & Sligar, K. (2022). Quality Improvement Project to Increase Postpartum Clinic Visits for Publicly Insured Women. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 51(3), 313–323. https://doi.org/10.1016/j.jogn.2022.01.002]

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.