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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. Telehealth and Remote Monitoring

Approach. Incorporate telehealth options for postpartum checkups and remote monitoring of treatable conditions such as hypertension

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Overview. Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care.[1] Telehealth interventions for postpartum care have been associated with decreased racial disparities in postpartum visit attendance and completion of postpartum care goals.[2] Defined as the use of medical information exchanged via electronic communications to improve the diagnosis, treatment, and prevention of disease and injuries, telehealth can be delivered in various formats.[3] In addition to synchronistic postpartum visits, which can take place on mobile devices or stationary computers, text messaging appears to be particularly promising as an effective, cost-saving intervention.[4] Text messages can be used to remind postpartum patients of upcoming medical appointments and also serve as reminders to report blood pressure readings or other measurable health outcomes.[3,4]

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 "Telemedicine" 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.

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. Direct Care (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 providers that offer and promote telehealth options for postpartum checkups and remote monitoring. (Measures the availability and accessibility of the strategy)
  • Number of telehealth encounters, including virtual visits and remote monitoring interactions, completed for postpartum care and management of treatable conditions. (Assesses the volume and utilization of the strategy)

OUTCOME MEASURES:

  • Number of postpartum patients who receive timely and appropriate care, including early detection and intervention for treatable conditions, through telehealth options and remote monitoring. (Measures the effectiveness and quality of care outcomes of the strategy)
  • Number of postpartum patients who report improved access, convenience, and satisfaction with their postpartum care experiences due to the availability and use of telehealth and remote monitoring options. (Assesses the patient-centered and experience outcomes of the strategy)

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

PROCESS MEASURES:

  • Percent of postpartum patients who are offered and educated about telehealth and remote monitoring options for their postpartum care and management of treatable conditions. (Measures the outreach and education efforts of the strategy)
  • Percent of postpartum patients who receive culturally and linguistically appropriate telehealth and remote monitoring services, including language assistance and digital literacy support. (Assesses the equity and inclusiveness of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum patients who adhere to recommended care plans, self-management practices, and follow-up appointments through the support and monitoring enabled by telehealth options. (Measures the patient activation and engagement outcomes of the strategy)
  • Percent reduction in disparities and inequities in postpartum care access, utilization, and outcomes between different patient populations, as a result of the increased availability and use of telehealth and remote monitoring options. (Assesses the health equity impact of the strategy)

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

PROCESS MEASURES:

  • Number of policies, reimbursement models, and regulatory frameworks developed and adopted to facilitate and incentivize the use of telehealth and remote monitoring for postpartum care and management of treatable conditions. (Measures the enabling environment and systems change efforts for the strategy)
  • Number of research studies, evaluations, and quality improvement initiatives conducted to assess the effectiveness, safety, and patient acceptance of telehealth and remote monitoring options for postpartum care. (Assesses the evidence generation and continuous improvement focus of the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that demonstrate improved postpartum care quality, patient satisfaction, and cost-effectiveness through the integration of telehealth and remote monitoring options into their care delivery and payment models. (Measures the healthcare value and return on investment of the strategy)
  • Number of healthcare providers, technology innovators, and patient supporters who become leaders and change agents in advancing the adoption and spread of telehealth and remote monitoring options for postpartum care. (Assesses the workforce development and leadership outcomes of the strategy)

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

PROCESS MEASURES:

  • Percent of postpartum individuals and families who are actively engaged as partners in the design, implementation, and evaluation of telehealth and remote monitoring options for their postpartum care. (Measures the patient and family engagement in the strategy)
  • Percent of telehealth and remote monitoring technologies and platforms used for postpartum care that are user-friendly, interoperable, and compliant with privacy and security standards. (Assesses the technological quality and responsibility of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum individuals, especially those from communities that have been economically or socially marginalized, who report feeling supported and satisfied with their ability to access and benefit from telehealth and remote monitoring options for their postpartum care. (Measures the patient agency and experience outcomes of the strategy)
  • Percent reduction in barriers, disparities, and social determinants of health that impact postpartum individuals' ability to utilize and benefit from telehealth and remote monitoring options, such as digital divide, broadband access, and socioeconomic status. (Measures the health equity and social justice 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] Cantor, A. G., Jungbauer, R. M., Totten, A. M., Tilden, E. L., Holmes, R., Ahmed, A., Wagner, J., Hermesch, A. C., & McDonagh, M. S. (2022). Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review. Annals of internal medicine, 175(9), 1285–1297. https://doi.org/10.7326/M22-0737.
[2] Kumar, N. R., Arias, M. P., Leitner, K., Wang, E., Clement, E. G., & Hamm, R. F. (2023). Assessing the impact of telehealth implementation on postpartum outcomes for Black birthing people. American journal of obstetrics & gynecology MFM, 5(2), 100831. https://doi.org/10.1016/j.ajogmf.2022.100831.
[3] Janssen, M. K., Demers, S., Srinivas, S. K., Bailey, S. C., Boggess, K. A., You, W., Grobman, W., & Hirshberg, A. (2021). Implementation of a text-based postpartum blood pressure monitoring program at 3 different academic sites. American journal of obstetrics & gynecology MFM, 3(6), 100446. https://doi.org/10.1016/j.ajogmf.2021.100446.
[4] Hoppe, K. K., Thomas, N., Zernick, M., Zella, J. B., Havighurst, T., Kim, K., Williams, M., Niu, B., Lohr, A., & Johnson, H. M. (2020). Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension. American journal of obstetrics and gynecology, 223(4), 585–588. https://doi.org/10.1016/j.ajog.2020.05.027

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.