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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Well-Woman Visit.

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Strategy. Designated Clinics/Extended Hours

Approach. Increase access and visibility to clinics that offer expanded preventive services/extended hours within close proximity to MCH populations

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Overview. Increase access to and visibility of clinics that offer preventive screening and/or extended hours within close proximity to MCH populations.[1,2] Multiple access, scheduling, and time-related factors contribute to 'missed opportunities' in providing comprehensive preventive care. Designated clinics and extended hours can provide greater opportunities for women to receive a preventive care visit yearly.[1,2]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Clinic directories and resource listings
  • Community awareness surveys
  • Referral data from partner organizations

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.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare 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. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of clinics offering extended hours of service within close proximity to MCH populations, supported by Title V agencies. (Measures the availability and usability of designated clinics)
  • Number of marketing and outreach campaigns conducted to increase visibility and awareness of designated clinics and extended hours among MCH populations. (Measures the efforts to promote the utilization of these services)

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

  • Percent of designated clinics with extended hours that meet established criteria for patient-centered, comprehensive preventive care delivery. (Measures the quality and fidelity of the intervention)
  • Percent of marketing and outreach materials that are appropriate for the MCH populations served. (Measures the relevance of the intervention's promotional efforts)

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

  • Number of policies and protocols developed and implemented to ensure the smooth operation and coordination of care at designated clinics during extended hours. (Measures the infrastructure and systems in place to support the intervention)
  • Number of continuous quality improvement initiatives undertaken at designated clinics to monitor, evaluate, and enhance the delivery of preventive care services during extended hours. (Measures the use of data-driven strategies to optimize the intervention's effectiveness)
  • Number of women from communities that have additional needs in the healthcare system who access preventive care services for the first time as a result of designated clinics and extended hours. (Measures the intervention's success in reaching and engaging previously unreached populations)
  • Number of preventable health conditions and complications detected early and managed effectively through preventive care services delivered at designated clinics during extended hours. (Measures the intervention's impact on early intervention and improved health outcomes)

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

  • Percent of designated clinics with extended hours that are located in communities with the greatest challenges to accessing preventive care services. (Measures the focused placement of the intervention)
  • Percent of designated clinics with extended hours that have representative staff reflecting the MCH populations served. (Measures the concordance between care providers and patients)
  • Percent reduction in gaps for annual well-woman visit rates and preventive care utilization between MCH populations with access to designated clinics and extended hours and those without such access. (Measures the intervention's impact on advancing health outcomes)
  • Percent of MCH populations who report sustained engagement with preventive care services and improved health outcomes over time as a result of the availability and usability of designated clinics with extended hours. (Measures the intervention's enduring impact on population health and well-being)

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] Lee, D., Loh, T., Blackmond, N., George, S., Fong, F., Quach, K., Franz, P., & Wharton, K. (2024). Establishing a gynecology student-run free clinic: A joint medical student and resident physician initiative. Journal of Student-Run Clinics, 10(1).

[2] Singh, M. K., Einstadter, D., & Lawrence, R. (2010). A structured women's preventive health clinic for residents: a quality improvement project designed to meet training needs and improve cervical cancer screening rates. Qual Saf Health Care, 19(5), e45-e45.

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.