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Racial and Geographic Variation of Prenatal Care Coordination Receipt in the State of Wisconsin, 2010–2019

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Abstract

Medicaid-funded obstetric care coordination programs supplement prenatal care with tailored services to improve birth outcomes. It is uncertain whether these programs reach populations with elevated risks of adverse birth outcomes—namely non-white, highly rural, and highly urban populations. This study evaluates racial and geographic variation in the receipt of Wisconsin Medicaid’s Prenatal Care Coordination (PNCC) program during 2010–2019. We sample 250,596 Medicaid-paid deliveries from a cohort of linked Wisconsin birth records and Medicaid claims. We measure PNCC receipt during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt), and we stratify the sample on three maternal characteristics: race/ethnicity, urbanicity of residence county; and region of residence county. We examine annual trends in PNCC uptake and conduct logistic regressions to identify factors associated with assessment or service receipt. Statewide PNCC outreach decreased from 25% in 2010 to 14% in 2019, largely due to the decline in beneficiaries who only receive assessments/care plans. PNCC service receipt was greatest and persistent in Black and Hispanic populations and in urban areas. In contrast, PNCC service receipt was relatively low and shrinking in American Indian/Alaska Native, Asian/Pacific Islander, and white populations and in more rural areas. Additionally, being foreign-born was associated with an increased likelihood of getting a PNCC assessment in Asian/Pacific Islander and Hispanic populations, but we observed the opposite association in Black and white populations. Estimates signal a gap in PNCC receipt among some at-risk populations in Wisconsin, and findings may inform policy to enhance PNCC outreach.

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Data Availability

Per data use agreements with providers, data for this project are not publicly available.

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Acknowledgements

We thank the Wisconsin Department of Children and Families and the Wisconsin Department of Health Services for providing data, and we thank Lawrence Berger and Madelyne Greene for comments. The design and conduct of the study are solely the responsibility of the authors and do not necessarily represent the official view of supporting agencies. Additionally, supporting agencies do not certify the accuracy of the analyses presented.

Funding

This work was supported by the following sources: the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD102125); the Health Resources and Services Administration through the University of Wisconsin Primary Care Research Fellowship (T32HP10010); and the University of Wisconsin-Madison Institute for Clinical & Translational Research (ICTR) with support from NIH-NCATS Clinical and Translational Science Award (CTSA) 1UL1TR002373 and funds through a grant from the Wisconsin Partnership Program (WPP 5129) at the University of Wisconsin School of Medicine and Public Health.

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Authors and Affiliations

  1. Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way, STE 200, Madison, WI, 53705, USA

    David C. Mallinson

  2. School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, WI, 53705, USA

    Kate H. Gillespie

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Conceptualization, DCM, KHG; Methodology, DCM; Interpretation, DCM, KHG; Data curation, DCM; Writing—original draft preparation, DCM; Writing—review and editing, KHG; Funding acquisition, DCM. All authors have read and agreed to the final version of the manuscript.

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Correspondence to David C. Mallinson.

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Mallinson, D.C., Gillespie, K.H. Racial and Geographic Variation of Prenatal Care Coordination Receipt in the State of Wisconsin, 2010–2019. J Community Health (2024). https://doi.org/10.1007/s10900-024-01338-5

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