Modeling Rural Perinatal Health Outcomes and Service Systems to Improve Health Equity

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Access to perinatal health services in rural counties has been declining, and maternal and infant health (perinatal) outcomes are also poorer in rural areas like Montana. Women with increased access to comprehensive perinatal services have improved outcomes. The main objective of this project is to remedy the lack of knowledge about how access to perinatal services could be improved in a rural, resource-constrained environment in ways that would improve health equity. This project will elucidate the spatial variation in perinatal health outcomes and perinatal care access across the state of Montana. By mapping out the full system of comprehensive perinatal services (i.e., obstetric care, mental health services, and substance abuse services), this research will generate new information about where inequities exist and model how system-wide improvements can be made. A community-engaged approach will be applied involving substantial engagement with community partners in order to identify problems, develop models, design the research approach, and finally disseminate the findings. The research team will form an Industry Advisory Board comprised of representatives of state government agencies, clinicians, and rural women who have given birth. The team will integrate data for Montana from robust secondary data sources that are nationally available, including information on sociodemographics, health outcomes, and service facilities. To achieve its objectives, the project will use spatial demographic techniques and facility planning optimization models. Aim 1 will create predictive models of perinatal health outcomes across Montana. The two main objectives of this aim are 1) to estimate the current demand for comprehensive perinatal care, and 2) to predict the future demand for comprehensive perinatal care. Population maps of demand for perinatal services (women of childbearing age and their sociodemographic characteristics) and outcomes (low birth weight, preterm deliveries, and infant mortality) will be developed. Aim 2 will develop prescriptive planning models to inform decisions about improving the effectiveness of the Montana perinatal care system. The two main objectives of this aim are 1) to develop a data-driven approach for assessing the degree of alignment between supply and demand of nearby comprehensive perinatal services for rural mothers, and 2) to develop prescriptive location planning models with the goal of maximizing equity and access for mothers and infants. Aim 3 will design an interactive Web- based mapping application that translates results from Aims 1 and 2 through a novel data visualization of perinatal health disparities in Montana. This mapping application can be used by policymakers and researchers as a tool that provides an evidence-based framework for redesigning perinatal health care systems in rural, medically underserved areas.