Disparities in Prenatal Medicaid Program are Focus of ICTR-supported Pilot Study

In Wisconsin, rates of preterm birth and low birthweight are disproportionately high among Black, American Indian/Alaska Native, very rural, and very urban populations. The Wisconsin Department of Health Services coordinates a program called Prenatal Care Coordination, or PNCC, which has led to improved birth outcomes on average. However, the state needs more data to understand if the program is effectively reaching and benefiting the populations that need it most.

Black and white photo of David Mallinson, PhD
David Mallinson, PhD, credits not just ICTR funding, but also other types of support and guidance, for moving his research forward. He says, “Skills in collaborative and cross-institutional science are just as important.”

Dr. David Mallinson, a primary care research fellow in the University of Wisconsin-Madison Department of Family Medicine and Community Health, is working to provide that data. In summer 2023, the UW Institute for Clinical and Translational Research (ICTR) selected him for an Advancing Health Equity and Diversity (AHEAD) Pilot Award to work with UW-Madison’s Big Data for Little Kids multisource dataset. He hopes it will provide a detailed picture of how PNCC affects health outcomes in communities across the state. He is working with the Department of Health Services so that his findings inform the program’s outreach.

PNCC connects pregnant and postpartum women receiving Medicaid and BadgerCare Plus to medical, social, and educational services. Beneficiaries meet with a care coordinator and tailor a plan for services that meet their needs. For example, the program can connect tobacco users to smoking cessation counseling. Beneficiaries also receive help finding employment or continuing education that pregnancy disrupted. Big Data for Little Kids allows Mallinson to see the use of those services across populations based on race, ethnicity, geography, and urbanicity.

“The primary advantage of Big Data for Little Kids is that we can link birth records to Medicaid claims,” Mallinson says. “Any state health department is going to have birth records or Medicaid claims, but they don’t have the resources to link the birth records with the claims to see the services that people received during pregnancy or that infants got when they were born. This data lets us track the whole suite of services in the Medicaid population. There are few other cohorts like this in the United States.”

Mallinson previously worked with Big Data for Little Kids as a population health sciences doctoral student at UW-Madison. Under the mentorship of Dr. Deborah Ehrenthal, he contributed to a project examining county-level variations in outreach and enrollment in the program. He also contributed to a study estimating the program’s effect on birth outcomes.

Mallinson’s current ICTR-funded study has two aims. For the first aim, he is tracking PNCC assessment and service uptake rates by race and ethnicity, county urbanicity, and region from 2008 to 2019. For the second aim, he will estimate the impact of PNCC on gestational age and birth weight and look for variances based on race, ethnicity, county urbanicity, and region.

The data he has collected shows an increase over time in PNCC post-assessment service receipt, particularly in the Black population in Wisconsin’s southeastern counties. Mallinson believes this indicates that some PNCC providers are on the right track. However, the data also shows a decline in use of services in rural areas and among the Native American and non-Hispanic white populations.

The project will conclude in spring 2024, but Mallinson is already thinking about how his findings can inform PNCC outreach. He is working with the Department of Health Services to have his findings inform policy. His work could help the state understand why providers in the southeastern counties are so successful while also indicating gaps in PNCC resources in rural areas. He notes that the data could be especially useful in the aftermath of the COVID-19 pandemic.

“COVID-19 essentially stopped PNCC for a year,” he says. “It’s a double-edged sword. On one hand you can say that it cleaned the slate, so our findings can help underperforming areas reevaluate the program and improve outreach. But on the other hand, COVID-19 may have disrupted the gains in populations where PNCC was doing well, such as Milwaukee County. Our findings can help indicate what worked well pre-COVID to help regain any losses in outreach.”

He also hopes that the data from this study will inform his future work. The next phase of his research may focus on health care service for mothers and young children after receiving PNCC. In some states, similar programs act as a bridge to build a relationship between families and preventative health care providers. Mallinson wants to know if that is also true in Wisconsin.

Mallinson notes that in addition to providing material support for his work, the ICTR AHEAD award has helped his professional development and will inform his future projects. He says:

“The AHEAD award helped guide the collaborative infrastructure of the project. I’ve built relationships with other researchers to analyze the data, fostered a relationship with the Department of Health Services, and figured out how to manage a grant. I think that the guidance, legitimacy, and support that I’ve received from ICTR has given me the opportunity to build up those skills in a short period. I will use what I’ve learned when I build bigger projects in the future. The financial component was necessary for my work, but those skills in collaborative and cross-institutional science are just as important.”

Find information about AHEAD and ICTR’s other pilot awards on the funding opportunities page.

Funding for the AHEAD award was provided by the UW School of Medicine and Public Health from the Wisconsin Partnership Program, which supports research, education and community engagement with the goal of improving health and advancing health equity among Wisconsinites.