Identifying Key Components and Outcomes of Prenatal Care Coordination in Wisconsin

Few interventions successfully address racial disparities in maternal health outcomes. Social conditions—or social and structural determinants of health—are the major causes of persistent racial disparities in the US. Integrated models of care that offer home visiting and care coordination can support maternal health and have the potential to meaningfully reduce disparities. <br>Prenatal care coordination (PNCC) is a fee-for-service Medicaid benefit, available in several states including Wisconsin. Its goal is to reduce rates of adverse birth outcomes including low birthweight and premature birth among mothers and infants at high risk. PNCC services include health education, care coordination, social support, and facilitating access to medical care and social services during pregnancy and up to 60 days following delivery for Medicaid-covered mothers. This research contributes to efforts to improve the health outcomes of high-risk mothers and reduce disparities between racial and ethnic groups by working towards strengthening the PNCC benefit’s implementation and impact. <br>Specifically, this study aimed to: 1: Describe the association of receiving PNCC services in WI with five distinct maternal health outcomes:<br>1) adequate prenatal care<br>2) a 6-week postpartum visit<br>3) utilization of needed behavioral health services<br>4) occurrence of severe maternal morbidity, and<br>5) emergency department visits, accounting for mother’s race and geographic location.<br>This part of the study used data that are not publicly available. each of five target outcomes2: Qualitatively describe diverse PNCC providers’ perspectives on the relative advantage of using a structured model to guide PNCC services, implementation processes that impact PNCC, and target outcomes of PNCC. Using a deductive qualitative approach, we conducted semi-structured interviews and focus groups at five PNCC sites across the state that varied by provider type and setting, and who serve clients from racially and ethnically diverse communities including Black and Native American mothers. <br>Coding and qualitative descriptive analyses were framed by the Consolidated Framework for Implementation Science (CFIR), which describes factors that can influence implementation and is flexible enough to apply in multiple contexts.