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

Project Leader Andreas Thorsen, Ph.D. 
MSU Jake Jabs College of Business & Entrepreneurship
andreas.thorsen@montana.edu

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 was 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 aimed to 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), the research generated new information about where inequities exist and modeled how system-wide improvements can be made. A community-engaged approach was applied involving substantial engagement with community partners in order to identify problems, develop models, design the research approach, and finally disseminate the findings.

To achieve its objectives, the project used spatial demographic techniques and facility planning optimization models. Aim 1 created predictive models of perinatal health outcomes across Montana. The two main objectives of this aim were 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) were developed. Aim 2 developed prescriptive planning models to inform decisions about improving the effectiveness of the Montana perinatal care system. The two main objectives of this aim were 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 designed 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.

The project built on a previous two-year CAIRHE pilot project and featured Maggie Thorsen, Ph.D., as co-investigator.

You can learn more about these important issues and the Thorsens' research in a July 2022 two-part feature in the Missoulian: 

• PART ONE: https://missoulian.com/news/local/we-have-no-specialized-care-here-reservations-struggle-with-limited-prenatal-care/article_f3330e51-7d93-58a8-b9db-b6f3f0bfb446.html
• PART TWO: https://missoulian.com/news/local/lucky-i-even-made-it-native-americans-face-barriers-accessing-lifesaving-maternal-care/article_f50dfef0-2420-59bc-9376-6702273c0d40.html#tracking-source=home-top-story

Related Publications and Presentations (Selected)

McGarvey, R. G., Thorsen, A., Thorsen, M. L., & Reddy, R. M. Measuring efficiency of community health centers: A multi-model approach considering quality of care and heterogeneous operating environments. Health Care Manag Sci. Forthcoming.

Thorsen, A., & McGarvey, R. (2017). Efficient Frontiers in a Frontier State: Viability of Mobile Dentistry Services in Rural Areas, European Journal of Operational Research, DOI 10.1016/j.ejor.2017.07.062.

Thorsen,  A.,  Thorsen, M. L., Mahdi Reddy, R., & McGarvey, R. Addressing Health Disparities at U.S. Community Health Centers: A Focus on Pregnancy-related Health Outcomes. Invited research presentation, INFORMS Annual Meeting. October 22-25, 2017. Houston, TX.

Thorsen, A., McGarvey, R., Madhi Reddy, R., & Thorsen, M. L. Multi-Criteria Evaluation of Systematic Issues at U.S. Health Centers. Research presentation, Industrial & Systems Engineering Research Conference. May 20-23, 2017. Pittsburgh, PA.

Thorsen,  A., & McGarvey, R. Mobile dentistry network design: Improving dental care access for under-served populations in rural regions. Invited research presentation, INFORMS Annual Meeting. November 13-16, 2016. Nashville, TN.