Operational efficiency, patient composition and regional context of U.S. health centers: Associations with access to early prenatal care and low birth weight

• Published in: Social science & medicine (1982) Vol. 226; pp. 143 - 152
• Main Authors: Thorsen, Maggie L., Thorsen, Andreas, McGarvey, Ronald
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2019; Pergamon Press Inc
• Subjects: Access; Censuses; Clinical outcomes; Community health centers; Community Health Centers - organization & administration; Community Health Centers - statistics & numerical data; Community health services; Data analysis; Data envelopment analysis; Economic conditions; Efficiency; Efficiency, Organizational; Generalized linear models; Geography; Health disparities; Health facilities; Health problems; Health services; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; Health status; Humans; Infant, Low Birth Weight; Infants; Latent Class Analysis; Linear analysis; Low birth weight; Low income groups; Medicine; Minority groups; Patients; Perinatal; Poverty; Prenatal care; Prenatal Care - standards; Prenatal Care - statistics & numerical data; Quality of care; Quality of Health Care - standards; Risk behavior; Risk factors; Rural areas; Rural communities; Rural poverty; Sociodemographics; Surveillance; Surveillance systems; United States; Urban poverty; Women; United States; United States > US; Latent class analysis; Efficiency; Community health centers; Prenatal care; Low birth weight; Data envelopment analysis
• ISSN: 0277-9536; 1873-5347; 1873-5347
• DOI: 10.1016/j.socscimed.2019.02.043

Community health centers (CHCs) provide comprehensive medical services to medically under-served Americans, helping to reduce health disparities. This study aimed to identify the unique compositions and contexts of CHCs to better understand variation in access to early prenatal care and rates of low birth weights (LBW). Data include CHC-level data from the Uniform Data System, and regional-level data from the US Census American Community Survey and Behavioral Risk Factor Surveillance System. First, latent class analysis was conducted to identify unobserved subgroups of CHCs. Second, data envelopment analysis was performed to evaluate the operational efficiency of CHCs. Third, we used generalized linear models to examine the associations between the CHC subgroups, efficiency, and perinatal outcomes. Seven classes of CHCs were identified, including two rural classes, one suburban, one with large centers serving poor minorities in low poverty areas, and three urban classes. Many of these classes were characterized by the racial compositions of their patients. Findings indicate that CHCs serving white patients in rural areas have greater access to early prenatal care. Health centers with greater efficiency have lower rates of LBW, as do those who serve largely white patient populations in rural areas. CHCs serving poor racial minorities living in low-poverty areas had particularly low levels of access to early prenatal care and high rates of LBW. Findings highlight that significant diversity exists in the sociodemographic composition and regional context of US health centers, in ways that are associated with their operations, delivery of care, and health outcomes. Results from this study highlight that while the provision of early prenatal care and the efficiency with which a health center operates may improve the health of the women served by CHCs and their babies, the underlying social and economic conditions facing patients ultimately have a larger association with their health. •Variety across Community Health Centers (CHCs) result in seven latent classes.•Classes vary in efficiency, access to prenatal care, and rates of low birth weight.•Access to early prenatal care is better in rural areas serving white patients.•CHCs in low-poverty areas serving poor racial minority patients have worse outcomes.