{"675441":{"#nid":"675441","#data":{"type":"news","title":"Expanding Access to Obstetric Care in Georgia: Challenges and Strategies ","body":[{"value":"\u003Cp\u003EMotherhood in the U.S. can be dangerous. The nation spends\u0026nbsp;\u003Ca href=\u0022https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2024\/jun\/insights-us-maternal-mortality-crisis-international-comparison\u0022\u003Emore on healthcare than any other high-income country\u003C\/a\u003E. But women giving birth here \u2014\u0026nbsp;\u003Ca href=\u0022https:\/\/sph.emory.edu\/features\/2023\/06\/maternal-mortality\/#:~:text=In%20fact%2C%20Georgia\u0026amp;apos;s%20maternal%20mortality,per%20the%202021%20CDC%20report.)\u0022\u003Eparticularly Black women, and particularly in Georgia\u003C\/a\u003E \u2014 are more likely to die in childbirth. A big reason for this maternal mortality crisis is a lack of access to obstetric care.\u003C\/p\u003E\u003Cp\u003E\u201cGeorgia has a problem with access to care \u2014 the whole country does,\u201d said\u0026nbsp;\u003Ca href=\u0022https:\/\/www.isye.gatech.edu\/users\/meghan-meredith\u0022\u003EMeghan\u0026nbsp;Meredith,\u003C\/a\u003E a fourth-year Ph.D. student in the\u0026nbsp;\u003Ca href=\u0022https:\/\/www.isye.gatech.edu\/\u0022\u003EH. Milton Stewart School of Industrial and Systems Engineering\u003C\/a\u003E (ISyE) who has spent much of her academic career studying the problem, which is particularly acute in rural, lower-income places.\u003C\/p\u003E\u003Cp\u003EMany of these places have been designated\u0026nbsp;\u003Ca href=\u0022https:\/\/www.marchofdimes.org\/maternity-care-deserts-report\u0022\u003E\u201cmaternity care deserts\u201d\u003C\/a\u003E by the March of Dimes. If a county doesn\u2019t have any obstetric care or providers, it\u2019s considered a desert. Another commonly used measure is whether a pregnant woman lives within 50 miles of critical care obstetrics (CCO).\u0026nbsp;\u003C\/p\u003E\u003Cp\u003EThese measures are often referred to in academic literature and popular media to highlight a lack of healthcare access, and by public policy leaders trying to address the issue. But it\u2019s become evident to Georgia Tech researchers that they just don\u2019t add up.\u003C\/p\u003E\u003Cp\u003E\u201cThese measures don\u2019t capture the complete picture,\u201d said\u0026nbsp;Meredith. \u201cThey aren\u2019t an accurate representation of access to care.\u201d\u003C\/p\u003E\u003Cp\u003EAnd that\u2019s what concerns Meredith and her faculty advisor, ISyE Assistant Professor \u003Ca href=\u0022https:\/\/www.isye.gatech.edu\/users\/lauren-steimle\u0022\u003ELauren Steimle.\u003C\/a\u003E\u003C\/p\u003E\u003Cp\u003E\u201cWe\u2019ve been interested in access to maternal care for a long time, and in countless news stories, the maternity care desert measure is reported on,\u201d Meredith said. \u201cWe recognized the limitations, so we thought, \u2018Let\u2019s write a paper that explains how this measure is not a complete representation of access.\u2019\u201d\u003C\/p\u003E\u003Cp\u003EThey\u003Cstrong\u003E \u003C\/strong\u003Epublished their work recently in the journal\u003Cstrong\u003E\u0026nbsp;\u003C\/strong\u003E\u003Ca href=\u0022https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-11135-4\u0022\u003E\u003Cem\u003E\u003Cstrong\u003EBMC Health Services Research\u003C\/strong\u003E\u003C\/em\u003E\u003C\/a\u003E\u003Cstrong\u003E.\u003C\/strong\u003E\u003C\/p\u003E\u003Ch4\u003E\u003Cstrong\u003EModeling the Landscape\u003C\/strong\u003E\u003C\/h4\u003E\u003Cp\u003ETo study these measures of access, Meredith and Steimle used the same kind of computer-based mathematical model that helps companies decide where to place a new distribution center, retail outlet, or even electric car charging stations: a facility location model.\u003C\/p\u003E\u003Cp\u003E\u201cThis model helps us determine where to place facilities, so demand is sufficiently covered with the fewest number of facilities,\u201d said Steimle. \u201cThere are tons of potential applications for this model, but we\u2019re using it for healthcare.\u201d For this study, they used the model to identify where Georgia would need to expand healthcare facilities to improve access under the commonly used measures.\u0026nbsp;\u003C\/p\u003E\u003Cp\u003EHere\u2019s some of what the researchers found:\u003C\/p\u003E\u003Cp\u003E\u2022 Of the 1,910,308 reproductive-age women in Georgia, 104,158 (5.5%) live in maternity care deserts, while 150,563 (7.9%) live more than 50 miles from CCO services; 38,202 live in both situations.\u003C\/p\u003E\u003Cp\u003E\u2022 Fifty-six counties in Georgia meet current \u201cmaternity care desert\u201d measures, which means eliminating these deserts would require 56 new obstetric hospitals. That would increase the number of obstetric hospitals statewide from 83 to 139 (a 67% increase).\u0026nbsp;\u003C\/p\u003E\u003Cp\u003E\u2022 Strategically expanding 16 hospitals (a 19% increase) would reduce the number of reproductive-age women living in deserts by half.\u003C\/p\u003E\u003Cp\u003E\u2022 82% of reproductive-age women designated as living in maternity care deserts live within 25 miles from an obstetric hospital.\u003C\/p\u003E\u003Cp\u003EThe researchers conclude that policymakers should be warned: Using the maternity care desert measure alone as a basis for where and how to invest in healthcare resources isn\u2019t a great idea.\u003C\/p\u003E\u003Cp\u003E\u201cIf we really want to improve pregnancy outcomes, our measures of access should promote risk-appropriate and regionalized care systems,\u201d Steimle said.\u003C\/p\u003E\u003Cp\u003ETurns out, Georgia is already headed in that direction.\u003C\/p\u003E\u003Ch4\u003E\u003Cstrong\u003ECounting Counties: One Size Doesn\u2019t Fit All\u003C\/strong\u003E\u003C\/h4\u003E\u003Cp\u003ETo illustrate the problems with the maternity care desert measure, Steimle compared Georgia with a very different state on the opposite side of the U.S.: Nevada.\u003C\/p\u003E\u003Cp\u003E\u201cA major problem with the maternity care desert measure is its emphasis on county-by-county infrastructure,\u201d she said. \u201cIt\u2019s a one-size-fits-all approach that doesn\u2019t tell the whole story about access to care.\u201d\u003C\/p\u003E\u003Cp\u003EFor example, Georgia has 159 counties and more than three times the population of Nevada. Meanwhile, Nevada has twice the square mileage of Georgia \u2014 and 16 very large counties.\u0026nbsp;\u003C\/p\u003E\u003Cp\u003EAt 18,147 square miles, Nye County is Nevada\u2019s largest, and it\u2019s been labeled a maternity care desert. There\u2019s also lots of actual desert in Nye, which is larger than nine U.S. states. So, it\u2019s difficult to accurately compare a vast jurisdiction like Nye with, say, central Georgia\u2019s Lamar County. Lamar, also labeled a desert, is a mere 185 square miles in size. It\u0027s also surrounded by counties that are veritable oases of care.\u003C\/p\u003E\u003Cp\u003E\u201cA lot of people in Georgia may be falsely labeled as not having access, at least geographically speaking, when in fact they have services nearby,\u201d noted Steimle. \u201cMeanwhile, in a state like Nevada, some women may be labeled as having access, but might be very far from obstetric hospitals in their county.\u201d\u003C\/p\u003E\u003Cp\u003ESteimle also point out that measuring access on a county-by-county basis ignores efforts to coordinate care across the whole state. \u201cThe maternity care desert model doesn\u2019t hold up. And it doesn\u0027t reflect Georgia\u2019s approach to a regionalization system.\u201d\u003C\/p\u003E\u003Cp\u003ESince 2009, the Georgia Department of Public Health has organized the state into six geographic perinatal regions (the perinatal period covers pregnancy, childbirth, and early postpartum). The idea is to coordinate the delivery of health services to ensure people in all regions have access to risk-appropriate maternal care.\u003C\/p\u003E\u003Ch4\u003E\u003Cstrong\u003EBuild a Better Model\u003C\/strong\u003E\u003C\/h4\u003E\u003Cp\u003EEach of Georgia\u2019s perinatal regions has a \u201chub\u201d \u2014 a major care center serving as an administrative unit to enable the coordination and delivery of maternal care services. For example,\u0026nbsp;\u003Ca href=\u0022https:\/\/med.emory.edu\/departments\/pediatrics\/divisions\/neonatology\/emory-regional-perinatal-center.html#:~:text=Georgia%20is%20divided%20into%20six,neonatal%2C%20and%20infant%20health%20care.\u0022\u003EThe Emory Perinatal Regional Center\u003C\/a\u003E at Emory University Hospital is the coordinating center for the 39-county metro Atlanta region.\u0026nbsp;\u003C\/p\u003E\u003Cp\u003EThis regionalization strategy also tries to address the problem of hospital closures, a troubling trend that leads to more deserts. In Georgia, 12 hospitals have closed since 2013; 18 rural hospitals are currently at risk of closure. And this new Georgia Tech study indicates that Georgia would somehow need to add 56 new facilities to eliminate the state\u2019s maternity care deserts \u2014 at least by the standards used by the March of Dimes.\u003C\/p\u003E\u003Cp\u003E\u201cEliminating maternity care deserts in Georgia would mean adding a larger number of obstetrics facilities to make sure every county has an obstetric hospital,\u201d Steimle said. \u201cBut this is likely unrealistic with the current economic forces pushing hospitals to close their obstetric units. With that many facilities in Georgia, some facilities would have a very small number of deliveries, which is not economically sustainable.\u201d\u003C\/p\u003E\u003Cp\u003EIn other words, eliminating maternity care deserts in Georgia wouldn\u2019t sufficiently address the larger problems related to access to care. Instead, Steimle and Meredith advocate for approaches that simultaneously consider the different dimensions of an ideal maternal healthcare system, not just access alone.\u003C\/p\u003E\u003Cp\u003EFor this initial study, Steimle and Meredith just focused on spatial access. They haven\u2019t yet addressed the complex issues of racial disparities, insurance access, or other hurdles facing reproductive-age women in Georgia. That may be coming.\u003C\/p\u003E\u003Cp\u003E\u201cThis is a start,\u201d Steimle said. \u201cOur future work entails thinking about how to come at this with the goal of maximizing or improving outcomes for women.\u201d\u003C\/p\u003E\u003Cp\u003EAnd as policy leaders across the country begin to address the maternal mortality crisis, Steimle believes her team\u2019s approach using more sophisticated tools can be helpful. So far, they\u2019ve shared their results with the Centers for Disease Control and Prevention, and members of the Georgia, Iowa, and Nevada departments of public health.\u003C\/p\u003E\u003Cp\u003E\u201cHow do we make measurements that point us toward our end goals? Our tools as mathematical modelers can really help us think through the system holistically and think through strategies before trying them in the real world,\u201d Steimle said. \u201cThink of it as a policy sandbox.\u201d\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003ECITATION:\u003C\/strong\u003E Meghan Meredith, Lauren Steimle, and Stephanie Radke.\u0026nbsp;\u003Ca href=\u0022https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-11135-4\u0022\u003E\u201cThe implications of using maternity care deserts to measure progress in access to obstetric care: a mixed-integer optimization analysis.\u201d\u003C\/a\u003E \u003Cem\u003EBMC Health Services Research\u0026nbsp;\u003C\/em\u003E(June 2024)\u003C\/p\u003E\u003Cp\u003E\u003Ca href=\u0022https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-11135-4#citeas\u0022\u003Edoi.org\/10.1186\/s12913-024-11135-4\u003C\/a\u003E\u003C\/p\u003E","summary":"","format":"limited_html"}],"field_subtitle":"","field_summary":[{"value":"\u003Cp\u003EGeorgia Tech researchers highlight the limitations of the \u0022maternity care desert\u0022 measure in accurately representing access to obstetric care in Georgia, urging for more sophisticated, region-specific approaches to address the state\u0027s high maternal mortality rates.\u003C\/p\u003E","format":"limited_html"}],"field_summary_sentence":[{"value":"Georgia Tech researchers highlight the limitations of the \u0022maternity care desert\u0022 measure in accurately representing access to obstetric care in Georgia, urging for more sophisticated, region-specific approaches to address the state\u0027s high maternal mortal"}],"uid":"28153","created_gmt":"2024-07-12 10:43:16","changed_gmt":"2024-07-12 16:58:33","author":"Jerry Grillo","boilerplate_text":"","field_publication":"","field_article_url":"","dateline":{"date":"2024-07-12T00:00:00-04:00","iso_date":"2024-07-12T00:00:00-04:00","tz":"America\/New_York"},"extras":[],"hg_media":{"674342":{"id":"674342","type":"image","title":"Meghan and Lauren","body":"\u003Cp\u003EISyE researchers Meghan Meredith (left) and Lauren Steimle have explored maternity care deserts in depth. \u0026nbsp;\u003C\/p\u003E","created":"1720780377","gmt_created":"2024-07-12 10:32:57","changed":"1720812750","gmt_changed":"2024-07-12 19:32:30","alt":"Meredith and Steimle","file":{"fid":"257842","name":"Meghan Lauren computers.jpg","image_path":"\/sites\/default\/files\/2024\/07\/12\/Meghan%20Lauren%20computers.jpg","image_full_path":"http:\/\/hg.gatech.edu\/\/sites\/default\/files\/2024\/07\/12\/Meghan%20Lauren%20computers.jpg","mime":"image\/jpeg","size":6614051,"path_740":"http:\/\/hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/2024\/07\/12\/Meghan%20Lauren%20computers.jpg?itok=5l8A6zWW"}}},"media_ids":["674342"],"groups":[{"id":"1188","name":"Research Horizons"}],"categories":[{"id":"131","name":"Economic Development and Policy"},{"id":"135","name":"Research"}],"keywords":[{"id":"168352","name":"maternity"},{"id":"187915","name":"go-researchnews"},{"id":"193845","name":"maternity care deserts"},{"id":"193846","name":"maternity mortality crisis"}],"core_research_areas":[{"id":"39511","name":"Public Service, Leadership, and Policy"}],"news_room_topics":[{"id":"71891","name":"Health and Medicine"}],"event_categories":[],"invited_audience":[],"affiliations":[],"classification":[],"areas_of_expertise":[],"news_and_recent_appearances":[],"phone":[],"contact":[{"value":"\u003Cp\u003E\u003Ca href=\u0022jerry.grillo@ibb.gatech.edu\u0022\u003EJerry Grillo\u003C\/a\u003E\u003C\/p\u003E","format":"limited_html"}],"email":["jerry.grillo@ibb.gatech.edu"],"slides":[],"orientation":[],"userdata":""}}}