'U' study seeks to close gaps in prenatal care

BY TINA HILDRETH
Daily Staff Reporter
Published October 12, 2004

Black women are three times more likely to die during pregnancy
than white women, and their babies are also twice as likely to die
during infancy, according to the University’s Medical School.
Every year billions of dollars are spent to define and explain
social health disparities such as these.

Beth Dykstra
Faculty from various University departments collaborating in a project to examine the discrepancies in the outcomes of black and white pregnancies: (from front) Scott Ransom, Lynn Wooten, Briggett Ford, Elizabeth Yakel, and Kristine Siefert. (mike hulseb

Many of the disparities, though heavily researched, remain
unresolved. This is especially true in the outcome of pregnancies,
where differences in the amount of health care blacks and whites
receive is not uncommon: For example, 89 percent of white women
seek prenatal care, compared to 75 percent of black women,
according to the University Medical School.

Now 17 different University departments have teamed up to begin
a new three-year research initiative called “Health
Disparities: Leaders, Providers, and Patients,” prompted by a
$1.7 million grant from the National Institute of Health.

The departments will seek to understand and fix disparities in
outcomes of births for all pregnant women, and disadvantaged women
in particular.

Scott Ransom, director of the University Program for Healthcare
Improvement and Leadership Development, said the disparities
between the outcomes of black and white pregnancies is due in part
to lack of correct research techniques.

Traditional research programs have been confined to one or two
academic disciplines, with medical researchers focusing on
biological problems faced by pregnant women and social researchers
seeking to understand the effect of socioeconomic status on
pregnant women. Little or no collaboration has occurred between the
two groups. That, according to Ransom, is precisely the
problem.

“While there has been tremendous effort and a lot of money
spent to address the problem, in my opinion almost nothing has been
accomplished with all that investment. Individual niche programs
are Band-Aids that don’t solve the problem,” Ransom
said in a written statement.

Ransom said the project will examine pregnancies from a broader
perspective, examining how prenatal care is coordinated between
health care providers and expectant mothers.

“This involves a lot more than the medical aspects of
prenatal care,” he said.

Instead, Ransom and his team will examine questions such as
whether expecting mothers have trouble finding transportation, what
communication issues exist between their healthcare providers and
family members, and whether gun violence occurs in their homes.

“We are going to look at this from preconception up
through delivery and beyond,” Ransom said.

The program is the first to coordinate research from many
disciplines on the issue of birth outcome disparities. Program
coordinators said they have high hopes for the outcome of their
teamwork.

The new Health Disparities program will explore three holistic
areas of health care and their influences on birth outcome
disparities.

The first area will focus on how a health care provider serves
as a leader in prenatal care, and how that leadership might
influence the outcomes of patients’ pregnancies. Business
Prof. Lynn Wooten is leading this aspect of the project.
“Several (leadership) models have developed that
haven’t been applied in health care,” she said.

She said many leadership models have been successfully applied
within the business world, but these same models have never been
applied to health care systems.

Wooten and her team will look at what factors make a good health
care leader, and how their leadership abilities affect the
organization of their providers, the motivation of their doctors
and nurses and what kind of vision they have to help alleviate
health care disparities.

The second area will examine how health care providers’
personal biases and other stereotypes may affect the care their
patients receive. This area will focus on communication between the
doctor and the patient, seeking to understand how providers can
offer better multicultural care to the various minorities within
their patient base.

The third area will examine the psychological and social aspects
of expectant mothers by examining such aspects as whether or not
they are eating correctly, whether they are sleeping in warm
places, or living in stressful environments that might negatively
affect their baby’s health.

This part of the research, spearheaded by Social Work Prof.
Brigett Ford will use focus groups and interviews to find out how
favorably patients view available systems of pre-natal and
post-natal care.

This exploratory program will seek information to create
augmented prenatal care, described by Ford as “medical care
plus,” tailored more to patients’ needs. Examples of
this are ways to get patients connected with available financial
assistance, educational support and job training, if needed.

“There are many resources out there,” Ford said.
”We will try to figure out what resources a person needs and
how we can incorporate them.”

At the end of their project, leaders of the Health Disparities
group hope their research will help develop a new discipline that
encompasses a range of social disparities, birth outcomes in
particular. Such a discipline could include, under one title,
aspects of business, social work and engineering.