Our Approach: Engaged scholarship with policymakers, communities, programs and providers to reduce socioeconomic and racial/ethnic health disparities and improve health of birthing persons and their infants.
Our program of research targets the health and health care of Medicaid insured pregnant persons, many of whom live in difficult life circumstances, experience racism, have a higher prevalence of depressive disorders, and are more likely to have chronic health conditions and health risk behaviours. They are also more likely to have limited access to care, face health literacy barriers when they do seek care, and given their competing family priorities, have difficulty participating in health care. Their infants are more likely to be born preterm and/or at low birth weight, with long term consequences for school success. This is especially true for African American women and infants, who have more than double the rates of adverse birth outcomes and infant mortality. We focus our research on interventions and programs that are designed to improve health care and health outcomes for these vulnerable populations.
Our research is considered “engaged scholarship”, that is we use the tools of science and partner with providers, communities and policymakers to create new knowledge that drives innovation in “real world” settings to improve health care—and ultimately the health and life chances of low income birthing persons and infants. We work in multi-disciplinary research teams with collaborators in epidemiology, economics, psychology and human development and other disciplines. We have developed a longitudinal linked data set (vital records, Medicaid claims, and Medicaid program data) that includes all Medicaid births from 2008 to present that, with appropriate data use agreements with the Michigan Department of Community Health, can be used to support research.
From a population perspective, we have a long-term relationship with Michigan Medicaid policymakers to conduct research that informed the redesign of the state sponsored Medicaid enhanced prenatal care, the Maternal and Infant Health Program (MIHP). A rigorous evaluation of the program is in progress and the research has already shown improved service utilization and reduction of risk for adverse birth outcomes for program participants. However, only 30% of Medicaid-insured women statewide participate in the MIHP program that offers care coordination for every woman.
To address underutilization of services, we now have a five year Agency for Health Care Research and Quality (AHRQ) research demonstration project to develop and test a county population perinatal system of care in Kent County/Grand Rapids Michigan. Our primary community partners are Spectrum Health, Cherry Street Health Services, Kent County Health Department, Arbor Circle, Priority Health, as well as, the Michigan Department of Community Health. The system of care model was developed using the well-established Chronic Care Model and will be tested for population health impacts.
We also have a special research interest in Community Health Workers (CHW) who are particularly successful in engaging women in services who live in difficult life circumstances. Our current work builds on a prior randomized trial comparing state-sponsored Medicaid MIHP services delivered by professionals, with a nurse-CHW team approach focused on women’s stress and mental health. Funded by the W.K. Kellogg Foundation, we are now conducting a study of the Grand Rapids Strong Beginnings Program that further enhanced the MIHP-CHW program.