Deputy Director of Operations, D.C. Department of Health

Dissertation Title

Are enabling services in federally qualified health centers associated with women receiving prenatal care in the first trimester?

Dissertation Abstract

The purpose of this study was to examine whether enabling services in federally qualified health centers (FQHCs) were associated with women receiving prenatal care services in the first trimester. The population for this study included FQHCs providing prenatal care services for the years 2008, 2009, and 2010. Data for this study were derived from two sources: Uniform Data System (UDS) and the Area Resource File (ARF).This study adopted the Andersen's (1973) Behavioral Model of Health Services Use.

The study consisted of longitudinal panel data analysis. Univariate and bivariate statistics were calculated using PASW/SPSS statistical software, version 18. For the multivariate analysis, generalized linear mixed models were used using SAS PROC Glimmix. The dependent variable consisted of the number of women receiving prenatal care in the first trimester in the FQHC. Independent variables included measures of enabling services provided by the FQHC, such as total enabling services, transportation services, and interpreter services, in addition to multiple control variables. Due to the dependent variable being measured as a count, Poisson regression was determined to be the most appropriate analysis.

There are several key findings in this study. First results suggest that the number of FQHC staff members providing enabling services per 100 patients is not significantly associated with the number of women receiving prenatal care in the first trimester. Second, transportation FTEs per 100 patients was positively associated with women receiving prenatal care services in the first trimester. However, transportation services did not have a differential effect on rural communities as we had hypothesized. Third, the higher the ratio of interpretation staff FTEs to non-English speaking patients at FQHCs, the higher the number of women receiving prenatal care in the first trimester. However, when the model was run to explore the effect of the squared variable, there was a statistically significant negative association. Interpretation services had an increasing effect until an FQHC reached 36.3 FTEs. Finally, we further found that enabling services had a positive effect on the number of women receiving prenatal care services in the first trimester for FQHCs with a higher proportion of minorities. This effect was higher for FQHCs with a higher proportion of African Americans.