Provider’s individual and network attributes in the selection process of a predominant prenatal care provider; a case-control study

Abstract

Abstract Background: Previous studies have explored the individual attributes of potential providers in the provider selection process. Among all potential providers, a predominant prenatal care provider, initially defined as the one who provided the most services or/and the first or last service during a pregnancy, had the most significant impact on prenatal care utilization and continuity of care. This study aims to examine the association between provider attributes, including network attributes (patient panel size, degree, and community size) and individual attributes (travel distance, specialties, and rural practice), and the selection of a predominant prenatal care provider. Methods This study utilized South Carolina’s Medicaid claims data from 2014 to 2018, involving live births delivered in hospitals. Samples were limited to pregnant women with continuous Medicaid enrollment throughout their pregnancies. Predominant providers (total = 2,153) were identified for 29,569 pregnancies. Network analyses were conducted on 5,520 providers, including 3,667 prenatal care (PNC) providers and 1,853 non-PNC providers. A Cartesian product (n=45,929,845) was created by combining five annual provider lists with all included pregnancies. Logistic regressions with repeated measure were applied in this retrospective case-control study. Results: The results demonstrated that providers with a medium or large degree were more likely to be the predominant provider if their community size was medium or large. A predominant prenatal care provider was more likely to be located near, rather than far from, the served woman, and in rural areas rather than urban ones. They were also more likely to be specialists, midwives, and nurse practitioners than primary care physicians. Conclusions: The results suggest that both individual and network attributes were significantly associated with the selection of a predominant provider. Policies aimed at addressing access issues for prenatal care should consider both the individual and network attributes of providers, as a provider may not be able to alter its individual attributes but can always optimize its social network.