Prenatal Care and Postnatal Outcomes for Publicly Insured Children with Congenital Heart Defects - PROJECT SUMMARY / ABSTRACT Candidate: Joyce Woo, MD, MS, is a pediatric and fetal cardiologist and health services researcher who aims to become a national leader in healthcare delivery systems for patients with congenital heart defects. Research Context: Congenital heart defects (CHDs) are the most common and resource-intensive birth defect in the United States. Prenatal diagnosis of critical CHDs allows for access to a CHD surgical center postnatally and is highly sensitive, but national prenatal diagnosis rates are only 30-60%. To develop policies that will increase prenatal CHD diagnosis rates and improve access to care, three knowledge gaps must be better understood: (1) how prenatal care is utilized, (2) how social determinants of health influence access to care via prenatal care, and (3) whether prenatal diagnosis has a longer-term effects on postnatal outcomes. To study these gaps, this proposal will use advanced statistical methods to analyze a novel, statewide, longitudinal database of linked maternal-infant New York Medicaid claims and surgical registry data. The proposal directly aligns with the NHLBI’s goal to leverage quantitative research to address public health needs. Specific Aims: 1) To identify the most common prenatal care utilization pathways that lead to delivery at a CHD surgical center, 2) To estimate the effects of neighborhood social determinants of health on prenatal care utilization and access to a CHD surgical center, and 3) To estimate an unbiased, quasi-causal effect of prenatal care utilization pathways on infant healthcare utilization and expenditures in the first five years of life. Research Plan: Dr. Woo will identify the combinations of prenatal care services, or utilization pathways, associated with the highest odds of delivery at a CHD surgical center. She will then use structural equation modeling to estimate the effects of neighborhood social determinants of health on prenatal care utilization pathways and access to CHD care, including surgery. Finally, she will use an econometric method to estimate quasi-causal effects between prenatal care utilization pathways and postnatal healthcare utilization (inpatient, outpatient and emergency room claims) and total Medicaid expenditures within the first five years of life. All findings will be presented to the New York State Department of Health. Findings will also serve as preliminary data for an R01 proposal that will test the impacts of public health policies in other states that were originally designed to increase newborn access to CHD care. Career Development Plan: Dr. Woo will develop expertise in 1) neighborhood social determinants of health and geocoding; 2) Bayesian analysis and econometrics; and 3) translating quantitative findings to policy. Her career development will be supported by close mentorship, coursework, and research meetings/seminars. Environment: Ann & Robert H. Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine offer the ideal environment for Dr. Woo to pursue this training, with the outstanding guidance of well- established mentors and interdisciplinary institutes dedicated to her success.
