Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Social Supports, Care Coordination, Prenatal Care Access,

Intervention Description: The study proposed an intervention framework based on the themes and ideas generated from the qualitative analysis of participant perspectives. The proposed intervention design included three overarching thematic domains: (1) social support in the form of accompaniment and reassurance, (2) improved care delivery with greater consistency, communication, and individualization of outpatient prenatal care, and (3) improved access to outpatient prenatal care, convenient appointment availability, and uninterrupted insurance coverage during pregnancy , . The proposed intervention features included integrating CHWs into care teams and existing childbirth education, connecting pregnant individuals with social services resources, group prenatal care support, health information exchange, prenatal passport cards or applications, visit checklists, advanced access scheduling, enhanced care team visibility, drop-in pregnancy support center, insurance screening and enrollment, and CHW support for navigation and continuity . The intervention design aimed to improve trust and impact of prenatal care, advance equitably improved outcomes, and address unmet needs in those at risk for poor pregnancy outcome

Intervention Results: The study identified unique unmet needs and ideas for improving prenatal care among pregnant women with different patterns of unscheduled care utilization. Participants expressed a desire for social support interventions that address unmet psychosocial needs, care coordination, accompaniment, and navigation for at-risk pregnant women, while also addressing broader needs such as insurance eligibility, navigation to community-based resources, and access to timely prenatal care . The proposed intervention framework aimed to address these needs and improve prenatal care delivery for low-SES, Medicaid-insured, predominantly Black, pregnant women . The study also identified limitations, including a small sample size and potential social desirability bias . Overall, the study offers the opportunity to leverage qualitative narratives, tailor and adapt intervention design to meet the specific needs of a hard-to-engage population, and reduce inequitable, preventable maternal morbidity and mortality .

Conclusion: The study concluded that the use of a qualitative study design generated person-centered intervention elements that can improve trust and impact of prenatal care. The findings focused on the differential needs and ideas of pregnant women with unique patterns of utilization of unscheduled care, demonstrating a need for embedding targeted social support alongside clinical care to advance equitably improved outcomes. The study suggested that targeted interventions incorporating user ideas and addressing unique unmet needs of specific subgroups may improve perinatal outcomes. The proposed intervention elements may help maternity care systems improve health care delivery for Black, low-SES pregnant women by specifically focusing on community health worker (CHW) integration to address unmet psychosocial needs, care coordination, accompaniment, and navigation for at-risk pregnant women, while also addressing broader needs such as insurance eligibility, navigation to community-based resources, and access to timely prenatal care , .

Study Design: The study utilized a participatory action, qualitative research design to explore the perspectives and experiences of pregnant women regarding their prenatal care, barriers to care, and unscheduled care utilization in an obstetric triage unit. The qualitative analysis involved conducting in-depth, semi-structured interviews with pregnant women at the point of unscheduled hospital-based obstetric care, prompting participants regarding perspectives on group prenatal care and community health worker (CHW) interventions, and asking open-ended questions regarding ideas for improving care 2, 2. The qualitative data obtained from these interviews were then analyzed using grounded theory to identify major themes and develop an intervention framework aligned with participant perspectives

Setting: The setting for the study was an academic hospital outpatient setting, where pregnant women enrolled in a prenatal clinic were interviewed at the point of unscheduled hospital-based obstetric care in a triage unit . This setting allowed the researchers to gather insights from pregnant women who had experienced unscheduled care and to explore their perspectives on group prenatal care and community health worker (CHW) interventions, as well as their ideas for improving care

Population of Focus: The target audience for the study included pregnant women, particularly those from low socioeconomic status (SES) and Medicaid-insured, predominantly Black, pregnant women. The study aimed to capture the perspectives and experiences of this specific demographic group regarding their prenatal care, unscheduled care utilization, and ideas for improving care delivery

Sample Size: The study enrolled a total of 40 participants, who were categorized into two groups: Group 1 (n = 20) and Group 2 (n = 20) . These groups were defined based on the degree of utilization of unscheduled care during pregnancy, allowing for a comparative qualitative analysis of participant ideas for improving prenatal care. The sample size of 40 participants provided a substantial basis for capturing diverse perspectives and experiences related to prenatal care and unscheduled care utilization.

Age Range: The study did not explicitly mention the age range of the participants. However, it provided the mean age of the participants in Group 1 as 25.5 years and in Group 2 as 25.0 years . This suggests that the participants were generally in their mid-20s, but without specific details on the age range.

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Medicaid,

Intervention Description: The study proposed several intervention features based on participant ideas for change. These intervention features were intended to address the unique unmet needs and preferences of pregnant women with varying degrees of unscheduled care utilization. The proposed intervention features included: 1. Social Support: - Integration of community health workers (CHWs) into care teams and existing childbirth education. - Connecting pregnant individuals with social services resources. - Group prenatal care support. 2. Care Delivery: - Health information exchange. - Prenatal passport cards or applications. - Visit checklists. - Integration of technology already in use. 3. Access: - Advanced access scheduling. - Enhanced care team visibility. - Drop-in pregnancy support center. - Insurance screening and enrollment. - Integration of CHW support for navigation and continuity. These intervention features were intended to address the participants' expressed needs for social support, improved care delivery, and enhanced access to outpatient prenatal care. The study aimed to leverage these person-centered intervention elements to improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes

Intervention Results: he study identified three overarching thematic domains from participant ideas for improving prenatal care: social support, improved care delivery, and improved access to outpatient prenatal care. The study found that pregnant women with frequent unscheduled care utilization had unique unmet needs compared to those with no prior unscheduled visits. Participants in Group 1 overwhelmingly wanted to feel heard and centered by providers, while those in Group 2 expressed ambivalence about increased social support. The study proposed several intervention features based on participant ideas for change, including integration of CHWs into care teams, group prenatal care support, and advanced access scheduling. The study concluded that these person-centered intervention elements could improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes

Conclusion: The study concluded that low-income, Medicaid-insured, predominantly Black pregnant women face unique unmet needs in prenatal care delivery, which can be addressed through person-centered intervention elements. The study proposed several intervention features based on participant ideas for change, including integration of CHWs into care teams, group prenatal care support, and advanced access scheduling. These intervention features were intended to address the participants' expressed needs for social support, improved care delivery, and enhanced access to outpatient prenatal care. The study aimed to leverage these person-centered intervention elements to improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes. The study highlights the importance of engaging pregnant women in the design of interventions to improve prenatal care delivery and reduce disparities in maternal and infant health outcomes

Study Design: The study design was a qualitative, participatory action research approach. The researchers conducted in-depth, semi-structured interviews with pregnant women at the point of unscheduled hospital-based obstetric care in a triage unit. The interviews were designed to explore the participants' perspectives on group prenatal care, community health worker (CHW) interventions, and ideas for improving care. The study team then used grounded theory to develop a coding structure and identify major themes that emerged from the data, relating to participant ideas for improving care. The resulting intervention framework was presented to all study team members for validation, adjustment, and finalization.

Setting: The setting for this study was focused on low-SES, Medicaid-insured, predominantly Black pregnant women. The study aimed to understand the experiences and perspectives of pregnant individuals who are frequent and infrequent users of unscheduled care in the emergency room and obstetric triage. The insights and recommendations provided in the study are based on the narratives and experiences of these specific groups of pregnant individuals, highlighting the importance of tailoring prenatal care delivery to meet the unique needs of this population.

Population of Focus: The target audience for this study was low-income, Medicaid-insured, predominantly Black pregnant women with varying degrees of unscheduled care utilization. The study aimed to understand the perspectives and experiences of this specific demographic group in order to identify unmet needs and propose interventions to improve prenatal care delivery tailored to their unique requirements. The findings and recommendations presented in the study are intended to inform healthcare providers, policymakers, and organizations involved in prenatal care for this target audience, with the goal of enhancing access to early prenatal care and improving perinatal outcomes.

Sample Size: he sample size for this study was 40 participants, who were enrolled and categorized as either Group 1 (n = 20) or Group 2 (n = 20). The participants were low-income, Medicaid-insured, predominantly Black pregnant women with varying degrees of unscheduled care utilization. The study team conducted in-depth, semi-structured interviews with these participants to explore their perspectives on barriers and facilitators of health and ideas for improvement in care delivery, with a focus on the potential role of community health workers and social support. The study team then used modified grounded theory to develop general and subset themes by study group and mapped these themes to potential intervention features.

Age Range: The study did not provide a specific age range for the participants. However, it did report that the mean age for Group 1 was 25.5 years and for Group 2 was 25.0 years. The study also reported that all enrolled participants self-identified as cis-gender women and were predominantly Black (95%).

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Prenatal Care Access, Targeting Interventions to Focused Groups

Intervention Description: The intervention in this study was Pennsylvania's criminal sentencing reform policy, which aimed to reduce the state's prison population by implementing revised sentencing guidelines and increasing investments in community-based services. The policy was implemented in 2012 and was expected to reduce the number of people admitted to state prisons in Pennsylvania. The study aimed to evaluate the impact of this policy on early and adequate prenatal care utilization among birthing people in Pennsylvania, with a focus on effect heterogeneity across birthing person race/ethnicity and educational attainment. The study found that the benefits of the policy for prenatal care were largely limited to counties where prison admission rates declined the most after the policy, and improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education

Intervention Results: The study found that in counties where prison admissions declined the most after the policy, early prenatal care increased from 69.0% to 73.2%, and inadequate prenatal care decreased from 18.1% to 15.9%. By comparison, improvements in early prenatal care were smaller in counties where prison admissions increased the most post-policy (73.5 to 76.4%) and there was no change to prenatal care inadequacy (14.4% pre and post). The study found this pattern of improvements to be particularly strong among Black birthing people and those with lower levels of educational attainment. The study concluded that Pennsylvania's sentencing reforms were associated with small advancements in racial and socioeconomic equity in prenatal care. However, the study also noted that incremental changes to criminal justice policy are unlikely to have broad effects for health equity, and transformative policy changes in the areas of healthcare, social welfare, and criminal justice together will be necessary to see dramatic shifts in preventative healthcare inequities.

Conclusion: The study concluded that Pennsylvania's criminal sentencing reform policy was associated with small advancements in racial and socioeconomic equity in prenatal care utilization. The study found that the benefits of the policy for prenatal care were largely limited to counties where prison admission rates declined the most after the policy, and improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education. The study also noted that incremental changes to criminal justice policy are unlikely to have broad effects for health equity, and transformative policy changes in the areas of healthcare, social welfare, and criminal justice together will be necessary to see dramatic shifts in preventative healthcare inequities. The study highlights the importance of contextual conditions of incarceration for preventative healthcare access and utilization and sheds light on how criminal justice reforms may have spillover effects for healthcare utilization and health equity.

Study Design: The study design was an interrupted time series analysis using individual-level birth certificate data linked to county-level rates of prison admissions in Pennsylvania from 2009 to 2015. The study aimed to evaluate the impact of Pennsylvania's criminal sentencing reform policy on early and adequate prenatal care utilization, with a focus on effect heterogeneity across birthing person race/ethnicity and educational attainment. The study used Poisson regression models with robust error variance to estimate changes in prenatal care utilization after the policy, stratified by quartiles of county-level pre-post difference in mean monthly prison admission rates. The study design allowed for the assessment of changes in prenatal care utilization over time, before and after the policy, and across different subgroups of the population.

Setting: The setting for this study is Pennsylvania, focusing on the period from 2009 to 2015. The researchers linked individual-level birth certificate data to monthly county-level rates of prison admissions in Pennsylvania during this time frame. By examining the effects of Pennsylvania's criminal sentencing reform on prenatal healthcare access and equity, the study provides valuable insights into the impact of policy changes on healthcare utilization in the context of the criminal justice system

Population of Focus: The target audience for this study is likely researchers, policymakers, and healthcare professionals interested in understanding the impact of criminal justice policies on healthcare access and equity, particularly in the context of prenatal care. The study provides important insights into the potential benefits of reducing incarceration rates for improving early and adequate prenatal care, particularly for marginalized communities. The findings may be of interest to those working in public health, criminal justice reform, and healthcare policy.

Sample Size: Thestudy used individual-level birth certificate microdata on births in Pennsylvania from 2009 to 2015, totaling 999,503 births. This large sample size allowed the researchers to assess the effects of Pennsylvania's criminal sentencing reform on prenatal healthcare access and equity across a significant number of births in the state. The substantial sample size contributes to the robustness of the study's findings.

Age Range: The study did not report a specific age range for the birthing people included in the sample. However, the study did collect data on self-reported age (< 19, 20–29, 30–39, 40 + years) as an individual-level covariate in their statistical analysis. Therefore, the study likely included birthing people across a range of ages, from under 19 to over 40 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Transportation Assistance, Prenatal Care Access, Access,

Intervention Description: It was a retrospective cohort study that aimed to investigate the association between travel time and prenatal care attendance among women who received prenatal care and delivered at North Carolina Women’s Hospital between July 1, 2014, and June 30, 2016. The study utilized electronic medical record (EMR) data from the Carolina Data Warehouse for Health (CDW-H) and the UNC Hospital Perinatal Database (PNDB) to identify a subset of women from the Care4Moms study with singleton pregnancies who received prenatal care from UNC OB/GYN physicians in the NC Women’s Hospital Clinic and were at least 18 years of age. The study used multinomial logistic regression models to estimate the association between travel time and appointment attendance, adjusted for sociodemographic covariates

Intervention Results: The study found that for every 10 minutes of additional travel time, women were 1.05 times as likely to arrive late and 1.03 times as likely to cancel appointments than arrive on time. However, travel time did not significantly affect a patient’s likelihood of not showing for appointments. Additionally, the study identified disparities in appointment attendance based on sociodemographic factors. Non-Hispanic black patients were 71% more likely to arrive late and 51% more likely to not show for appointments than non-Hispanic white patients. Publicly insured women were 28% more likely to arrive late to appointments and 82% more likely to not show for appointments than privately insured women

Conclusion: The study concluded that changes to transportation availability alone may only modestly affect outcomes compared with strategically improving access for sociodemographically marginalized women. The findings suggested that marginalized socioeconomic groups may have a higher risk of poor attendance, widening existing health disparities. The study recommended that providers consider re-evaluating punitive late-arrival policies and informed strategies to better address the needs of patients with longer travel times, particularly those belonging to marginalized sociodemographic groups

Study Design: The study design was a retrospective cohort study of women who received prenatal care and delivered at North Carolina Women’s Hospital between July 1, 2014, and June 30, 2016. The study utilized electronic medical record (EMR) data from the Carolina Data Warehouse for Health (CDW-H) and the UNC Hospital Perinatal Database (PNDB) to identify a subset of women from the Care4Moms study with singleton pregnancies who received prenatal care from UNC OB/GYN physicians in the NC Women’s Hospital Clinic and were at least 18 years of age. The study used multinomial logistic regression models to estimate the association between travel time and appointment attendance, adjusted for sociodemographic covariates

Setting: The setting of the study is based on a U.S.-based population of pregnant women older than 18 years. The research aims to provide insights into the impact of travel time on appointment attendance outcomes within this demographic

Population of Focus: e target audience for this study includes healthcare professionals, policymakers, and researchers involved in maternal and child health, particularly those interested in understanding the impact of travel time on prenatal care attendance and its implications for marginalized socio-demographic groups. Additionally, public health officials and organizations focused on improving access to prenatal care for underserved populations would also find this research relevant and valuable

Sample Size: The study included a sample size of 2,808 women who received prenatal care and delivered at North Carolina Women’s Hospital between July 1, 2014, and June 30, 2016. This sample size encompassed a total of 24,021 appointments, providing a robust dataset for analyzing the association between travel time and prenatal care attendance

Age Range: The study included women who were at least 18 years of age. The age range was categorized into five levels: 18–24, 25–28, 29–32, 33–35, and 36 years and older. This age restriction was implemented to mitigate potential differences in this population’s access to transit, as North Carolina law restricts access to a regular driver’s license to those older than 18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Other (Provider Practice), Prenatal Care Access, Non-Traditional Providers

Intervention Description: The intervention in this study was the provision of obstetric care, specifically prenatal care and delivery services, by family physicians (FPs) in a rural county in Alabama. The FPs provided full-time prenatal care and delivery services at a local hospital, with high-risk pregnancies and infants referred to a regional medical center located 38 miles away. The FPs were trained through an obstetrics fellowship and had experience in managing high-risk deliveries. The study examined the impact of the availability of local obstetric services, particularly prenatal care provided by FPs, on infant mortality rates in the county

Intervention Results: The results of the study indicated that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), was associated with lower infant mortality rates in the rural county of Pickens, Alabama. The study found that during the period when both prenatal care and delivery services were provided locally by FPs, the county achieved an infant mortality rate (IMR) that was lower than both the state and national IMRs during the same period. The closure of the local maternity unit coincided with a 50% increase in IMR, while the provision of full-time prenatal care by an FP trained through an obstetrics fellowship, even in the absence of local delivery services, contributed to an 11% decline in IMR compared to a period with no obstetric care available locally . Furthermore, the study observed a significant decrease in IMR in Pickens County between periods when no obstetric services were available and when full prenatal care and delivery services were provided locally by FPs. The results also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. Despite the loss of local delivery services, the provision of full-time prenatal care by an FP trained through an obstetrics fellowship resulted in a decline in IMR, indicating the potential benefit of prenatal care alone in reducing infant mortality . Additionally, the study compared IMR trends in other rural counties with and without obstetric services and observed variations in IMR changes based on the availability of obstetric care. These findings supported the association between the provision of obstetric care, particularly by FPs, and changes in IMR in rural communities .

Conclusion: The study concluded that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), can have a significant impact on infant mortality rates in rural areas. The study found that the provision of full-time prenatal care and delivery services by FPs was associated with lower infant mortality rates in a rural county in Alabama. The study also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. The study suggested that properly trained FPs can have a profound impact on infant mortality in rural areas and that efforts should be made to maintain their competencies in managing high-risk deliveries. The study also emphasized the importance of access to prenatal care in reducing infant mortality rates, even in the absence of local delivery services

Study Design: The study utilized a natural experiment design to investigate the impact of the availability of obstetric services, particularly prenatal care provided by family physicians, on infant mortality in a rural county. The natural experiment involved variations in the availability of obstetric services in Pickens County, Alabama, over different time periods, allowing the researchers to assess the association between the closure and reopening of local obstetric units and changes in infant mortality rates . This design enabled the researchers to examine the potential impact of the availability of local obstetric services on infant mortality in a real-world setting.

Setting: The setting of the study was Pickens County, Alabama, a rural area where obstetric services, including prenatal care, were unavailable for a period of time . This rural setting allowed the researchers to examine the impact of the availability of obstetric care provided by family physicians on infant mortality in a specific geographic area.

Population of Focus: The target audience for this study includes healthcare professionals, policymakers, and researchers interested in maternal and child health, particularly in rural areas. The findings of the study are relevant to family physicians, obstetricians, public health officials, and policymakers involved in improving access to prenatal care and reducing infant mortality in rural communities

Sample Size: The study focused on a specific rural county, Pickens County in Alabama, and did not explicitly mention a sample size. The researchers likely used available data on infant mortality, prenatal care, and obstetric services within the county to conduct their analysis. Therefore, the "sample size" in this context would refer to the population of the county and the available data on births, infant deaths, and prenatal care services within that population.

Age Range: The study focused on infant mortality, which is defined as the number of deaths among infants less than one year of age . Therefore, the age range of interest in this study was from birth to one year of age.

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access, Community Health Centers

Intervention Description: The study did not involve an intervention. Instead, it focused on analyzing the operational efficiency, patient composition, and regional context of U.S. health centers and their associations with access to early prenatal care and low birth weight. The study utilized data from multiple sources to examine the quality of prenatal care and birth outcomes of patients served at Community Health Centers (CHCs) operating in the United States in 2015. The research involved analyzing existing data to understand the relationships between sociodemographic composition of CHCs and the efficiency of health centers, as well as how CHC demographics and efficiency are associated with the numbers of patients served and patient health outcomes relating to pregnancy and childbirth

Intervention Results: The study found that there were significant differences in the association between latent classes and access to prenatal care in the first trimester. CHCs in Class 2, characterized by patients who are Older Rural Whites, had the highest rate of access to prenatal care in the first trimester. Compared to other classes, CHCs in Class 2 had more prenatal patients who received early prenatal care. The study also found that greater efficiency at health centers was associated with lower rates of low birth weight (LBW), even controlling for the sociodemographic composition of CHC patients and regional context. However, greater efficiency was not associated with improved access to early prenatal healthcare. The study noted several limitations, including that their measure of prenatal care only captured the timing of initiation of care and did not capture other dimensions of prenatal care quality. Additionally, the study was unable to identify and separate what share of the labor and financial inputs to their DEA model were being used specifically for pregnancy-related services.

Conclusion: The study concluded that Community Health Centers (CHCs) play a crucial role in providing prenatal care, particularly in rural areas where access to obstetric services is declining. The findings highlighted the importance of CHCs in addressing the unique challenges of providing prenatal and perinatal health care in rural communities. The study also emphasized the persistent racial inequalities in prenatal care and birth outcomes, with CHCs serving predominantly white patients having the highest rates of early access to prenatal care and the lowest rates of low birth weight (LBW) births. Conversely, CHCs serving a larger share of Black and Hispanic patients had significantly lower rates of early access to prenatal care and higher rates of LBW births. The study suggested that patient and regional sociodemographic factors had a stronger association with lower or higher rates of LBW at health centers than either patient access to early prenatal care or the relative efficiency of the centers. Additionally, the study highlighted the need for future research to examine how patient characteristics within particular regional settings of healthcare are associated with patient engagement in care and health outcomes.

Study Design: The study design was a cross-sectional analysis of data from the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA) for the year 2015. The study used a combination of latent class analysis (LCA), data envelopment analysis (DEA), and generalized linear models with a fractional response to analyze the associations between operational efficiency, patient composition, regional context of U.S. health centers, and access to early prenatal care and low birth weight. The study aimed to identify and classify diversity among health centers in terms of their patient populations and regional contexts and to understand how these factors are associated with the degree of access to early prenatal care for patients and the health outcomes of prenatal patients and their babies.

Setting: The setting of this study is the United States, specifically community health centers (CHCs) that provide primary care services to underserved populations. The study used data from the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA) to analyze the associations between operational efficiency, patient composition, regional context of U.S. health centers, and access to early prenatal care and low birth weight.

Population of Focus: The target audience for this study includes researchers, policymakers, and practitioners interested in improving maternal and child health through the community health center (CHC) system in the United States. Additionally, stakeholders involved in healthcare delivery, public health, and health disparities may also find the findings of this study relevant to their work.

Sample Size: The initial sample size for this study was 1,331 community health centers (CHCs) funded by the Community Health Center (CHC) Program. However, 79 health centers were excluded, resulting in a final sample of 1,252 CHCs for the latent class analysis (LCA). For the data envelopment analysis (DEA) model, an additional 187 CHCs were excluded, reducing the sample to 1,065. Finally, 24 CHCs were excluded from the sample for analyses predicting the proportion of births born at low birth weight (LBW), resulting in a final sample of 1,041 CHCs for LBW analyses.

Age Range: The study did not have a specific target age group. Instead, the study focused on perinatal health outcomes, which includes health outcomes related to pregnancy and childbirth. The study analyzed data on patient demographics, health outcomes, quality of care indicators, costs, and revenues for all 1,375 federally-qualified health centers (FQHCs) in the United States. The study also used regional zip code tabulation area (ZCTA)-level data from the US Census American Community Survey (ACS; 2010–2014) and Behavioral Risk Factor Surveillance System (BRFSS; 2009–2012) to obtain regional data associated with each CHC's service area.