Serving vulnerable populations: Does organizational type, ownership, and funding diversity matter in prenatal case management programs?

Prenatal case management (PCM) of medically or socially high-risk pregnant women is intended to improve birth outcomes. PCM, as a community-based health service, is provided by a variety of organizations to vulnerable women. Research consistently finds that hospitals with different organizational characteristics serve different types of clients. However, little is known whether these same organizational variables are related to having more diverse (more vulnerable) clients in community-based programs, such as PCM. Our study investigated whether the characteristics of PCM clients differ by organizational characteristics (type, ownership), program funding source, or program policies and procedures. Data available from an ongoing national survey of PCM programs were analyzed. Program directors (n=43) reported on the PCM program client characteristics (low birth weight, cesarean birth, first pregnancy, race, ethnicity, age, insurance status), and on organizational variables (ownership, organizational type). They also provided data on the funding sources for the PCM program, from which we generated a funding diversity score. There were significant Spearman's rho correlations between organizational type and the percent of PCM clients who are Hispanic (r=.36, p<.05) and younger than 17 years old (r=.36, p<.05), and between organizational ownership and the number of program policies (r=.65, p<.000). There were no significant bivariate correlations between the diversity of funding or number of policies and any of the client characteristics variables. Local health departments have a more standardized program, but that does not translate into serving a more diverse population. The results reveal complex relationships, and one that is not consistent with the broader health services literature. Such findings hint at potential policies that would encourage PCM programs to increase the diversity and vulnerability of their client base.