Assessing Disparities in Access to Care in a Postpartum Pelvic Floor Healing Clinic

Objectives:

Objective: To assess for disparities in access to care in a Postpartum Pelvic Floor Healing Clinic (PPFHC) compared to a historical cohort (pre-PPFHC) of patients at high-risk for postpartum pelvic floor concerns. We hypothesized that patients residing in resource-deprived neighborhoods with higher area deprivation indices (ADI) would be less represented amongst the cohort evaluated in the PPFHC.

Methods: Retrospective cohort study of two existing datasets from a large academic hospital. The PPFHC cohort comprised all postpartum vaginal delivery patients seen in the clinic from July 2021-July 2022. The historical pre-PPFHC cohort comprised all patients with third or fourth-degree obstetrical lacerations after vaginal delivery from December 2019-January 2021. Sociodemographic data and delivery characteristics were obtained from the medical record. Patients were excluded if missing address data or if they resided in a state outside our normal referral base. Our primary outcome was the ADI (Neighborhood Atlas®, University of Wisconsin) where higher decile neighborhoods are considered more resource-deprived. Secondary outcomes included median household income (2020 American Community Survey, U.S. Census Bureau), driving time, and distance to the hospital (ArcMap GIS, ESRI, Redlands, California). Statistical comparisons were performed using Mann-Whitney U or t-tests, Chi-Square or Fisher's Exacts (SPSS). This project was IRB approved.

Results: There were 191 patients in the pre-PPFHC cohort and 266 patients in the PPFHC cohort. Patients seen in the PPFHC were older and more likely to be multiparous. Race, ethnicity, marital status, and insurance type were similar between groups (Table 1). Gestational age at delivery was similar, but patients in the pre-PPFHC had higher birthweights. Rates of operative vaginal delivery (34%) were similarly high between groups. Patients in the PPFHC cohort had more postpartum visits than pre-PPFHC [3 (IQR 2-4) vs. 2(IQR 1-2), p< 0.01] (Table 1).

For our primary outcome, there was a non-significant trend towards fewer patients from more deprived neighborhoods being seen in the PPFHC compared to the historical pre-PPFHC. There were half as many patients from the highest (most deprived) ADI decile seen in the PPFHC than pre-PPFHC (4.5% vs 8.9%, p=0.06). Median income was not significantly different between cohorts. Patients seen in the PPFHC lived closer to the hospital by distance and driving time than the pre-PPFHC historical cohort, although absolute differences were small (Table 2).

Conclusions: There were no significant differences between neighborhood ADI or median income among patients seen in a postpartum pelvic floor healing clinic compared to a historical cohort. While access to care in our postpartum pelvic floor healing clinic overall seems equitable, trends in our data suggest that access to care may be more difficult for patients from more resource-deprived neighborhoods and for patients who live farther from the hospital.