Examining Perinatal Regionalization in Practice: A Network Analysis of Maternal Transport in Georgia

Perinatal regionalization is a systems-level strategy for coordinating care to ensure pregnant people receive timely care in facilities with risk-appropriate personnel and services. Inter-facility transport of patients to risk-appropriate facilities is a critical component of regionalized systems. As regionalized systems of maternal care are recently emerging, it remains unclear how maternal transport is being operationalized in practice. Using network analysis, we constructed maternal transport network to represent maternal transport routes (network edges) among obstetric facilities (network nodes) as directional network. We characterized patients and regions that were more likely to be involved in transport, and those more likely to be transported across the state’s designated perinatal regions. Network metrics were used to discern dynamics and structure of maternal transport in each perinatal region. Finally, we applied Louvain community detection algorithm to cluster obstetric facilities into communities that are observed to transport among each other most frequently. We compared these algorithm-detected communities with state’s formal designated perinatal regions. We demonstrated this data-driven approach using maternal transports as indicated on 2017-2022 birth records from the state of Georgia. We identified 8 algorithm-detected communities within each of which transports were coordinated frequently. While these detected communities were largely aligned with the state’s designated perinatal regions, geographical proximity between facilities and transporting within health systems tend to trump formal perinatal region designations. Redesigning the state’s perinatal region to align with the observed maternal transport networks and to formalize relationships that are naturally occurring in practice could potentially improve access to risk-appropriate maternal care.