Coordinating care between Veterans Health Administration (VA) and community providers is essential for providing high-quality comprehensive maternity care to women veterans, particularly those with chronic medical or mental health issues. We iteratively developed and assessed feasibility, as well as facilitators and barriers, of implementing the VA Maternity Care Coordinator Telephone Care Program, and identified specific health needs of pregnant women Veterans served by the program. We used three Plan-Do-Study-Act cycles. The final program consisted of materials supporting seven structured phone calls spanning initiation of pregnancy care through six weeks postpartum. We used logs to measure veteran uptake and surveys and field notes to capture care-coordinator perceptions about potential program value and facilitators and barriers to implementing it. We conducted a medical record review assessing pregnant veterans' need for coordination of services for physical and mental health problems and health behaviors. Veterans' uptake was 60%. Implementation facilitators included conducting training sessions for program coordinators and tailoring materials to address differences across VA facilities. Implementation barriers included limited information and communication technology tools to support the program and lack of coordinator time for delivering the telephone care. Among 244 pregnant veterans, 41% had pre-pregnancy chronic physical problem(s); 34% mental health problem(s); 18% actively or recently smoked. Implementation of a telephone-based care coordination program for pregnant veterans was feasible. Effective program spread required tailoring for local variations in resources and processes, investing in information and communication technology tools and allocating coordinator time to deliver care. Pregnant women veterans have a substantial burden of physical health, mental health, and risky health behaviors needing care coordination.

We designed a patient-centered smoking cessation program for women in 2004/2005, incorporating women's preferences and expert opinion. Our four-step process included: (1) concept-development focus groups; (2) an expert panel; (3) concept-testing focus groups, and (4) a pilot study. Data analyses occurred in 2004-2007. The new program offered options: the traditional Veterans Health Administration (VA) male-dominated program was the least selected option in the pilot study. Patients can be effectively involved in program development. The study's implications and limitations are noted. This research (conducted in Los Angeles, California) was funded by the American Legacy Foundation with additional VA support.

We used a consumer-driven approach to develop a model smoking-cessation program for women. Four focus groups (N = 23 [5-7/group]), each lasting 2 hours, were led by a professional moderator and audiotaped in 2004. Researchers reviewed transcripts; key themes were identified using scrutiny techniques (Ryan and Bernard, 2003). Necessary elements of a smoking-cessation program for women included support and choice (i.e., control over the program components), suggesting the need for an individualized program. Identifying appropriate components is a critical step in the development of efficacious programs that target substance-abusing populations; focus group methodology is useful in this endeavor. The study's implications and limitations are noted.

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