Care coordination for pregnant veterans: VA’s Maternity Care Coordinator Telephone Care Program

Abstract

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.

Coordinating women's preventive health care for rural veterans

“…As the number of women who are “dual‐users” between VA and non‐VA settings continues to increase, so does the need to coordinate their care 11–13 . Effective coordination aims to optimize communication between providers for women veterans so that all providers are up‐to‐date on the veteran's medical history, current medications, test results, and management plans 14 . At small, rural facilities Women Veteran Program Managers, the facility‐level executive leaders of the Womens’ Health Program, have been given collateral responsibility to cover all VA and CCN coordination needs for women.…”

“…One model that has been found to be effective is to have a nurse designated as the Women Veterans’ Care Coordinator (WVCC) who collaborates with the VA primary care teams and CCN providers to coordinate care, track results, and connect women veterans to appropriate care 16 . This model draws on the experience of previously successful VA interventions, in which the nurse is coordinating and acting as a care manager for women veterans who are utilizing multiple providers for their care 14 . The addition of the WVCC position to VHA clinics is intended to assist in the continuity of care.…”

“…While both VA and non‐VA providers have reported significant frustration with cross system care, there remains little information regarding WVCCs’ perspectives 14,18 . The goal of this research is to understand the perceptions and experiences of coordinating care for rural veterans under the VHA ORH/WHS initiative.…”

Coordinating Care for Reproductive Health Malignancies in the Veterans' Health Administration: Promising Practices, Ongoing Challenges, and Future Research

“…48,[89][90][91] Innovations and practice redesigns, including using women's health PCPs and care coordinators, enterprise-wide educational programs and resources, gender-specific clinical decision support and performance management tools, and telehealth pro-grams, have transformed VA's care for women Veterans. 30,40,[46][47][48][49]92,93 VA can build on this foundation to foster further innovation and research on optimizing coordination of care for reproductive health malignancies which, in turn, would provide insights that VA may be able to apply more broadly in caring for women Veterans.…”

Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial

“…Evidence from previous randomized controlled trials (RCTs) including pregnant women with obstetric risk factors suggests that midwifery continuity of care models [17][18][19], care-coordination [20,21], implementation of specialized multidisciplinary teams [22], and antenatal and postpartum telephone support [23,24] have the potential to improve the quality of maternity care with positive effects on patient-reported outcomes, health utilization and maternal and infant outcomes. However, no prior trials have explicitly focused on maternity care for women with CMCs, and the question of how to deliver the best maternity care to women with CMC remains essentially unexplored.…”