Women Veterans’ Experiences with Department of Veterans Affairs Maternity Care: Current Successes and Targets for Improvement

Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs

“… 39 , 40 , 42 , 45 Study designs included: 14 observational articles, 31 , 33 , 35 , 36 , 38 – 47 and 2 descriptive articles. 34 , 37 While all articles examined the care coordination of rural Veterans, study participants varied: 7 included Veterans, 33 , 39 , 40 , 42 – 45 5 included VA providers, 34 , 36 , 40 , 46 , 47 and 8 included Community Care or other non-VA providers. 31 , 35 , 36 , 38 , 41 , 44 , 45 , 47 Study settings included: 6 National studies, 33 , 37 , 39 , 42 , 44 , 47 6 in Northern Plains states, 31 , 35 , 36 , 38 , 41 , 43 2 in Western states 34 , 46 and 2 in New England states.…”

“… 34 , 37 While all articles examined the care coordination of rural Veterans, study participants varied: 7 included Veterans, 33 , 39 , 40 , 42 – 45 5 included VA providers, 34 , 36 , 40 , 46 , 47 and 8 included Community Care or other non-VA providers. 31 , 35 , 36 , 38 , 41 , 44 , 45 , 47 Study settings included: 6 National studies, 33 , 37 , 39 , 42 , 44 , 47 6 in Northern Plains states, 31 , 35 , 36 , 38 , 41 , 43 2 in Western states 34 , 46 and 2 in New England states. 40 , 45 The Veteran health care focus of VA Community programs varied greatly: 3 on American Indian Community Care, 34 , 35 , 46 3 on sharing electronic health record (EHR) data, 31 , 44 , 47 2 on obstetrics and maternity, 39 , 42 1 on housing for the homeless, 36 1 on treatment for opioid use, 40 1 on retail immunization, 33 and 5 on interorganizational care coordination itself.…”

“…VA and community partners leveraged their similarity or complementarity for alignment on one or more of the following: purpose, 31 , 33 – 35 , 38 – 40 , 46 scale, 33 geography, 44 or shared history or experience. 35 , 36 For example, strong alignment of purpose and complementarity of resources was demonstrated by the VA Maternity Care Coordination Program which guarantees women Veterans maternal and perinatal care through community specialists and mental health services through VA. 42 …”

“…Of these, 6 articles praised VA, particularly primary care providers, noting that communication improves when tailored to the needs of the care setting. 31 , 36 , 41 , 42 , 45 , 47 Seven articles cited both VA and Community Care for problematic communication and information sharing, such as: lack of contact information, reliance on Veterans to convey health records between systems, 41 and delayed response to requests. 31 , 37 , 38 , 41 , 43 , 44 One community provider remarked: “information-wise it’s a black hole in space.” 45 …”

“…The role of designated care coordinators and facilitators assigned at key service junctures or to high-risk patients was identified in 5 articles. 31 , 34 , 39 , 40 , 42 For example, one VA program instituted a full-time Native American nurse care coordinator 34 while in another, a facilitator coordinated contracted electronic HIE network completion. 31 Three articles featured TPAs who brought much-needed personnel and expertise to challenging care settings.…”