Risk-standardized mortality rates for IHD and CHF varied widely across the VA health system, and this variation was not well explained by differences in demographics or comorbidities. This variation may signal substantial differences in the quality of cardiovascular care between VAMCs.

Background Pregnant persons have received mixed messages regarding whether or not to receive COVID-19 vaccines as limited data are available regarding vaccine safety for pregnant and lactating persons and breastfeeding infants. Objective The aims of this study were to examine pregnant Veteran’s acceptance of COVID-19 vaccines, along with perceptions and beliefs regarding vaccine safety and vaccine conspiracy beliefs. Design and Participants We conducted a cross-sectional survey of pregnant Veterans enrolled in VA care who were taking part in an ongoing cohort study at 15 VA medical centers between January and May 2021. Main Measures Pregnant Veterans were asked whether they had been offered the COVID-19 vaccine during pregnancy, and whether they chose to accept or refuse it. Additional questions focused on perceptions of COVID-19 vaccine safety and endorsements of vaccine knowledge and conspiracy beliefs. Logistic regression was utilized to examine predictors of acceptance of a vaccine during pregnancy. Key Results Overall, 72 pregnant Veterans were offered a COVID-19 vaccine during pregnancy; over two-thirds (69%) opted not to receive a vaccine. Reasons for not receiving a vaccine included potential effects on the baby (64%), side effects for oneself (30%), and immunity from a past COVID-19 infection (12%). Those who received a vaccine had significantly greater vaccine knowledge and less belief in vaccine conspiracy theories. Greater knowledge of vaccines in general (aOR: 1.78; 95% CI: 1.2–2.6) and lower beliefs in vaccine conspiracies (aOR: 0.76; 95% CI: 0.6–0.9) were the strongest predictors of acceptance of a COVID-19 vaccine during pregnancy. Conclusions Our study provides important insights regarding pregnant Veterans’ decisions to accept the COVID-19 vaccine, and reasons why they may choose not to accept the vaccine. Given the high endorsement of vaccine conspiracy beliefs, trusted healthcare providers should have ongoing, open discussions about vaccine conspiracy beliefs and provide additional information to dispel these beliefs.

Key Points Question What is the association between health care spending and survival in patients with chronic heart failure across US Veterans Affairs Medical Centers? Findings This cohort study of 265 714 patients found that mean annual expenditures varied from $21 300 to $52 800 per patient, and annual survival varied between 81.4% and 88.9%. There was a modest, statistically significant V -shaped association between spending and survival; however, the general association between spending and survival was weak. Meaning Several Veterans Affairs Medical Centers with high expenditures may be less economically efficient than their peer institutions in producing good health outcomes in their patients with chronic heart failure.

Although many successful Community Advisory Boards (CABs) are discussed in the literature, some articles report that community members feel they are treated as token participants, or that their voices are not heard. This article describes the initial steps we took in designing an effective and empowered CAB, the underlying group dynamics principles we employed to formulate this CAB, and the structure and processes we instituted. We focused on how to build decision-making procedures that support and enhance the group’s function and effectiveness over the long term. Additionally, we considered how we might intervene when these features become out of balance. Though the literature on CABs often talks about power dynamics, explanations of what is meant by this label are rare. We resolved to explore these dynamics and to design a CAB that would operate successfully in full recognition of power dynamics.

Purpose As the number of women veterans receiving care from the Veterans Health Administration (VHA) continues to increase, so does the need to access gender‐specific preventive health care services through the VHA. In rural areas, women veterans are the numeric minority, so many preventive screenings are performed outside of the VA by community providers. As the numbers of veterans utilizing both VHA and non‐VHA providers for their preventive care continue to increase, so does the need to coordinate this care. This research examines the role of the Women Veterans’ Care Coordinator (WVCC) at rural facilities and their perceptions of coordinating preventive care. Methods Between March and July 2019, semi‐structured telephone interviews were conducted with WVCCs at 26 rural VA facilities. Each interview was digitally recorded and transcribed verbatim. Transcripts were loaded into Atlas.ti for further analysis. Once the codes were refined, the investigators coded the 26 interviews independently and conferred to achieve consensus on the underlying themes. Findings Five themes arose from the WVCC interviews: (1) Rural women veterans have varying needs of coordination; (2) Fragmented communication between the VA and non‐VA care settings hinders effective coordination; (3) Difficulties in prioritizing rural care coordination; (4) Care coordination impacts patient care; and (5) WVCC recommendations to improve rural care coordination. Conclusions The recent addition of WVCCs to rural facilities has expanded the VA's reach to veterans living in the most rural areas. As a result, many of these women are now receiving timely, quality, and coordinated health care.