Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Abstract

VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities.

Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps

“…15 Shaw and colleagues' study of Veteran births in California reconfirmed this growth, and notably found that by 2012 the fraction of pregnant Veterans relying on VA for maternity benefits had grown markedly to 14%, nearly equaling those relying on Medicaid (15%) for maternity benefits. 13 A smaller analysis, by Katon et al, which relied on 2008-2009 National Survey of Women Veterans, found a slightly higher self-reported fraction of use of VA maternity benefits: 29% of 334 VA-eligible Although women have historically been excluded from serving in direct combat positions, even before recent changes in policy, 23,24 they have frequently worked in supportive roles that put them in the line of direct fire which may cause considerable stress. 25 Women, like their male colleagues, may return from conflicts with mental health problems.…”

“…29 Hypertensive disorders and gestational diabetes are two of the most common complications of pregnancy and have been examined in a handful of Veterans studies which consistently suggested elevated risk in this population, especially in the context of Veterans with greater mental health burden. 29,31,32 Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies and are a leading cause of maternal and perinatal morbidity and mortality. Although the etiology of preeclampsia remains unknown, identification of women at risk for the disease can lead to more prompt treatment that can improve outcomes.…”

HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

“…), state data from California birth records (Shaw et al. ), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al. ).…”

“…Medicare data were the most commonly linked data (used in Wang et al 2018;Thorpe et al 2018;Vaughan Sarrazin et al 2018;Trivedi et al 2018;Reddy et al 2018;Nelson et al 2018a, b;Vanneman et al 2018;Liu et al 2018;Chui et al 2018;Hebert et al 2018;Lei et al 2018), because these data have been available to VA researchers within the VA under an agreement with Centers for Medicare and Medicaid Services via the VIReC for more than fifteen years and have well-established documentation and file structures (Hynes et al 2007). Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018). These papers leveraged the linked data they created to address a range of topics, including VA and non-VA health care use and costs (Wang et al 2018;Vaughan Sarrazin et al 2018;Hebert et al 2018;Vanneman et al 2018;Liu et al 2018;Lei et al 2018), medication use (Thorpe et al 2018;Carlson et al 2018;and Chiu et al 2018), and the impact of homelessness on health care use and costs (Nelson et al 2018, andTrivedi et al 2018).…”

“…One study focused on health care use in VA and VA community care (Rosen et al 2018). Clinical conditions addressed included mental health , dementia (Thorpe et al 2018;Lei et al 2018), end-stage kidney disease (Wang et al 2018), pain management (Carlson et al 2018;Chiu et al 2018), high-risk pregnancy (Shaw et al 2018), and infectious disease (Nelson et al 2018). Two studies linked Medicare data to examine the impact of the VA's patient aligned care team intervention Reddy et al 2018).…”