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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.

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

Cordasco

Katzburg

Katon

et al. 2018

Translational Behavioral Medicine

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Women with Diabetes during Pregnancy: Sociodemographics, Outcomes, and Costs of Care

York

Brown

1995

Public Health Nursing

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This study provides sociodemographic, outcome, and cost data on a population (N = 55) of predominately low-income, diabetic women who were hospitalized during pregnancy. Study findings indicated that 43 percent received no prenatal care in the first trimester, 20 percent delivered a low-birthweight infant, 47 percent had a cesarean delivery, and 63 percent reported an annual income under $12,500. Following the women's initial admission for glucose control, 19 acute care visits and 32 rehospitalizations were recorded for them. The mean hospital charges for antepartum initial hospitalization for glucose control were $4,665 (4.3 days). The mean charges for postpartum hospitalization were $7,793 (4.3 days). The mean hospital charges per infant were $12,991. Given the data presented in this study, it is imperative that monies be targeted to provide a broad spectrum of health care services that will meet the unique needs of this population. These services should address not only the needs related to superimposed disease state but also identify mechanisms to assist women to receive care prior to conception, or at the very least to begin prenatal care in the first trimester of pregnancy.

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Pregnant Women With Diabetes: Antepartum and Postpartum Morbidity

York¹,

Brown²,

Miovech³

et al. 1995

Diabetes Educ

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Cited by 4 publications

References 3 publications

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

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

Women with Diabetes during Pregnancy: Sociodemographics, Outcomes, and Costs of Care

Pregnant Women With Diabetes: Antepartum and Postpartum Morbidity

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