Evaluating Care Coordination Program for Pregnant Veterans
BACKGROUND:
VA strives to provide high-quality, coordinated maternity care. VA purchases maternity care from non-VA providers and established a national maternity care coordination policy in 2012 that requires each pregnant Veteran to have a maternity care coordinator (MCC). The VA Maternity Care Coordinator Telephone Care Program (MCC-TCP) was created to support MCCs and includes, among other things, outlines to guide up to eight calls with Veterans and scripts for training MCCs. Topics covered during these calls include VA maternity care benefits, chronic health problems, substance use cessation, and depression and suicide screening. In addition to developing MCC-TCP, study investigators evaluated the program and assessed its feasibility, as well as facilitators and barriers to its implementation in 11 VA facilities. In its third year of implementation, 957 pregnant Veterans participated in MCC-TCP.
FINDINGS:
- The VA Maternity Care Coordinator Telephone Care Program was successfully implemented and was perceived by the maternity care coordinators (n=12) as valuable in meeting the care coordination needs of pregnant Veterans.
- MCC-TCP implementation barriers included limited information and communication technology tools to support the program – and lack of coordinator time for delivering telephone care.
- Consistent with prior research, pregnant women Veterans using VA maternity care had a high need for care coordination services due to their substantial burden of physical and mental health problems: 41% had pre-pregnancy chronic physical problem(s); 34% had mental health problem(s), particularly depression (28%) and PTSD/anxiety (21%); and 18% actively or recently smoked.
IMPLICATIONS:
- Given the substantial and growing maternity care coordination needs among pregnant Veterans, especially those with chronic medical and mental illness, further investments in programs such as the Maternity Care Coordinator Telephone Care Program should be prioritized.
- When implementing care coordination programs, it is essential that organizational leaders prioritize giving care coordinators training and time necessary to meet Veterans' needs. Further, VA needs to invest resources to develop, deploy, evaluate, and sustain supporting information technology tools.
LIMITATIONS:
- Findings may underestimate comorbidities and obstetric complications as investigators relied on patient report and used free text rather than coded electronic medical record data.
- This study did not assess the impact of MCCs hired exclusively for this role versus the use of existing providers who took on core functions of maternity care coordination.
AUTHOR/FUNDING INFORMATION:
This work was funded by VA's Office of Rural Health and Office of Women's Health Services in Patient Care Services. Dr. Katon was supported by an HSR&D Career Development Award, and Dr. Yano was supported by an HSR&D Senior Research Career Scientist Award. Drs. Cordasco, Katzburg, Chrystal, and Yano (Director) are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy. Dr. Katon is part of HSR&D's Center of Innovation and Value-Driven Care.
Cordasco K, Katzburg J, Katon J, Zephyrin L, Chrystal J, and Yano E. Care Coordination for Pregnant Veterans: VA’s Maternity Care Coordinator Telephone Care Program. Translational Behavioral Medicine. June 2018;8(3):419-428.
