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Development and formative evaluation of VHA’s maternity care coordinator telephone care program
Cordasco KM, Katzburg JR, Solloway M, Zephyrin LC, Yano EM. Development and formative evaluation of VHA’s maternity care coordinator telephone care program. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.
In order to ensure every pregnant Veteran using non-VA care receives high-quality and well-coordinated care, each VA healthcare system (HCS) must have a Maternity Care Coordinator (MCC). We developed and formatively evaluated a program that supports MCCs in their telephone care of pregnant Veterans.
We developed the program using Plan-Do-Study-Act cycles. Year 1: a multi-disciplinary workgroup used professional experiences and a literature survey to identify informational and screening needs of pregnant/post-partum Veterans and develop call topics with training scripts. One MCC tested the materials. Year 2: expanding to four VA-HCSs, we modified materials to account for system-level variations in resources and processes. Year 3: expanding to 11 VA-HCSs, we assessed program implementation using logs to measure participation and MCC time burden and a survey of participating MCCs capturing their perceptions.
The developed program consists of seven phone calls containing: an overview of VA maternity/newborn benefits; assessments of health problems; smoking/alcohol cessation counseling; depression and interpersonal violence screening; breastfeeding support; identification of community resources; post-partum contraception counseling; and, post-partum, encouragement to follow-up with obstetric care and VA primary care. We found that materials needed to be adjusted substantially for resources and processes differences across VA-HCSs. In fiscal year 2014, 896 pregnant Veterans received 2748 phone calls. Time logs revealed that, on average, MCCs spent 28 minutes monthly, per Veteran, with 23% of this time spent reviewing charts, 38% making phone calls, 27% documenting calls and activities, and 12% performing other care coordination activities. MCCs serving higher proportions of rural women spent more time per Veteran, compared to those serving more urban women (51 v. 27 minutes, p = 0.09). The 12 surveyed MCCs perceived the program as beneficial and reported Veterans appreciating the calls.
The program is well-received, the time-burden modest, and uptake by pregnant Veterans is good. Rural pregnant Veterans may have more care coordination needs than their urban counterparts.
The MCC Telephone Care Program is a potential model for coordinating VA and non-VA care. It is being disseminated across VA. Further work is needed to assess its implementation, effects, and potential differences in coordination needs between rural and urban Veterans.