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2015 HSR&D/QUERI National Conference Abstract

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1078 — Evaluating a VISN-wide Maternity Care Coordination Demonstration Program for Pregnant Veterans

Mattocks KM, VA Central Western Massachusetts Healthcare System; Kuzdeba J, VA Central Western Massachusetts Healthcare System; Kinney R, VA Central Western Massachusetts Healthcare System; Adams K, VA Cenetral Western Massachusetts Healthcare System; Phillips B, VA Central Western Massachusetts Healthcare System; Gerber M, VA Boston;

Objectives:
In 2012, VHA Handbook 1330.03 established procedures for providing and coordinating maternity care for pregnant women Veterans enrolled in VA care. In VISN 1, all maternity care coordination (MCC) at 7 of 8 VISN 1 facilities is provided by a centralized nurse who provides remote care coordination to pregnant Veterans through an Office of Rural Health (ORH) Demonstration Grant. The goal of this evaluation is to examine pregnant Veterans' use and satisfaction with centralized MCC services, which is especially important for pregnant Veterans living in rural areas.

Methods:
After pregnancy identification at their local VA facility in VISN 1, the MCC nurse contacts all pregnant Veterans to offer MCC services. Approximately 6-8 weeks after their deliveries, postpartum Veterans that had received MCC services from the VISN 1 maternity care coordination nurse were contacted by the VISN 1 MCC evaluation team. These postpartum Veterans were invited to participate in a telephone survey to assess their perceptions and experiences with VISN MCC, and to understand how the VISN 1 MCC program could be improved.

Results:
In the first year of the VISN 1 MCC program (March 2014-March 2015), 189 women Veterans from 7 VA facilities received VISN 1 maternity care coordination services, and 57% have completed the post-partum telephone interview. Thirty percent of the pregnant women enrolled in MCC lived in rural areas of VISN 1. Of the women that completed the evaluation, 93% reported high satisfaction with services they received from the VISN 1 MCC nurse. Eighty-one percent of the postpartum Veterans reported that the MCC program was very helpful in understanding their maternity and newborn benefits, while 79% believed the program help them acquire breastfeeding support and supplies. Fifty-eight percent of women credited the MCC program as a way to coordinate care between their VA and non-VA providers. The biggest unmet need identified by postpartum Veterans was further support navigating non-VA care and lack of reimbursement coordination between the VA and their community-based obstetrician.

Implications:
The VISN 1 MCC program evaluation suggests that women Veterans are extremely satisfied with the care coordination provided through the regional MCC program. Further developments in the MCC program should include more specialized assistance with fee basis billing and reimbursement.

Impacts:
Providing highly-coordinated care during pregnancy to women Veterans is crucial if the VA is to continue its mission to provide comprehensive care services to all women Veterans. This MCC program demonstrates that care coordination services can be centralized to one care coordination team responsible for the care of pregnant Veterans across the VISN, and especially to those pregnant Veterans living in rural areas.