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2015 HSR&D/QUERI National Conference Abstract

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1155 — Development and Formative Evaluation of VHA's Maternity Care Coordinator Telephone Care Program

Cordasco KM, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; Katzburg JR, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; Solloway M, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; Zephyrin LC, VHA Women's Health Services; Yano EM, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy;

Objectives:
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.

Methods:
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.

Results:
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.

Implications:
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.

Impacts:
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.