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CDA 13-266 – HSR&D Study

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CDA 13-266
Women Veterans' VA Maternity Care Utilization, Satisfaction, and Health Outcomes
Jodie G. Katon PhD MS
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: July 2016 - June 2021

BACKGROUND/RATIONALE:
Maternity care is a key component of comprehensive care for women Veterans, for which there is growing demand. Due to the high prevalence of pre-existing medical and mental health conditions, women Veterans using VA maternity care are a high-risk population. Importantly, access to maternity care (including digital access) is necessary but not sufficient for improving maternal and newborn outcomes. Increasing emphasis is being placed on the coordination and content of maternity care. Understanding women Veterans' maternity care experiences, including utilization of virtual care technology, and identifying modifiable risk factors for receiving poor quality care is essential for developing meaningful, effective intervention strategies for improving women Veterans' maternity care access, utilization, and outcomes.

OBJECTIVE(S):
Aim 1. To understand women Veterans' experiences, preferences, and challenges accessing and utilizing VA maternity care.
Aim 2. To field a survey of pregnant women Veterans in VISN 20 to identify determinants of access, utilization, and outcomes of care to inform development of a virtual care intervention.
Aim 3. To determine acceptable strategies for delivering a virtual care intervention, by identifying preferences and challenges of pregnant women Veterans, and their VA providers regarding digital technology.

METHODS:
The proposed study uses a multi-component mixed-methods approach. Aim 1 will be a qualitative study with semi-structured interviews of women Veterans who recently used VA maternity care. Questions will focus on experiences with VA maternity care, alternate models of maternity care and virtual care, non-VA maternity care providers, preferences regarding maternity care, and the transitions between VA and non-VA care. Aim 2 will collect quantitative data on access, utilization, and outcomes of care through a web-based survey of women Veterans in VISN 20 with a recent live birth. Aim 3 will be a qualitative study with semi-structured interviews of women Veterans participating in Aim 2 as well as interviews with other VISN 20 stakeholders (e.g. Women Veterans' Program Managers, maternity care coordinators).

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Women Veterans of childbearing age remain the fastest growing group of new VA users, and improving care and services for this group remains a national priority. This study will provide essential information needed to develop Veteran-centric enhancements to VA maternity care.

PUBLICATIONS:

Journal Articles

  1. McCabe JE, Katon JG, Ma E, Fortney JC, Grote NK, Zephyrin LC, Callegari LS. Preconception Health Risk Factors in Women with and without a History of Military Service. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2018 Nov 1; 28(6):539-545.
  2. Callegari LS, Katon JG, Gray KE, Doll K, Pauk S, Lynch KE, Uchendu US, Zephyrin L, Gardella C. Associations between Race/Ethnicity, Uterine Fibroids, and Minimally Invasive Hysterectomy in the VA Healthcare System. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jan 1; 29(1):48-55.
  3. Katon JG, Ma EW, Sayre G, Zephyrin LC, Cordasco KM, Yano EM, Fortney JC. Women Veterans' Experiences with Department of Veterans Affairs Maternity Care: Current Successes and Targets for Improvement. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2018 Nov 1; 28(6):546-552.
  4. Lehavot K, Goldberg SB, Chen JA, Katon JG, Glass JE, Fortney JC, Simpson TL, Schnurr PP. Do trauma type, stressful life events, and social support explain women veterans' high prevalence of PTSD?. Social psychiatry and psychiatric epidemiology. 2018 Sep 1; 53(9):943-953.
  5. Cordasco KM, Katzburg JR, Katon JG, Zephyrin LC, Chrystal JG, Yano EM. Care coordination for pregnant veterans: VA's Maternity Care Coordinator Telephone Care Program. Translational behavioral medicine. 2018 May 23; 8(3):419-428.
  6. Gray KE, Katon JG, LeBlanc ES, Woods NF, Bastian LA, Reiber GE, Weitlauf JC, Nelson KM, LaCroix AZ. Vasomotor symptom characteristics: are they risk factors for incident diabetes?. Menopause (New York, N.Y.). 2018 May 1; 25(5):520-530.
  7. Lehavot K, Katon JG, Chen JA, Fortney JC, Simpson TL. Post-traumatic Stress Disorder by Gender and Veteran Status. American journal of preventive medicine. 2018 Jan 1; 54(1):e1-e9.
  8. Lehavot K, Katon JG, Simpson TL, Shipherd JC. Transgender Veterans' Satisfaction With Care and Unmet Health Needs. Medical care. 2017 Sep 1; 55 Suppl 9 Suppl 2:S90-S96.
  9. Katon JG, Lewis L, Hercinovic S, McNab A, Fortney J, Rose SM. Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program. Maternal and child health journal. 2017 Aug 1; 21(8):1598-1605.
  10. Shepherd-Banigan M, Kelley ML, Katon JG, Curry JF, Goldstein KM, Brancu M, Wagner HR, Fecteau TE, VA Mid-Atlantic MIRECC Women Veterans Workgroup, VA Mid-Atlantic MIRECC Workgroup, Van Houtven CH. Paternal history of mental illness associated with posttraumatic stress disorder among veterans. Psychiatry Research. 2017 Oct 1; 256:461-468.
  11. Katon JG, Gray K, Callegari L, Gardella C, Gibson C, Ma E, Lynch KE, Zephyrin L. Trends in hysterectomy rates among women veterans in the US Department of Veterans Affairs. American journal of obstetrics and gynecology. 2017 Oct 1; 217(4):428.e1-428.e11.
  12. Shaw JG, Asch SM, Katon JG, Shaw KA, Kimerling R, Frayne SM, Phibbs CS. Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia. Paediatric and perinatal epidemiology. 2017 May 1; 31(3):185-194.
  13. Souter V, Kauffman E, Marshall AJ, Katon JG. Assessing the potential impact of extending antenatal steroids to the late preterm period. American journal of obstetrics and gynecology. 2017 Oct 1; 217(4):461.e1-461.e7.
  14. Katon J, Cypel Y, Raza M, Zephyrin L, Reiber G, Yano EM, Barth S, Schneiderman A. Deployment and Adverse Pregnancy Outcomes: Primary Findings and Methodological Considerations. Maternal and child health journal. 2017 Feb 1; 21(2):376-386.
  15. Gibson CJ, Gray KE, Katon JG, Simpson TL, Lehavot K. Sexual Assault, Sexual Harassment, and Physical Victimization during Military Service across Age Cohorts of Women Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Mar 1; 26(2):225-31.
  16. Kauffman E, Souter VL, Katon JG, Sitcov K. Cervical Dilation on Admission in Term Spontaneous Labor and Maternal and Newborn Outcomes. Obstetrics and gynecology. 2016 Mar 1; 127(3):481-8.
  17. Callegari LS, Gray KE, Zephyrin LC, Harrington LB, Gerber MR, Cochrane BB, Weitlauf JC, Bean-Mayberry B, Bastian LA, Mattocks KM, Haskell SG, Katon JG. Hysterectomy and Bilateral Salpingo-Oophorectomy: Variations by History of Military Service and Birth Cohort. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S67-77.
  18. Gray KE, Katon JG, Rillamas-Sun E, Bastian LA, Nelson KM, LaCroix AZ, Reiber GE. Association Between Chronic Conditions and Physical Function Among Veteran and Non-Veteran Women With Diabetes. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S112-25.
  19. Katon JG, Gray KE, Gerber MR, Harrington LB, Woods NF, Weitlauf JC, Bean-Mayberry B, Goldstein KM, Hunt JR, Katon WJ, Haskell SG, McCutcheon SJ, Gass ML, Gibson CJ, Zephyrin LC. Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S40-53.
  20. Washington DL, Gray K, Hoerster KD, Katon JG, Cochrane BB, LaMonte MJ, Weitlauf JC, Groessl E, Bastian L, Vitolins MZ, Tinker L. Trajectories in Physical Activity and Sedentary Time Among Women Veterans in the Women's Health Initiative. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S27-39.
  21. Weitlauf JC, LaCroix AZ, Bird CE, Woods NF, Washington DL, Katon JG, LaMonte MJ, Goldstein MK, Bassuk SS, Sarto GE, Stefanick ML. Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Nov 1; 25(6):649-57.
  22. Katon JG, Lehavot K, Simpson TL, Williams EC, Barnett SB, Grossbard JR, Schure MB, Gray KE, Reiber GE. Adverse Childhood Experiences, Military Service, and Adult Health. American journal of preventive medicine. 2015 Oct 1; 49(4):573-82.
  23. Davydow DS, Katon JG, Rollman BL, Unützer J. Improving mental and physical health outcomes in general healthcare settings: a Gedenkschrift in honor of Wayne Katon, MD (1950-2015). General hospital psychiatry. 2015 Sep 1; 37(5):375-86.
  24. Katon JG, Washington DL, Cordasco KM, Reiber GE, Yano EM, Zephyrin LC. Prenatal Care for Women Veterans Who Use Department of Veterans Affairs Health Care. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Jul 1; 25(4):377-81.
  25. Katon JG, Hoggatt KJ, Balasubramanian V, Saechao FS, Frayne SM, Mattocks KM, Feibus KB, Galvan IV, Hickman R, Hayes PM, Haskell SG, Yano EM, Phibbs CS, Zephyrin LC. Reproductive health diagnoses of women veterans using department of Veterans Affairs health care. Medical care. 2015 Apr 1; 53(4 Suppl 1):S63-7.
  26. Katon J, Mattocks K, Zephyrin L, Reiber G, Yano EM, Callegari L, Schwarz EB, Goulet J, Shaw J, Brandt C, Haskell S. Gestational diabetes and hypertensive disorders of pregnancy among women veterans deployed in service of operations in Afghanistan and Iraq. Journal of women's health (2002). 2014 Oct 1; 23(10):792-800.
VA Cyberseminars

  1. Katon JG. Women Veterans' Reproductive Health Research across the Life Cycle: from Pregnancy to Menopause. Health Services Research & Development Cyber Seminars [Cyberseminar]. VA Health Services Research & Development Career Development Award. VA Women's Health Research Network. 2017 Sep 13.
  2. Callegari L, Katon JG, Weitlauf JC. Women Veterans in the Women's Health Initiative: Reproductive Health and Menopause. Spotlight on Women's Health [Cyberseminar]. VA HSR&D. 2016 Mar 2.
Conference Presentations

  1. Cordasco KM, Katon JG, Katzburgh JR, Zephyrin L, Yano EM. Physical, mental and obstetric needs of rural and urban pregnant Veterans. Poster session presented at: VA Rural Health State of the Science Conference; 2016 Sep 12; Washington, DC.
  2. Katon JG. Vasomotor symptoms, depression, obesity and health related quality of life among Veteran and non-Veteran postmenopausal women. Paper presented at: Academy of Psychosomatic Medicine Annual Meeting; 2015 Nov 13; New Orleans, LA.


DRA: Health Systems, Other Conditions
DRE: Technology Development and Assessment
Keywords: Outcomes - Patient
MeSH Terms: none