Women Veterans' VA Maternity Care Utilization, Satisfaction, and Health Outcomes

女退伍军人的退伍军人管理局产妇护理利用、满意度和健康结果

• 批准号: 9080879
• 负责人: Jodie Katon
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9080879
• 关键词: Address; Address; Age; Age; Assessment tool; Assessment tool; Caring; Caring; Chronic; Chronic; Clinical Data; Clinical Data; Communities; Communities; Complex; Complex; Comprehensive Health Care; Comprehensive Health Care; Continuity of Patient Care; Continuity of Patient Care; Critical Care; Critical Care; Data; Data; Data Set; Data Set; Databases; Databases; Developed Countries; Developed Countries; Developing Countries; Development; Development; Diabetes Mellitus; Diabetes Mellitus; Effectiveness; Effectiveness; Elements; Enrollment; Enrollment; Ensure; Ensure; Epidemiology; Epidemiology; Face; Face; Fees; Fees; Frequencies; Frequencies; Future; Future; Geography; Goals; Goals; Gynecology; Gynecology; Health; Health; Health Services; Health Services; Health Services Accessibility; Health Services Accessibility; Health Services Research; Health Services Research; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Home environment; Home visitation; Improve Access; Improve Access; Individual; Individual; Infant; Infant; Infant Care; Internet; Internet; Intervention; Intervention; Interview; Interview; Knowledge; Knowledge; Link; Link; Low Birth Weight Infant; Low Birth Weight Infant; Measures; Measures; Medical; Medical; Mental Depression; Mental Depression; Mental Health; Mental Health; Mentors; Mentors; Mentorship; Mentorship; Methods; Methods; Monitor; Monitor; Mothers; Mothers; Newborn Infant; Newborn Infant; Online Systems; Online Systems; Outcome; Outcome; Patients; Patients; Population; Population; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Complications; Pregnancy Outcome; Pregnancy Outcome; Pregnant Women; Pregnant Women; Premature Birth; Premature Birth; Program Development; Program Development; Provider; Provider; Publishing; Publishing; Qualitative Methods; Qualitative Methods; Qualitative Research; Qualitative Research; Quality of Care; Quality of Care; Reporting; Reporting; Reproductive Health; Reproductive Health; Research; Research; Research Personnel; Research Personnel; Research Training; Research Training; Respondent; Respondent; Risk; Risk; Risk Factors; Risk Factors; Series; Series; Site; Site; Social support; Social support; Specialist; Specialist; Structure; Structure; Subgroup; Subgroup; Surveys; Surveys; System; System; Technology; Technology; Telephone; Telephone; Testing; Testing; Training; Training; Veterans; Veterans; Washington; Washington; Woman; Woman; Women' s Health; Women' s Health; Work; Work; base; base; care outcomes; career; career; child bearing; child bearing; design; design; digital; digital; effective intervention; effective intervention; experience; experience; follow-up; follow-up; handheld mobile device; handheld mobile device; health science research; health science research; high risk; high risk population; improved; improved; improved outcome; improved outcome; innovation; innovation; interest; interest; male; male; meetings; meetings; method development; modifiable risk; modifiable risk; novel strategies; novel strategies; peer; peer; postpartum care; preference; preference; prenatal; prenatal; prepregnancy; programs; programs; satisfaction; satisfaction; skills; skills; therapy design; therapy design; therapy development; therapy development; virtual; virtual

 DESCRIPTION (provided by applicant): BACKGROUND: I am a Research Health Science Specialist at the Seattle HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care and a Senior Epidemiologic Consultant for the VA Office of Women's Health (WHS). My research and operational projects include: establishing the VA Maternity Care Database to collect data on women Veterans (WVs) whose delivery is paid for by VA, contributing to and disseminating findings from the first VA report on the State of Reproductive Health in Women Veterans, contributing to and editing the VA Gynecology Capacity Report, and analyzing and publishing findings regarding WVs reproductive health using diverse VA and non-VA datasets. My work addresses critical gaps in current knowledge related to VA maternity care, which includes prenatal, labor and delivery, and postpartum care. I am seeking additional training through this CDA-2 to strengthen my health services research skills in 1) use of qualitative methods, 2) developing health services research surveys, and 3) designing, testing and implementing health care interventions, to build a career as an independent VA health services researcher focused on VA maternity care and reproductive health of WVs. KEY ELEMENTS OF THE RESEARCH PLAN: Under the guidance of my mentorship team I will complete a series of projects to identify objectives and strategies for development of a virtual care intervention to improve access, utilization, and outcomes of maternity care for WVs. I will first conduct a qualitative study of WVs' experiences, preferences, and challenges accessing VA maternity care. Informed by these findings, I will then conduct an on-line survey of pregnant WVs using VA care in VISN 20 to quantitatively identify modifiable determinants of access, utilization, and outcomes of maternity care. I will link survey data with organizational data from the Women's Assessment Tool for Comprehensive Health to examine individual and organizational determinants of access, utilization, and outcomes of maternity care. Next I will complete a series of semi- structured follow-up interviews with a subset of survey respondents, VA providers, and stakeholders to identify acceptable strategies for delivering a virtual care intervention designed to address determinants of access, utilization, and outcomes of maternity care identified through the survey. MENTORS: I am supported in my training by my co-primary mentors, Drs. Gayle Reiber and Elizabeth Yano. I will obtain additional guidance from Dr. Laurie Zephyrin, the WHS Director of Reproductive Health; Dr. Kristin Mattocks, an expert in reproductive health and qualitative research; Dr. Donna Washington, an expert in patient surveys; Dr. John Fortney an expert in virtual care interventions; and Dr. Charles Maynard on use of VA administrative and clinical data. CAREER GOAL: My career goal is to become an independent VA health services researcher focusing on improving reproductive health care for WVs. Maternity care is an integral component of reproductive health care and comprehensive health care for the growing population of WVs. WVs, particularly those who use VA maternity care, are a high-risk population. Given the implications for maternal and newborn health, optimizing WVs' access, utilization, and outcomes of maternity care is critical for providing high quality Veteran-Centered care. Given its flexibiliy, potential for anonymity, and ability to reach geographically dispersed individuals, virtual care is a promising means for improving care for pregnant WVs, and in turn increasing their satisfaction and engagement with VA care. Improving WVs' access, utilization, and outcomes of maternity care may increase retention of WVs in VA, an issue of growing concern given that 30% of WVs discontinue VA use within three years of enrolling. The proposed research and training will provide the necessary experience and knowledge to develop an independent program of health services research focused on VA maternity care and reproductive health of WVs.

 描述（由申请人提供）： 背景技术背景：我是西雅图HSR&D退伍军人中心和价值驱动护理创新中心的研究健康科学专家，也是VA妇女健康办公室（WHS）的高级流行病学顾问。我的研究和业务项目包括：建立退伍军人管理局产妇护理数据库，收集退伍军人管理局支付分娩费用的退伍军人数据，为退伍军人管理局关于退伍军人生殖健康状况的第一份报告提供资料并传播其中的调查结果，为退伍军人管理局妇科能力报告提供资料并进行编辑，使用不同的VA和非VA数据集分析和发布关于WVs生殖健康的调查结果。我的工作解决了与VA孕产妇护理相关的当前知识的关键差距，其中包括产前，分娩和产后护理。我正在通过这个CDA-2寻求额外的培训，以加强我的卫生服务研究技能1）使用定性方法，2）开发卫生服务研究调查，3）设计，测试和实施卫生保健干预措施，以建立一个职业生涯作为一个独立的VA卫生服务研究员专注于VA产妇保健和WVs的生殖健康。研究的关键要素：在我的导师团队的指导下，我将完成一系列项目，以确定虚拟护理干预的发展目标和战略，以改善妇女的孕产妇护理的可及性、利用率和结果。我将首先进行WVs的经验，偏好和挑战访问VA产妇护理的定性研究。根据这些发现，我将在VISN 20中使用VA护理对怀孕的WVs进行在线调查，以定量确定孕产妇护理的访问，利用和结果的可修改决定因素。我将把调查数据与妇女综合健康评估工具的组织数据联系起来，以研究孕产妇保健的获得、利用和结果的个人和组织决定因素。接下来，我将完成一系列半结构化的后续采访，采访一部分调查受访者、VA提供者和利益相关者，以确定提供虚拟护理干预的可接受策略，这些干预旨在解决访问、利用和 通过调查确定的产妇护理成果。导师：我在我的培训支持我的共同小学导师，博士盖勒雷伯和伊丽莎白矢野。我将从WHS生殖健康主任劳里泽弗林博士、生殖健康和定性研究专家克里斯汀·马托克斯博士、患者调查专家唐娜·华盛顿博士、虚拟护理干预专家约翰·福特尼博士和使用VA管理和临床数据的查尔斯·梅纳德博士那里获得额外的指导。职业目标：我的职业目标是成为一名独立的VA健康服务研究员，专注于改善WVs的生殖健康护理。产妇保健是日益增多的寡妇自愿者人口的生殖保健和全面保健的一个组成部分。妇女志愿者，特别是那些使用退伍军人事务部产妇护理的妇女，是高风险人群。考虑到对孕产妇和新生儿健康的影响，优化WVs获得、利用和孕产妇护理的结果对于提供高质量的以退伍军人为中心的护理至关重要。鉴于其灵活性，匿名性的潜力，并能够达到地理上分散的个人，虚拟护理是 这是一种很有前途的方法，可以改善对怀孕妇女的护理，从而提高她们对退伍军人事务部护理的满意度和参与度。改善妇女志愿者获得、利用和产妇护理的结果可能会增加妇女志愿者在退伍军人事务部的保留，鉴于30%的妇女志愿者在入学后三年内停止使用退伍军人事务部，这一问题日益受到关注。拟议的研究和培训将提供必要的经验和知识，以制定一个独立的保健服务研究方案，重点是退伍军人事务部的产妇保健和退伍军人的生殖健康。