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

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 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.