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

 描述(由申请人提供)： 背景：我是西雅图HSR&D以退伍军人为中心和价值驱动的护理创新中心的研究健康科学专家，也是退伍军人事务部妇女健康办公室(WHS)的高级流行病学顾问。我的研究和业务项目包括：建立退伍军人保健数据库，以收集由退伍军人管理局支付分娩费用的退伍军人的数据；撰写和传播退伍军人生殖健康状况第一份报告的结果；撰写和编辑退伍军人妇科能力报告；使用不同的退伍军人和非退伍军人数据集分析和发布有关退伍军人生殖健康的结果。我的工作解决了与退伍军人事务部产妇护理相关的现有知识的严重空白，包括产前、分娩和产后护理。我正在寻求通过CDA-2进行更多的培训，以加强我在1)使用定性方法，2)开发卫生服务研究调查，以及3)设计、测试和实施卫生保健干预措施方面的卫生服务研究技能，以建立一个独立的VA卫生服务研究员的职业生涯，专注于WVS的VA产妇保健和生殖健康。研究计划的关键要素：在我的指导团队的指导下，我将完成一系列项目，以确定虚拟护理干预措施的发展目标和战略，以改善WVS的产妇保健的可及性、利用率和结果。我将首先对WVS获得退伍军人事务部产妇保健的经验、偏好和挑战进行定性研究。根据这些发现，我将使用VISN 20中的VA护理对怀孕的WVS进行在线调查，以定量确定产妇护理的可获得性、利用率和结果的可修改决定因素。我将把调查数据与妇女全面健康评估工具中的组织数据联系起来，以检查个人和组织对产妇保健的获取、利用和结果的决定因素。接下来，我将完成对部分调查受访者、退伍军人管理局提供者和利益相关者的一系列半结构化后续访谈，以确定可接受的战略，以提供旨在解决访问、利用和 通过调查确定的产妇保健结果。导师：我的培训得到了我的联合小学导师盖尔·雷伯博士和伊丽莎白·亚诺博士的支持。我将从世界卫生组织生殖健康主任劳里·泽菲林博士、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·福特尼博士和查尔斯·梅纳德博士那里获得有关使用退伍军人管理局管理和临床数据的其他指导。职业目标：我的职业目标是成为一名独立的退伍军人健康服务研究员，专注于改善WVS的生殖健康保健。产妇保健是生殖保健和为不断增长的世界卫生组织人口提供全面保健的一个组成部分。WVS，特别是那些使用退伍军人保健的人，是一个高危人群。考虑到对孕产妇和新生儿健康的影响，优化WVS的获取、利用和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。考虑到它的灵活性、匿名的潜力以及能够接触到地理上分散的个人，虚拟护理是 这是一种很有希望的方法，可以改善对怀孕妇女的护理，进而提高她们对VA护理的满意度和参与度。改善WVS的可获得性、利用率和产妇保健结果可能会增加WVS在退伍军人管理局的保留，这是一个日益令人担忧的问题，因为30%的WVS在登记后三年内停止使用VA。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生殖健康。

 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.