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Timeliness and Adequacy of Prenatal Care Among Department of Veterans Affairs–Enrolled Veterans: The First Step May Be the Biggest Hurdle

  • Jodie G. Katon
    Correspondence
    Correspondence to: Jodie G. Katon, PhD, MS, VA Puget Sound Healthcare System, 1660 S Columbian Way, S-152, Seattle, WA 98108. Phone: (206) 277-1843.
    Affiliations
    Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington

    Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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  • Jonathan G. Shaw
    Affiliations
    Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California

    VA HSR&D Center for Innovation to Implementation, U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California

    Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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  • Vilija R. Joyce
    Affiliations
    VA HSR&D Health Economics Resource Center, U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California
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  • Susan K. Schmitt
    Affiliations
    VA HSR&D Health Economics Resource Center, U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California

    Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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  • Ciaran S. Phibbs
    Affiliations
    VA HSR&D Center for Innovation to Implementation, U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California

    VA HSR&D Health Economics Resource Center, U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, California

    Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Published:January 21, 2022DOI:https://doi.org/10.1016/j.whi.2021.12.008

      Abstract

      Introduction

      Little is known about access to and use of prenatal care by veterans using U.S. Department of Veterans Affairs (VA) maternity benefits. We compared the timeliness and adequacy of prenatal care by veteran status and payor.

      Study Design

      We used VA clinical and admistrative data linked with California vital statistics patient discharge data to identify all births to VA-enrolled veterans and non-veterans between 2000 and 2012. Births were categorized based on veteran status and payor (non-veterans with Medicaid, non-veterans with private insurance, VA-enrolled veterans using VA maternity care benefits, and VA-enrolled veterans with other payor). Outcomes were timeliness of prenatal care (initiation before the end of the first trimester) and adequacy of prenatal care as measured by the Kotelchuck Index (inadequate, intermediate, adequate). Covariates included demographic, health, and pregnancy characteristics. We used generalized linear models and multinomial logistic regression to analyze the association of veteran status and payor with timeliness of prenatal care and adequacy of prenatal care, respectively.

      Results

      We identified 6,196,432 births among VA-enrolled veterans (n = 17,495) and non-veterans (n = 6,178,937). Non-veterans using Medicaid had the lowest percentage of timely prenatal care (78.1%; n = 2,240,326), followed by VA-enrolled veterans using VA maternity care benefits (82.8%; n = 1,248). VA-enrolled veterans using VA maternity care benefits were the most likely to receive adequate prenatal care (92.0%; n = 1,365). Results remained consistent after adjustment.

      Conclusions

      This study provides key baseline data regarding access to and use of prenatal care by veterans using VA maternity benefits. Longitudinal studies including more recent data are needed to understand the impact of changing VA policy.
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      Biography

      Jodie G. Katon, PhD, MS, is a Core Investigator, VA Puget Sound Health Services Research and Development Center of Innovation, and Assistant Research Professor, University of Washington, Department of Health Services. Her research focuses on women veterans' reproductive health and health disparities.

      Biography

      Jonathan G. Shaw, MD, MS, is a practicing family physician, Ravenswood Family Health Center, East Palo Alto, and a health services researcher at Stanford and the VA Palo Alto. His research focuses on psychosocial influences on health and health care across the lifespan.

      Biography

      Vilija R. Joyce, MS, is Associate Director/Research Associate, VA Health Economics Resource Center. Vilija's work has focused on assessing health-related quality of life as well as the costs of care for veterans living with HIV, hepatitis C, and opioid use disorder.

      Biography

      Susan K. Schmitt, PhD, a statistical programmer at the Health Economics Resource Center and the Center for Health Care Evaluation, VA Palo Alto HCS, works on a variety of research projects to improve the quality of health care for veterans.

      Biography

      Ciaran S. Phibbs, PhD, is a Health Economist, Health Economics Resource Center/the Center for Health Care Evaluation, VA Palo Alto HCS; Health Research and Policy Department, and Pediatrics Department, Stanford University. His research includes perinatal care, nurse staffing, and hospital markets.