Closing the Gap: a Site-Developed Quality Improvement Project to Optimize the Early Care of Pregnant Veterans

Abstract: From FY00 to FY15, the Veterans Health Administration (VHA) saw a 14-fold increase (FY00: 260; FY15: 3756) in deliveries among pregnant veterans. The number of pregnant veterans is expected to rise as more young women enter the military. In the past five years, VA San Diego Healthcare System (VASDHS) provided and coordinated care for about 1500 pregnant veterans. Although they receive their maternity care in the community, pregnant veterans continue to access the VA for their primary and specialty care needs. VA primary care providers (PCPs) are the first point of contact for pregnant veterans and serve a pivotal role in care coordination including referrals within VA and the community. Mental health conditions (depression, anxiety, PTSD) among women veterans often worsen during pregnancy and may require collaboration with mental health specialists for closer monitoring. A detailed maternity care consult placed by a PCP is required for veterans in VASDHS to receive prenatal care in the community. This consult specifically asks about the patient’s medical, obstetric, mental health, social history, and current medications. During the interval between a maternity care consult and the veteran’s first prenatal appointment which is often 4–6 weeks, pregnant veterans may seek advice and medical care from their PCPs. Addressing essential issues early on that impact the health of a pregnancy including medication reconciliation, mental health concerns, substance use, and personal safety is critical to provide optimal care to pregnant veterans. At VASDHS, the authors designed a survey as the first part of a quality improvement project to (1) assess PCPs’ screening and care practices towards pregnant veterans and (2) utilize results to further educate PCPs on their roles in the maternity care referral process and caring for pregnant veterans.