Perceived importance of obstetric quality measures to Veterans receiving community-based obstetric care

Abstract:Background: Racial and ethnic disparities in obstetric care persist in the United States. Veterans enrolled in Department of Veterans Affairs (VA) care receive obstetric care from community providers enrolled in the VA Community Care Network (CCN), yet little is known about Veterans’ prenatal care decision-making. This study described how Black, Indigenous, and People of Color (BIPOC) Veterans select prenatal care providers and perceive hospital-level obstetric quality measures. Methods: Pregnant BIPOC Veterans (n = 27) were identified from a community-based doula pilot (N=29) at two VA medical centers. During semi-structured telephone surveys conducted around 20 weeks gestation, Veterans described factors influencing provider selection and rated the importance of three Joint Commission obstetric quality measures—cesarean birth, unexpected complications in term newborns, and exclusive breast milk feeding—on a 3-point scale (“not,” “somewhat,” or “very” important). Open-ended responses contextualized these ratings, and participants were asked if they knew how to access hospital-level quality data. Results: Participants (mean age=33 years) were predominantly Black (85.2%) and multiparous (70.4%). Provider selection was most influenced by geographic proximity (48.2%) and VA insurance coverage (44.4%). Hospital-level unexpected complications in term newborns was rated “very important” by 66.7%, followed by cesarean birth (48.1%) and exclusive breast milk feeding (40.7%). Most Veterans valued measures perceived as related to infant well-being. However, 74.1% did not know how to access quality data. Conclusions for Practice: BIPOC Veterans valued hospital-level obstetric quality measures related to infant outcomes and prioritized geographic accessibility and insurance coverage when selecting providers. Relevant, accessible quality information may allow Veterans to make better informed prenatal care decisions.