Developing and Testing VHA's Maternity Care Coordinator Telephone Care Program

Background: In 2012, VA established that VA healthcare systems (VA-HCS) must have Maternity Care Coordinators (MCCs).  We developed an MCC Telephone Care program.

Methods:  We used Plan-Do-Study-Act cycles.  Year 1: a multi-disciplinary workgroup used professional experiences and a literature survey to identify informational and screening needs of pregnant/post-partum Veterans and then developed call topics with training scripts.  One MCC tested the materials.  Year 2: expanding to four VA-HCSs, we modified materials to account for system-level variations in resources and processes.  Year 3: expanding to 10 VA-HCSs, we assessed program implementation.  We used logs to measure participation, call completion rates and MCC time burden. 

Results:  Seven MCC phone calls contain: an overview of VA maternity/newborn benefits; assessments of health problems; smoking/alcohol cessation counseling; depression and interpersonal violence screening; breastfeeding support; identification of community resources; post-partum contraception counseling; and, post-partum, encouragement to follow-up with obstetric care and VA primary care.  Program materials were adjusted substantially for resources and processes differences across VA-HCSs.  In quarter 1 of fiscal year 2014, of 260 eligible Veterans, 208 (80%) received at least one completed phone call; more than 70% of calls scheduled were successfully completed. MCC time burden was 33 minutes per eligible patient monthly.   

Conclusions:  The VA MCC Telephone Care Program is feasible with good uptake.  In developing programs for implementation across VA, program materials and designs must include flexibility to adjust to differences in VA-HCS resources and processes. Additional work is needed to further assess program implementation and effects on patient satisfaction and outcomes.