Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Jonathan G Shaw; Vilija R Joyce; Susan K Schmitt; Susan M Frayne; Kate A Shaw; Beate Danielsen; Rachel Kimerling; Steven M Asch; Ciaran S Phibbs

doi:10.1111/1475-6773.13041

Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Health Serv Res. 2018 Dec;53 Suppl 3(Suppl Suppl 3):5260-5284. doi: 10.1111/1475-6773.13041. Epub 2018 Sep 10.

Authors

Jonathan G Shaw^{1

2

3}, Vilija R Joyce⁴, Susan K Schmitt^{4

5}, Susan M Frayne^{1

2}, Kate A Shaw³, Beate Danielsen⁶, Rachel Kimerling^{2

7}, Steven M Asch^{1

2}, Ciaran S Phibbs^{2

4

5}

Affiliations

¹ Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
² VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.
³ Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA.
⁴ VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.
⁵ Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
⁶ Health Information Solutions, Rocklin, CA.
⁷ National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.

Abstract

Objective: To describe variation in payer and outcomes in Veterans' births.

Data/setting: Secondary data analyses of deliveries in California, 2000-2012.

Study design: We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using VA coverage and (2) Veteran vs. all other births. We calculated odds ratios (aOR) adjusted for age, race, ethnicity, education, and obstetric demographics.

Methods: We anonymously linked VA administrative data for all female VA enrollees with California birth records.

Principal findings: From 2000 to 2012, we identified 17,495 births to Veterans. VA covered 8.6 percent (1,508), Medicaid 17.3 percent, and Private insurance 47.6 percent. Veterans who relied on VA health coverage had more preeclampsia (aOR 1.4, CI 1.0-1.8) and more cesarean births (aOR 1.2, CI 1.0-1.3), and, despite similar prematurity, trended toward more neonatal intensive care (NICU) admissions (aOR 1.2, CI 1.0-1.4) compared to Veterans using other (non-Medicaid) coverage. Overall, Veterans' birth outcomes (all-payer) mirrored California's birth outcomes, with the exception of excess NICU care (aOR 1.15, CI 1.1-1.2).

Conclusions: VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities.

Keywords: California; Maternal care; Veterans; health services; pregnancy.

Publication types

Observational Study
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
California
Cesarean Section / statistics & numerical data
Delivery, Obstetric / statistics & numerical data*
Female
Gestational Age
Humans
Insurance Coverage / statistics & numerical data*
Insurance, Health / statistics & numerical data*
Intensive Care Units, Neonatal / statistics & numerical data
Maternal Health Services / statistics & numerical data*
Medicaid / statistics & numerical data*
Middle Aged
Pregnancy
Pregnancy Complications / epidemiology
Pregnancy Outcome / epidemiology
Retrospective Studies
Risk Assessment
Socioeconomic Factors
United States
United States Department of Veterans Affairs / statistics & numerical data*
Young Adult