{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T20:05:28Z","timestamp":1784145928877,"version":"3.55.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","funder":[{"name":"VA Advanced Fellowship in Health Systems Research"},{"name":"Office of Academic Affiliations, U.S. Department of Veterans Affairs and Office of Academic Affiliations and Office of Research and Development"},{"name":"HSR Service, Department of Veterans Affairs"},{"name":"Durham Center of Innovation to Accelerate Discovery and Practice Transformation","award":["CIN 13-410"],"award-info":[{"award-number":["CIN 13-410"]}]},{"name":"Durham VA Health Care System"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Women Veterans (WVs) with rheumatoid arthritis (RA) experience increased risks during pregnancy and often require coordinated, multi-disciplinary care across Veterans Affairs (VA) and community health systems. Although the VA provides maternity care coordinators (MCCs), little is known about how WVs with RA and their providers perceive pregnancy-related care and communication within and outside the VA. This study identified barriers and facilitators to coordinated pregnancy and postpartum care for WVs with RA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted semi-structured virtual interviews with WVs with RA (n\u2009=\u20099) and VA health care providers involved in reproductive and rheumatologic care, including rheumatologists (n\u2009=\u20095), primary care provider (PCPs) (n\u2009=\u20094), and MCCs (n\u2009=\u20094). Interview guides were informed by the Cumulative Complexity Model and Chronic Care Model. Using Hamilton\u2019s rapid qualitative analysis approach, we summarized transcripts into a structured matrix, compared themes across participant groups, and generated system-level insights regarding reproductive care coordination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Veterans reported limited awareness of RA-specific pregnancy and postpartum resources. They relied on OB\/GYNs, rheumatologists, MCCs, and online communities for disease-specific guidance, particularly regarding medication safety and symptom management. Although OB\/GYN and PCP care were generally perceived as supportive, rheumatology engagement during pregnancy varied widely because of lack of communication pathways, unclear provider roles, and variable provider comfort with pregnancy care. Veterans frequently served as intermediaries between their VA and non-VA providers. Providers across roles reported minimal formal training in reproductive rheumatology and limited access to reproductive rheumatology expertise within the VA. Rheumatologists and PCPs depended heavily on MCCs and community obstetric teams for pregnancy-related decision-making. MCCs described structured trimester-based workflows and emphasized their role in referral management and care navigation but noted challenges including delays in community subspecialty access and lack of resources tailored to chronic conditions like RA. Across participants, limited direct communication between VA and community obstetric teams was a key barrier to care coordination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pregnant WVs with RA experience fragmented care across systems despite strong MCC support. Opportunities exist to improve outcomes through disease-specific educational resources, enhanced provider training in reproductive rheumatology, and standardized workflows that facilitate early and ongoing communication between VA subspecialists and community obstetric teams. These findings may also inform care models for other chronic conditions requiring multidisciplinary pregnancy management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag319","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T19:41:23Z","timestamp":1784144483000},"source":"Crossref","is-referenced-by-count":0,"title":["Experiences of Pregnancy Care Coordination in the VA Health Care System Among Women Veterans With Rheumatoid Arthritis: A Qualitative Exploration of Barriers and Facilitators"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2890-4445","authenticated-orcid":false,"given":"Catherine A","family":"Sims","sequence":"first","affiliation":[{"name":"VA Durham Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"Duke University , Durham, NC 27710,","place":["United 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27710,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Howard","sequence":"additional","affiliation":[{"name":"VA Durham Healthcare System , Durham, NC 27705,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahima","family":"Cintron","sequence":"additional","affiliation":[{"name":"VA Durham Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"Duke University , Durham, NC 27710,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankoor","family":"Shah","sequence":"additional","affiliation":[{"name":"VA Durham Healthcare System , Durham, NC 27705,","place":["United States"]},{"name":"Duke University , Durham, NC 27710,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M","family":"Goldstein","sequence":"additional","affiliation":[{"name":"VA Durham Healthcare System , Durham, NC 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