{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T13:13:40Z","timestamp":1773839620333,"version":"3.50.1"},"reference-count":67,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2018,9,10]],"date-time":"2018-09-10T00:00:00Z","timestamp":1536537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IIR 14\u2010099"],"award-info":[{"award-number":["IIR 14\u2010099"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe variation in payer and outcomes in Veterans\u2019 births.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data\/Setting<\/jats:title><jats:p>Secondary data analyses of deliveries in California, 2000\u20132012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We performed a retrospective, population\u2010based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (<jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> coverage and (2) Veteran vs. all other births. We calculated odds ratios (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>) adjusted for age, race, ethnicity, education, and obstetric demographics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We anonymously linked <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> administrative data for all female <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> enrollees with California birth records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>From 2000 to 2012, we identified 17,495 births to Veterans. <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> covered 8.6 percent (1,508), Medicaid 17.3 percent, and Private insurance 47.6 percent. Veterans who relied on <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> health coverage had more preeclampsia (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.4, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.0\u20131.8) and more cesarean births (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.2, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.0\u20131.3), and, despite similar prematurity, trended toward more neonatal intensive care (<jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content>) admissions (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.2, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.0\u20131.4) compared to Veterans using other (non\u2010Medicaid) coverage. Overall, Veterans\u2019 birth outcomes (all\u2010payer) mirrored California's birth outcomes, with the exception of excess <jats:styled-content style=\"fixed-case\">NICU<\/jats:styled-content> care (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.15, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.1\u20131.2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> covers a higher risk fraction of Veterans\u2019 births, justifying maternal care coordination and attention to the maternal\u2013fetal impacts of Veterans\u2019 comorbidities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13041","type":"journal-article","created":{"date-parts":[[2018,9,10]],"date-time":"2018-09-10T07:21:09Z","timestamp":1536564069000},"page":"5260-5284","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7884-3604","authenticated-orcid":false,"given":"Jonathan G.","family":"Shaw","sequence":"first","affiliation":[{"name":"Division of Primary Care and Population Health Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"VA HSR&amp;D Center for Innovation to Implementation (Ci2i) US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"Department of Obstetrics &amp; 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