Veteran-Reported Receipt of Prepregnancy Care: Data from the Examining Contraceptive Use and Unmet Need (ECUUN) Study

Drs. Lisa Callegari and Ginny Ryan recently authored an article entitled "Veteran-Reported Receipt of Prepregnancy Care: Data from the Examining Contraceptive Use and Unmet Need (ECUUN) Study", published in the Maternal Child Health Journal.

Meet the Team

Cathea M. Carey, MPH
Cathea (she/her) is a Washington Native. She received her MPH from the University of Washington’s Department of Health Services and a Certificate in Demography. Her research experience includes a broad array of physical and mental health disparities including racial/ethnic disparities, reproductive health, and LGBTQIA rights.

Erica V. Tartaglione, BS
Erica (she/her) is the VA Puget Sound HSR&D Center of Innovation Special Initiatives Manager. She joined the VA in 2009 as a project manager and has been overseeing multiple research and operations projects. Her interests include reproductive health, maternity care services, Veteran research engagement, and promoting diversity equity and inclusion in all phases of the research process.

Gillian Monty, BA
Gillian (she/her) is originally from Phoenix Arizona and moved to Seattle in 2016 to attend Seattle University as an undergraduate. Gillian began working as a research assistant on the VA women’s health research team shortly after graduating with a BA in Psychology.

 

Katon.jpg


Jodie Katon, PhD, MS
Dr. Jodie Katon (she/her) is an epidemiologist and health services researcher, a Core Investigator at the VA Puget Sound HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, and a Research Assistant Professor in the University of Washington Department of Health Services.  Her research focuses on reproductive and sexual health and health equity.

 

 

 

Gray.jpg


Kristen Gray, PhD, MS
Dr. Gray (she/her) is an epidemiologist and health services researcher in Health Services Research & Development, VA Puget Sound Health Care System and a Research Assistant Professor in the Health Services Department, University of Washington School of Public Health. Her primary research interests include understanding and improving Veterans’ health behaviors, particularly physical activity and diet, and women’s reproductive health care delivery.

 

 

 

Callegari.jpg


Lisa Callegari, MD, MPH
Dr. Callegari (she/her) is an obstetrician gynecologist and health services researcher focused on developing and testing interventions to promote provider-patient communication, patient-centered care, and equity in reproductive health.  She is a Core Investigator at the VA HSR&D Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care and Associate Professor of Obstetrics & Gynecology and Adjunct Associate Professor of Health Services at the University of Washington.

 

Molly Silvestrini, BA
Molly (she/her) is from San Francisco and joined the VA women’s health research team as a qualitative analyst in 2021. She is interested in health disparities, LGBTQ health, and reproductive/sexual health.

Sam Benson, MPH
Sam (she/her) hails from the Midwest but has called Seattle home since 2010. She joined the VA women’s health research team as a project manager in 2019 and has research experience in areas including adolescent health, sexual and reproductive health, and STD/HIV prevention.

Siobhan Mahorter, MPH
Siobhan (she/her) joined the VA women’s health research team in 2020, and has called Seattle home since 2012. She has a professional background in state-level health policy and public health program development. Her research interests include program and policy evaluation, women’s health and family planning. Outside of work, she enjoys singing, kayaking and reading with her cat.

Research Projects

Title: Hysterectomy in the Veterans Health Administration
PIs: Lisa Callegari, MD, MPH, Jodie Katon, PhD, MS, Kristen Gray, PhD, MS
Background: Identifying predictors or deterrents of minimally invasive hysterectomy techniques may help highlight factors which can be modified to improve uptake of these techniques, where appropriate.
Aims: 
1. Conduct chart abstraction among women undergoing hysterectomy within VA for benign gynecologic conditions to capture individual/clinical factors not captured through ICD-9 codes that may contribute to surgical decision making.
2. Conduct a series of stakeholder interviews to understand system level determinants of surgical decision making, and how these potentially impact use of minimally invasive surgery.
Funding Source: VA Health Services Research and Development, VA Office of Health Equity
Associated Publications:
1. Katon JG, Gray KE, Callegari LS, Gardella C, Gibson CJ, Ma E, Zephyrin LC.  Trends in hysterectomy rates among women Veterans in the US Department of Veterans Affairs. American Journal of Obstetrics Gynecology. 2017 October;217:428.e1-11.
2. Callegari L, Katon JG, Gray KE, Doll K, Pauk S, Lynch KE, Uchendu US, Zephyrin L, Gardella C.  Associations between race/ethnicity, uterine fibroids, and minimally invasive hysterectomy in the VA healthcare system.  Women’s Health Issues. 2019 January-February; 29(1): 48-55.
3. Gray KE, Ma EW, Callegari LS, Magnusson SL, Tartaglione EV, Christy AY, Katon JG. Understanding Variation in Availability and Provision of Minimally Invasive Hysterectomy: A Qualitative Study of Department of Veterans Affairs Gynecologists. Women’s Health Issues. September 2019.
4. Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs.  Medical Care. 2019 December 15:57(12):930-6.


MyPath_HomePage.PNGTitle: MyPath: A Patient-Centered Web-Based Intervention to Improve Reproductive Planning for Women Veterans
PIs: Lisa Callegari, MD, MPH
Background: Patient-centered conversations about reproductive goals in preventive care settings can empower individuals to optimize health and well-being prior to desired pregnancies and to prevent unwanted pregnancy and births. Conversations about reproductive needs are often absent, however, and the conversations that do happen frequently fail to incorporate women's values and preferences. Interventions are needed to improve both the frequency and quality of counseling about reproductive needs in preventive care settings.
We developed MyPath, a novel web-based decision support tool designed to be used prior to primary care visits to help women Veterans with reproductive capacity consider their reproductive goals; improve their knowledge about fertility, contraception, and prepregnancy health risks; align contraceptive decisions with their preferences and goals; and engage in shared decision making (SDM) with providers.
Aims:
1. Test the effect of the MyPath tool used before primary care visits on occurrence of reproductive needs discussions with shared decision making (primary outcome), patient-provider communication self-efficacy, and contraceptive decision quality, compared to usual care;
2. Test the longer-term effect of MyPath on contraceptive utilization, unwanted pregnancy, and behaviors to modify preconception health risks, compared to usual care at 3- and 6-month follow up;
3. Conduct an implementation process evaluation, including quantitative and qualitative data collection to identify implementation barriers and facilitators and intervention costs.
Exploratory analyses will look for effect modification by patient race/ethnicity, patient age, appointment modality (in-person vs. virtual) and clinical setting.
Funding Source: VA Health Services Research & Development
Associated Publications: 
Callegari LS, Nelson KM, Arterburn DE, Dehlendorf C, Magnusson SL, Benson SK, Schwarz EB, Borrero S. Development and Pilot Testing of a Web-Based Reproductive Decision Support Tool for Primary Care. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06506-6


URISELogo.jpg
Title: 
Understanding Racial Inequities in Fibroid Care for Veterans (U-RISE)
PIs: Jodie Katon, PhD, MS, Lisa Callegari, MD, MPH
Background: Due to disparities in uterine fibroid incidence, severity, treatment, and outcomes in black women compared to white women, we proposed to conduct a mixed methods study to understand the mechanisms underlying this Black/White difference in uterine fibroid outcomes among women veterans who received VA care.
Aims:
1. Examine Black/White differences in treatment patterns for women Veterans with UF, including time from diagnosis to initial treatment and surgical treatments; type of initial treatment (medical, non-definitive procedure/surgery, hysterectomy); and mode of surgery (minimally invasive vs abdominal), independent of clinical severity, using administrative data and chart review.
2. Examine Black/White differences in clinical (emergency room visits, hospitalization for anemia, blood transfusion) and surgical outcomes (surgical complications, 30-day readmission) for UF, independent of clinical severity, using administrative data and chart review.
3. Understand and contextualize disparities identified in Aims 1 and 2 using qualitative exploration of Black women Veterans’ experiences with UF symptoms, care-seeking behaviors, and treatment and how they differ from those of White women Veterans, to ensure future interventions are informed by Black women Veterans’ perspectives.
Funding Source: VA Health Services Research & Development


Title: Evaluating and enhancing women’s health care quality through the Cerner transition 
PIs: Kristen Gray, PhD, MS
Background: Electronic health record modernization (EHRM), during which VA will transition to the Cerner Electronic Health Record, presents both opportunities and challenges to move VA forward in the provision of gender-specific care. The goal of the EHRM is to provide seamless care for Veterans across VA, Department of Defense (DoD), and the community, but the transition may also introduce unintended consequences and new challenges. Research on the real-world effects of transitioning between electronic health records is sparse, but early DoD experiences underscore the difficulties associated with such a massive technological and human factors transformation. At VA, EHRM will be staggered across the many facilities, which allows VA to capitalize on learning health care system principles to support continuous quality improvement as the modernization unfolds.
Aims:
1. Evaluate changes in care coordination processes pre- and post-EHRM using process mapping, which involves interviews with front-line personnel.
2. Identify pre- and post-EHRM challenges, workarounds, and successes in women’s health care coordination using qualitative interviews with VA providers, care coordinators, and other staff.
3. Evaluate the volume, timeliness, and completeness of mammography in VA before and after disruptive events, including the COVID-19 pandemic and EHRM.
Funding Source: VA Health Services Research & Development


Title: Reproductive, Sexual, and Socio-Behavioral Health Data Repository and Registry
PIs: Jodie Katon, PhD, MS; Lisa Callegari MD, MA; Kristen Gray, PhD, MS
Background: The overarching goal of this data repository/registry is to improve reproductive, sexual, and socio-behavioral health.
Aims:
1. Securely store/update identifiable and de-identified data obtained during previous relevant studies or activities preparatory to research
2. Make data available to investigators for future studies
3. Invite repository subjects to participate in future studies
Funding Source: Unfunded