Systematic identification of family caregivers in health systems: Proposed solutions from a caregiver‐focused research study
Abstract: Patient electronic health records (EHR) were not built to identify family caregivers (hereafter “caregivers”). New policies such as the CARE1 and RAISE2 Acts pressure health systems to identify caregivers in a systematic way, yet few health systems include a caregiver field in their EHR. As such, caregiver identification relies on self-identification or providers asking patients about assistance in the home during health care encounters. Caregiver information, recorded as free text in EHR notes, is not easily extractable at a population level. Thus, current health system approaches hinder the ability to use caregiver expertise fully in the patient encounter and delay linking caregivers to services. Methods used in caregiver-focused research can inform future health system approaches to identify caregivers for engagement. We describe (1) a patient EHR driven approach using the Veterans Affairs (VA) EHR to identify Veterans with caregivers for a research survey (iHI-FIVES)5 and associated results; and (2) caregiver characteristics of survey participants from iHI-FIVES and CHASE,6 a national phone survey that recruited from a list of caregivers enrolled in the VA Caregiver Support Program (CSP). The goal of this comparison was to assess whether different recruitment methods allow the identification of similar types of caregivers. Similarities would indicate the iHI-FIVES EHR-driven approach identifies caregivers resembling those enrolled in services; dissimilarities may help identify groups to target for future enrollment in caregiver services.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.