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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3072 — Organizational Factors Related to Military Sexual Trauma (MST) Screening

Hyun JK, Office of Mental Health Services (OMHS), Military Sexual Trauma Support Team and National Center for PTSD; Kimerling R, OMHS, Military Sexual Trauma Support Team and National Center for PTSD and Center for Health Care Evaluation; Cronkite R, Center for Health Care Evaluation, VA Palo Alto Health Care System, Center for Primary Care and Outcomes Research, Stanford School of Medicine; McCutcheon S, OMHS National Mental Health Director of Family Services, Military Sexual Trauma, and Women's Mental Health; Frayne SM, Center for Health Care Evaluation, VA Palo Alto Health Care System and Center for Primary Care and Outcomes Research, Stanford School of Medicine;

Objectives:
Organizational factors influence diffusion of new programs, and their influence on program implementation should be evaluated. In 2000, VHA implemented a universal MST screening program that initially exhibited wide variability in MST screening rates among facilities. This study investigated both facility-and patient-level factors associated with a patient’s receipt of MST screening during the early implementation phase of VHA’s universal MST screening policy and assessed if there was differential impact on continuing and new VHA users.

Methods:
The sample consisted of 50,763 female and 1,004,758 male Veterans eligible for MST screening in 119 VHA facilities in FY2005. Multivariate generalized estimating equation analyses were conducted separately by gender and by continuing vs. new user status. Facility-level variables included specialized programming within the facility (e.g., women’s health clinic or specialized PTSD program), implementation of facility-level policies and audit and feedback practices, and facility volume characteristics. Patient-level variables included demographics and utilization of a women’s health clinic (for female Veterans only).

Results:
Facility-level mandatory universal MST screening policies and audit and feedback practices were associated with increased odds of receiving MST screening among new patients and continuing male patients. Although the facility-level effect for the women’s health clinic did not emerge as significant, patient-level effects indicated that women who used a women’s health clinic had greater odds of being screened for MST compared to women who had not used a women’s health clinic.

Implications:
This study showed that facility policies that promote universal MST screening, as well as audit and feedback practices at the facility, significantly improved the odds of patients receiving MST screening. Women Veterans’ utilization of a women’s health clinic was associated with higher odds of receiving MST screening.

Impacts:
This study provides empirical support for the use of policies and audit and feedback practices which the VHA has used since the implementation of the MST screening directive to encourage compliance with VHA’s MST screening objective, and is likely associated with the present day success in MST screening across all VHA facilities. This study also illustrates challenges in the use of specialized facility resources to influence diffusion of knowledge.


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