1025 — Comprehensive Women's Health Provider Policy: The First Four Years

Maisel NC, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA; Haskell S, Women's Health Services, VA Central Office, Washington, DC; VA Connecticut Health Care System, West Haven, CT; Yale University School of Medicine; Hayes PM, Women's Health Services, VA Central Office, Washington, DC; Romodan Y, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA; Balasubramanian V, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA; Torgal A, Women's Health Services, VA Central Office, Washington, DC; Ananth L, Health Economics Research Center (HERC), VA Palo Alto Health Care System, Menlo Park, CA; Iqbal S, Women's Health Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA; Phibbs CS, VA HSR&D Center for Innovation to Implementation & Health Economics Research Center, VA Palo Alto; Stanford University School of Medicine; Frayne SM, VA HSR&D Center for Innovation to Implementation & Women's Health Section, Medical Service, VA Palo Alto; Stanford University School of Medicine

Objectives:
To increase comprehensive primary care for women Veterans, 2010 VHA policy established Designated Women's Health Providers (DWHPs), trained and proficient in women's primary care, who are preferentially assigned women patients. We assessed longitudinal trends in uptake of this policy across its first four years.

Methods:
National assessments conducted in Fiscal Year (FY) 2012 and in FY2014 collected information on DWHPs in FY2011-2012 and FY2013-2014, respectively. The Women Veteran Program Manager at each VHA facility identified the facility's DWHPs (response rate 100%, both assessments). Assessment data were linked to national VHA administrative data from the corresponding year.

Results:
Number of DWHPs increased each year since the policy was implemented (FY2011: 1,716; FY2012: 1,937; FY2013: 1,962; FY2014: 2,327). Since 2012, 100% of Health Care Systems have had at least 1 DWHP. While a higher proportion of Medical Centers than Community-Based Outpatient Clinics (CBOCs) have DWHPs, the proportion of CBOCs with at least 1 DWHP has been growing rapidly (FY2011: 65%; FY2014: 90%). Among women patients, the proportion of encounters in primary care that had a DWHP as the provider increased over time (FY2011: 52%; FY2014: 67%), rising at Medical Centers (FY2011: 55%; FY2014: 72%) and at CBOCs (FY2011: 50%; FY2014: 62%). On average, women consistently represented a greater proportion of the patients seen by DWHPs versus other primary care providers (FY2011: 19% vs. 5%; FY2014: 20% vs. 4%), yet represented < 10% of the panel for many DWHPs (FY2011: 62% of DWHPs, FY2014: 57% of DWHPs).

Implications:
In the past four years, the number of sites across VHA with at least 1 DWHP has increased steadily to meet the goals of women's health policy. Number of DWHPs has increased annually since the policy began, women's primary care encounters are increasingly occurring with DWHPs, and DWHPs are seeing more women than are other primary care providers. However, the majority of DWHPs still have panels under 10% female.

Impacts:
This evaluation of early policy implementation will help to shape the next strategic phase. Volume of women seen remains low for the majority of DWHPs, magnifying salience of training and other approaches to proficiency maintenance.