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2015 HSR&D/QUERI National Conference Abstract

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1083 — Gender Differences in Satisfaction with VA Health Care

Zickmund SL, CHERP VA Pittsburgh Healthcare System; Gao S, CHERP VA Pittsburgh Healthcare System; Borrero S, CHERP VA Pittsburgh Healthcare System; Stone RA, CHERP VA Pittsburgh Healthcare System; Hausmann LH, CHERP VA Pittsburgh Healthcare System; Burkitt KH, CHERP VA Pittsburgh Healthcare System; Switzer GE, CHERP VA Pittsburgh Healthcare System; Obrosky DS, CHERP VA Pittsburgh Healthcare System; Rodriguez KL, CHERP VA Pittsburgh Healthcare System; Fine MJ, CHERP VA Pittsburgh Healthcare System

Objectives:
VA is committed to equal treatment for all Veterans; however, concerns exist that women are not as satisfied as their male counterparts with VA health care. We sought to examine gender differences in satisfaction with VA care in a racially-diverse patient sample.

Methods:
Our study of gender, race, and ethnic differences in satisfaction with VA care drew Veterans from 25 VA Medical Centers (VAMCs). From 6/13-1/15, we invited a sample of Veterans who had > 1 outpatient visits in the prior 12 months to complete a telephone interview on satisfaction with VA care overall and within 15 distinct domains (e.g., access, respect). We used a 5-category Likert scale (very satisfied to very dissatisfied) to classify satisfaction. We assessed proportions of patients who were "very satisfied," "somewhat satisfied," or were in the 3 remaining categories (collapsed due to small numbers). Then we used mixed-effects multinomial regression to model gender differences in satisfaction overall and by domain. Models included fixed effects for gender, age, race/ethnicity, gender-by-race/ethnicity interaction, and random effects for VAMCs to account for clustering of Veterans within facilities.

Results:
Of 1,928 eligible Veterans, 1,203 (62%) completed the Likert questions, including 589 (49%) men and 614 (51%) women. Overall, 53% males and 43% females were "very satisfied" with overall VA care (unadjusted chi-square test with p < 0.01). We found at least 10 percent point differences by gender in being "very satisfied" in the following domains: outpatient care (p < 0.01), access (p < 0.01), coordination of care (p < 0.01), respect (p < 0.01), and inpatient care (p = 0.01). In our multinomial models, white women were less satisfied than white men in the domains of outpatient care, respect, and main and clinic facility; black women were less satisfied than black men in access, pharmacy, and respect; and Hispanic women were less satisfied than Hispanic men in mental health and inpatient care.

Implications:
Women Veterans are less satisfied than men with VA within select domains of care. Across domains, gender differences in satisfaction vary by race/ethnicity.

Impacts:
Understanding gender differences in satisfaction and how these differences vary by race/ethnicity will enable VA to improve the health care experiences for the growing number of racially diverse female Veterans.