4079 — Expanding Access to Women's Health Primary Care Providers, FY11 to FY15

Lead/Presenter: Yasmin Romodan, COIN - Palo Alto
All Authors: Romodan Y (HSR&D Center for Innovation to Implementation (Ci2i), Palo Alto, 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, CT) Hayes P (Women’s Health Services, VA Central Office, Washington, DC) Masiel N (Institute for Research in the Social Sciences, Stanford University, Stanford, CA) SooHoo S () Saechao F (HSR&D Ci2i) Lee J (HSR&D Ci2i) Iqbal S (Medical Service, VA Palo Alto Health Care System, Palo Alto, CA ) Harris L (Women’s Health Services, VA Central Office, Washington, DC) Frayne S (HSR&D Ci2i; Stanford University School of Medicine, CA)

Objectives:
Issued in 2010, VHA Handbook 1330.01 established national policy regarding accessibility of comprehensive primary care under a Women's Health Primary Care Provider (WH-PCP). We assessed longitudinal trends in facilities' progress toward meeting the policy's requirements, FY11 through FY15.

Methods:
The annual Designated Women's Health Provider Assessment for Workforce Capacity (DAWC) evaluates facilities' progress toward implementation of the policy. The Women Veterans Program Manager at each of VHA's 140 health care systems completes this 35-item assessment. Using DAWC data linked to PCMM provider data and national VA outpatient encounter data, we conducted descriptive analyses of the WH-PCP workforce annually, FY11 through FY15.

Results:
Nationally, total number of WH-PCPs increased by 931 providers from FY11 to FY15 (FY11 = 1,716, FY15 = 2,647; 54% increase); the workforce grew at VA Medical Centers (VAMCs: FY11 = 681, FY15 = 985; 45% increase) and at Community-Based Outpatient Clinics (CBOCs: FY11 = 970, FY15 = 1,661; 71% increase). The panels of WH-PCPs were increasingly enriched with women, indicated by the proportion of WH-PCPs for whom women represented at least 10% of encounters (FY11 = 38%, FY15 = 43%; 13% increase). WH-PCPs represent an expanding proportion of all primary care providers (FY11 = 20%, FY15 = 28%; 40% increase). While every VHA health care system now has at least one WH-PCP, there is site-level variability in staffing: the proportion of sites with at least one WH-PCP increased over this period at VAMCs (FY11 = 96%, FY15 = 99%; 3% increase) and, more substantially, at CBOCs (FY11 = 65%, FY15 = 86%; 29% increase). Among women primary care patients, the proportion receiving care from a WH-PCP increased at both VAMCs (FY11 = 55%, FY15 = 71%; 29% increase) and CBOCs (FY11 = 50%; FY15 = 60%; 20% increase).

Implications:
Over the course of five years since implementation of VHA's comprehensive women's health primary care policy, VHA health care systems have been steadily expanding women's access to WH-PCPs. A minority of CBOCs had no WH-PCP on site by FY15.

Impacts:
Despite these successes, opportunities remain for further spread of the WH-PCP workforce expansion initiative, to ensure women have ready access to care, whether they visit a VAMC or a CBOC; the 71% increase in number of WH-PCPs at CBOCs over this period suggests substantial momentum in this direction.