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2019 HSR&D/QUERI National Conference Abstract

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1163 — Evidence-Based Quality Improvement Improves Team Function, Provider Gender-Sensitivity and Burnout, and Maintains Preventive Care among Women Veterans

Lead/Presenter: Elizabeth Yano,  COIN - Los Angeles
All Authors: Yano EM (Center for the Study of Healthcare Innovation, Implementation & Policy), Than C (Center for the Study of Healthcare Innovation, Implementation & Policy), Canelo I (Center for the Study of Healthcare Innovation, Implementation & Policy) Hamilton AB (Center for the Study of Healthcare Innovation, Implementation & Policy)

Objectives:
Women Veterans' numerical minority, high rates of military sexual trauma, and gender-specific healthcare needs have complicated implementation of comprehensive primary care under PACT. We deployed evidence-based quality improvement (EBQI) to gender-tailor PACT and determine its effects on provider and patient experience and utilization.

Methods:
We evaluated EBQI effectiveness in a cluster randomized trial with unbalanced random allocation to EBQI (n = 8) vs. naturalistic PACT implementation VAMCs (n = 4). Primary care (PC) and women's health (WH) providers and staff completed surveys, as did women Veterans with 3+ PC and/or WH clinic visits in the prior year. Using VA administrative data, we explored PACT-related utilization outcomes. Over 24-months, EBQI included multilevel, multidisciplinary stakeholder engagement and priority-setting to generate VISN-level QI roadmaps, followed by training and technical support of EBQI teams who developed local projects based on VISN-level QI roadmaps. The research team provided formative feedback of data and external practice facilitation of local teams, and convened across-EBQI site collaboration calls. For patient and provider/staff outcomes, we adjusted for relevant covariates, baseline information, and non-response for difference-in-differences analyses.

Results:
EBQI improved PACT team function by 0.43 points (95% CI: -0.01, 0.87) and provider gender-sensitivity by 0.33 points (95% CI: 0.10, 0.57). EBQI was also associated with lower provider burnout (AOR: 0.79; 95% CI: 0.30, 2,07). Over a 24-month period, patients in EBQI sites maintained the average number of PC and WH visits, while visits decreased among patients in control sites (1.2 adjusted mean difference for PC [95% CI: 0.1, 2.4]; 1.7 adjusted mean difference for WH [95% CI: 0.9, 2.5]). Patient-level experiences of PACT constructs of access, continuity and coordination did not differ significantly between EBQI and control sites, nor did other experiential measures (e.g., patient-rated provider communication).

Implications:
EBQI was effective in improving team- and provider-level behaviors and attitudes but not patient-level experience by 24-months. More time with EBQI may be necessary for provider- and staff-level changes to affect what patients experience.

Impacts:
Improvements in EBQI sites resulted in VA adoption of EBQI for use in VAs where implementation of comprehensive women's health care was low compared to other VAs.