March 2017

In this Issue: VA Healthcare for Women Veterans
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Impacts of Comprehensive VA Women's Healthcare

Feature Article

Providing comprehensive care for women Veterans is often made more complex by the necessary integration of gender-specific services within the VA healthcare system, mental health burden, as well as by care coordination challenges across multiple providers and settings within and outside VA. In response to these challenges, VA policymakers have advanced specific care models and services that must be made available to women to ensure equitable access to comprehensive care. Part of the Women Veterans Health CREATE initiative, this study aims to:

• Assess determinants of variations in the delivery of comprehensive care for women Veterans; and
• Examine the impact of comprehensive care delivery on women Veterans' quality of and experience with care.

Investigators will gather survey information from four key informants: 1) primary care director, regarding arrangements for women Veterans in general (mixed-gender) in primary care clinics; 2) women's health medical director or women's health liaison, regarding arrangements in women-only health clinics; 3) mental health lead; and 4) women Veteran program managers. Once collected, survey data will be linked to other organizational and administrative data, including area and facility characteristics, in order to examine multi-level determinants of different levels and types of comprehensive care achievement. Investigators will then link these data with VA quality of care and patient survey data among women Veterans to examine the impact of different levels and types of comprehensive care implementation on women Veterans' processes of care (e.g., cancer screenings) and intermediate health outcomes (e.g., LDL<100). Thus far, preliminary modeling has demonstrated the essential importance of area and organizational factors predictive of women Veterans' ratings of VA care quality, access, and preventive care.

Impact: A better understanding of area and organizational factors associated with achievement of key elements of comprehensive care will inform VA practice improvement and policy development to hasten implementation of comprehensive care for women Veterans. Study results also will provide information on critical factors associated with the implementation of innovations designed to improve women Veterans' care.

Principal Investigator: Danielle Rose, PhD, MPH, part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA.

Yano EM. A partnered research initiative to accelerate implementation of comprehensive care for women Veterans: the VA Women's Health CREATE. Medical Care. April, 2015; 53(4 Suppl 1):S10-4.

Impacts of Comprehensive VA Women's Healthcare project abstract