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IAE 07-170 – HSR&D Study

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IAE 07-170
Impact of Practice Structure on Quality of Care for Women Veterans (Phase 2)
Elizabeth M Yano PhD MSPH
VA Greater Los Angeles Healthcare System, Sepulveda, CA
Sepulveda, CA
Funding Period: April 2008 - September 2009

BACKGROUND/RATIONALE:
Women's increased participation in the military and higher participation in VA care is rapidly changing the sociodemographics of the veterans served by VHA. However, the historical predominance of men in VA health care settings has resulted in most VA providers having little or no exposure to female patients. VA policymakers and providers are faced with profound challenges in organizing clinical services to ensure women veterans' equitable access to high-quality, user-friendly health care.

OBJECTIVE(S):
This study built on findings from prior work examining the impact of practice structure on the quality of care for women veterans in VA primary care and women's clinic settings. This project represented Phase 2 of our ongoing work designed to arm VA managers with evidence supporting care arrangements that optimize women veterans' care. Specifically, this study aimed to improve our understanding of the changes in how VA care is organized in response to the rapid infusion of women veterans into the VA health care system, with respect to locally available resources for women's health, organizational characteristics of individual VA facilities and the environments in which VA facilities operate.

METHODS:
To examine changes in how VA women's health care was organized over time, we conducted analyses of VA women's health organizational surveys administered in 2001 and 2006-07 to the census of VA medical centers (VAMCs) and large community-based outpatient clinics (CBOCs) that served 300 or more women veterans based on prior year Austin-generated workload data. With over 80% response rates in both survey years, we identified 120 matching VA facilities, representing all regions, all 21 VISNs, as well as both urban and rural VA facilities within each VISN, augmented with patient caseload/workload characteristics.

FINDINGS/RESULTS:
Contrary to expectation, we found almost no increases in on-site availability of women's health services over the 6-year period examined, and several statistically significant declines, with significant shifts to use of community providers through fee basis and other arrangements. No measures of gender sensitivity increased save one. Several environmental and organizational factors predicted changes in on-site availability of women's health services and delivery of women's focused care arrangements over time. Constructs associated with diffusion theory suggested that greater centralization and formalization of women's health care delivery may be needed to ensure active adoption and improvement of VA women's care, as standard diffusion strategies do not appear to be at work.

IMPACT:
Given the increases in women veterans' use of the VA health care system, our findings point to the vital importance of the Women Veterans Health Strategic Healthcare Group's initiatives to substantially enhance the comprehensiveness of women's health care that women veterans can expect to obtain at individual VA facilities. Many VA facilities are struggling with how best to deliver care to women veterans, and our findings represent opportunities for informing the design of implementation plans that better map to local contextual factors. Given increases in use of community providers, more research is needed on the quality of care women veterans receive while outside the VA and how women veterans' VA and non-VA use is coordinated.

PUBLICATIONS:

Journal Articles

  1. Reddy SM, Rose DE, Burgess JF, Charns MP, Yano EM. The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Nov 1; 26(6):648-655.
  2. Katon J, Reiber G, Rose D, Bean-Mayberry B, Zephyrin L, Washington DL, Yano EM. VA location and structural factors associated with on-site availability of reproductive health services. Journal of general internal medicine. 2013 Jul 1; 28 Suppl 2:S591-7.
Journal Other

  1. Yano EM, Bean-Mayberry B, Rose DE, Canelo IA, Washington DL. Women and war: How are Veterans Health Administration (VA) facilities adapting to their changing demographics? [Abstract]. Journal of general internal medicine. 2009 Jun 1; 24(S1):S220.
Conference Presentations

  1. Rose DE, Bean-Mayberry BA, Canelo IA, Washington DL, Yano EM. Is the Comprehensiveness of Women’s Health Services in VA associated with Patients’ Ratings of Care? Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 22; Baltimore, MD.
  2. Canelo IA, Rose DE, Bean-Mayberry BA, Washington DL, Yano EM. Availability of General and Specialty Women’s Health Services at CBOCs: VHA Survey of Women Veterans Health Programs and Practices, 2007. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD.
  3. Washington DL. Women Veterans Research. Paper presented at: CalVet Women Veterans Conference; 2010 Sep 11; Los Angeles, CA.
  4. Washington DL. Women Veteran Research. Paper presented at: Disabled American Veterans Annual Convention; 2010 Aug 2; Atlanta, GA.
  5. Oishi S, Washington DL, Bean-Mayberry BA, Canelo IA, Yano EM. Organizational Features of Outpatient Women’s Mental Health Services in VHA: Findings from the VHA Survey of Women Veterans Health Programs and Practices, 2007. Poster session presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 15; Arlington, VA.
  6. Rose DE, Washington DL, Bean-Mayberry BA, Canelo IA, Yano EM. Mitigating gender disparities in VA depression screening: The role of women’s healthcare services and programs. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 15; Arlington, VA.
  7. Rose DE, Washington DL, Bean-Mayberry BA, Canelo IA, Yano EM. Breast cancer screening and treatment arrangements in the VA: Findings from the VHA Survey of Women. Poster session presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 15; Arlington, VA.
  8. Taylor SL, Rose DE, Yano EM. Geographic variation in the availability of female providers for women Veterans’ care. Poster session presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 15; Arlington, VA.
  9. Rose DE, Washington DL, Bean-Mayberry BA, Canelo IA, Yano EM. The diffusion of women’s health care services in the VA: 2001-2006. Paper presented at: Healthcare Organizational Research Association Annual Conference; 2010 Jun 6; Berkeley, CA.
  10. Rose DE, Mitchell MN, Canelo IA, Yano EM. Rural/urban differences in coordination of care problems with specialty clinics and services in VA primary care clinics: National survey results from organizational surveys of VA primary care directors, 2007. Poster session presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 5; Portland, ME.
  11. Yano EM, Rose DE, Mitchell MN, Bean-Mayberry BA, Washington DL. Erosion of women's health services in the VA: VHA Survey of Women Veterans Health Programs & Practices, 2001-2006. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2010 Apr 30; Minneapolis, MN.
  12. Yano EM. Research on women and deployment. Paper presented at: VA / DoD Evolving Paradigms II OEF / OIF National Conference; 2009 Sep 22; Las Vegas, NV.
  13. Yano EM, Bean-Mayberry B, Mitchell MN, Canelo IA, Lanto AB, Washington DL. Impact of practice structure on quality of care among women veterans. Paper presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.
  14. Yano EM, Bean-Mayberry B, Rose DE, Canelo IA, Washington DL. Women and war: How are Veterans Health Administration (VA) facilities adapting to their changing demographics? Paper presented at: Society of General Internal Medicine Annual Meeting; 2009 May 15; Miami Beach, FL.
  15. Rose DE, Washington DL, Bean-Mayberry B, Yano EM. Changes in Basic and Specialty Services Available On-Site for Women Veterans, 2001-2007. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD.
  16. Rose DE, Yano EM, Washington DL, Bean-Mayberry B, Yano EM. Changes in Service Delivery Arrangements for Women Veterans: Findings from the VHA Surveys of Women Veterans’ Health Programs and Practices, 2001-2007. Paper presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD.
  17. Yano EM, Bean-Mayberry B, Hayes P, Wright S, Schnurr P, Washington DL. Effectively Integrating Women Veterans into VA Health Services Research. Presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
  18. Yano EM, Bean-Mayberry B, Lanto A, Washington DL. Barriers to Delivering Quality Care to Women Veterans: Competing Demands, Lack of Proficient Providers, and Inadequate Resources for Outreach. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
  19. Yano EM, Bean-Mayberry B, Hayes P, Wright S, Washington DL. Women’s Health Care Delivery and Quality of Care: Effectively Integrating Women Veterans into the Mindset of QUERI Stakeholders. Presented at: VA QUERI National Meeting; 2008 Dec 11; Phoenix, AZ.
  20. Yano EM, Bean-Mayberry B, Canelo IA, Washington DL. What does women's health care look like in the VA? Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 10; Washington, DC.
  21. Yano EM. How VA primary care is organized influences women veterans’ access and quality. Paper presented at: National Quality Forum Annual Meeting; 2008 May 20; Washington, DC.
  22. Yano EM. VA women’s health services research: Using research to improve quality of care. Paper presented at: VA Advisory Committee on Women Veterans Biannual Meeting; 2007 Oct 31; Washington, DC.


DRA: Health Systems
DRE: none
Keywords: Organizational issues, Women - or gender differences
MeSH Terms: none

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