BACKGROUND/RATIONALE:
Prior research has found gaps in VA access, services, and quality of care for women veterans. Subsequent policy recommended VA sites adopt one of the primary care delivery models identified as optimal for women's care (full-service women's primary care clinics and/or teams providing comprehensive care, including basic gender-specific care).

OBJECTIVE(S):
Our objective was to determine the impact of VA women's health practice structure on access, satisfaction, and quality of care for women veteran VA healthcare users. Specific aims were to: (1) compare these ratings of care for sites that had implemented recommended optimal care models compared with other VA sites; and (2) compare ratings for sites that differed in selected features of women's primary care practice structure.

METHODS:
The National Survey of Women Veterans (NSWV) telephone survey, conducted in 2008-09, enrolled a population-based sample of VA users and nonusers. The 2007 VHA Survey of Women Veterans Health Programs and Practices identified VA primary care practice arrangements for care delivery to women. Current VA healthcare users who also had matching information on women's primary care practice structure comprised the analytic sample (n=1,749). NSWV measures included women veterans' ratings of their VA healthcare in the prior 12 months on quality, satisfaction, and access; ratings of VA provider skills in treating women and the VA environment for women; and socio-demographic, health, and utilization measures. Data were weighted to represent the U.S. women veteran population. Statistical corrections for multiple comparisons were applied.

FINDINGS/RESULTS:
There were variable levels of optimal care model implementation across VA sites used by women veterans. There were also military cohort differences in use of sites with different types of practice arrangement. Adjusting for differences in socio-demographics, health, and VA utilization of their women veteran patient populations, optimal model sites received higher ratings of gender-related satisfaction and perceptions of VA provider skills than other sites. Optimal model sites also received higher adjusted ratings of gender appropriateness than small caseload sites. Adjusted ratings of quality of care did not differ by type of site.

IMPACT:
VA sites with primary care models tailored to women were rated higher on most dimensions of care. Facilitating establishment of these optimal care models at other sites is one strategy for improving women veterans' experiences with VA care. However, we also found that the passive diffusion of comprehensive primary care for women has not been sufficient to assure availability of high quality gender-sensitive continuity care for women in all VA settings. This suggests that directive actions are required to assure systemwide uptake and complete implementation of comprehensive primary care for women. Research to identify other features of care associated with quality could also inform ongoing VA quality transformation efforts.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Washington DL, Bean-Mayberry B, Riopelle D, Yano EM. Access to care for women veterans: delayed healthcare and unmet need. Journal of general internal medicine. 2011 Nov 1; 26 Suppl 2:655-61. [view]
2. Washington DL, Farmer MM, Mor SS, Canning M, Yano EM. Assessment of the healthcare needs and barriers to VA use experienced by women veterans: findings from the national survey of women Veterans. Medical care. 2015 Apr 1; 53(4 Suppl 1):S23-31. [view]
3. Lehavot K, Der-Martirosian C, Simpson TL, Sadler AG, Washington DL. Barriers to care for women veterans with posttraumatic stress disorder and depressive symptoms. Psychological Services. 2013 May 1; 10(2):203-12. [view]
4. Goldstein KM, Oddone EZ, Bastian LA, Olsen MK, Batch BC, Washington DL. Characteristics and Health Care Preferences Associated with Cardiovascular Disease Risk among Women Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2017 Nov 1; 27(6):700-706. [view]
5. Hamilton AB, Frayne SM, Cordasco KM, Washington DL. Factors related to attrition from VA healthcare use: findings from the National Survey of Women Veterans. Journal of general internal medicine. 2013 Jul 1; 28 Suppl 2:S510-6. [view]
6. Cordasco KM, Mengeling MA, Yano EM, Washington DL. Health and Health Care Access of Rural Women Veterans: Findings From the National Survey of Women Veterans. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2016 Sep 1; 32(4):397-406. [view]
7. Der-Martirosian C, Cordasco KM, Washington DL. Health-related quality of life and comorbidity among older women veterans in the United States. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2013 Dec 1; 22(10):2749-56. [view]
8. Hamilton AB, Williams L, Washington DL. Military and mental health correlates of unemployment in a national sample of women veterans. Medical care. 2015 Apr 1; 53(4 Suppl 1):S32-8. [view]
9. Hoggatt KJ, Williams EC, Der-Martirosian C, Yano EM, Washington DL. National prevalence and correlates of alcohol misuse in women veterans. Journal of substance abuse treatment. 2015 May 1; 52:10-6. [view]
10. Katon JG, Washington DL, Cordasco KM, Reiber GE, Yano EM, Zephyrin LC. Prenatal Care for Women Veterans Who Use Department of Veterans Affairs Health Care. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Jul 1; 25(4):377-81. [view]
11. Weitlauf JC, LaCroix AZ, Bird CE, Woods NF, Washington DL, Katon JG, LaMonte MJ, Goldstein MK, Bassuk SS, Sarto GE, Stefanick ML. Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Nov 1; 25(6):649-57. [view]
12. Washington DL, Davis TD, Der-Martirosian C, Yano EM. PTSD risk and mental health care engagement in a multi-war era community sample of women veterans. Journal of general internal medicine. 2013 Jul 1; 28(7):894-900. [view]
13. Washington DL, Yano EM. PTSD women Veterans' prevalence of PTSD care. Journal of general internal medicine. 2013 Oct 1; 28(10):1265. [view]
14. Rose DE, Farmer MM, Yano EM, Washington DL. Racial/ethnic differences in cardiovascular risk factors among women veterans. Journal of general internal medicine. 2013 Jul 1; 28 Suppl 2:S524-8. [view]
15. Lehavot K, Der-Martirosian C, Simpson TL, Shipherd JC, Washington DL. The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans. Journal of traumatic stress. 2013 Dec 1; 26(6):772-5. [view]
16. Washington DL, Bean-Mayberry B, Hamilton AB, Cordasco KM, Yano EM. Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans. Journal of general internal medicine. 2013 Jul 1; 28 Suppl 2:S571-6. [view]

Reports

1. Katon JG, Tartaglione V, Eleazer JR, Frayne SM, Haeger KO, Schule AK, Luo S, Offer C, Phibbs CS, Rose DE, Saechao F, Shankar M, Shaw J, Vinekar KS, Yano EM, Christy AY, Johnson AM. State of Reproductive Health Volume II: VA Reproductive Health Diagnoses and Organization of Care. Washington, DC: Office of Women's Health, Veterans Health Administration, Department of Veterans Affairs; 2023 Jan 1. 1-52 p. [view]

Conference Presentations

1. Lehavot K, Der-martirosian C, Simpson T, Sadler A, Washington DL. Barriers to Care for Women Veterans with Posttraumatic Stress Disorder and Depressive Symptoms. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 1; Los Angeles, CA. [view]
2. Hamilton A, Washington DL. Barriers to Psychosocial Services among Women Veterans Who Were Homeless. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD. [view]
3. Washington DL, Sun S, Lee ML, Mitchell MN, Canning M, Yano EM. Distance as a barrier to VA women’s health care use. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 15; Arlington, VA. [view]
4. Joseph N, Rose DE, Bean-Mayberry BA, Farmer MM, Washington DL. Emotional Difficulties, Perceived Weight Loss Barriers, and Exercise in Overweight or Obese Women Veterans. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
5. Hamilton A, Frayne SM, Cordasco KM, Washington DL. Factors Related to Attrition from VA Healthcare Use: Findings from the National Survey of Women Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD. [view]
6. Farmer Coste MM, Bean-Mayberry BA, Zuchowski J, Yosef JA, Wight C, Batuman F, Hamilton AB. Identifying barriers to cardiovascular risk identification and reduction for women Veterans. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
7. Zuchowski J, Hamilton AB, Washington DL, Cordasco KM. Learning needs and preferred learning modalities of VA women’s health providers. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
8. Hamilton A, Maisel N, Oishi S, Klap R, Balasubramanian V, Yano E, Frayne SM. Mental health needs and conditions among women Veterans receiving Veterans Health Administration health care. Presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
9. Hamilton A, Washington DL. Military and mental health predictors of unemployment in a national sample of women Veterans. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
10. Washington DL. National Survey of Women Veterans. Poster session presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 14; Washington, DC. [view]
11. Davis TD, Der-Martirosian C, Hamilton A, Yano EM, Washington DL. Post-deployment readjustment stressors and mental health service utilization among OEF/OIF women Veterans. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
12. Lehavot K, Der-Martirosian C, Simpson T, Shipherd JC, Washington DL. PTSD and Military Social Support Predict Physical Health and VHA Utilization in Women Veterans. Poster session presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2013 Nov 1; Nashville, TN. [view]
13. Farmer MM, Rose DE, Yano EM, Washington DL. Racial-Ethnic Variations in Women Veterans’ Healthcare Use. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
14. Washington DL. Risk for OEF/OIF Combat-related PTSD: Findings from the National Survey of Women Veterans. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 16; Washington, DC. [view]
15. Washington DL, Kimerling R, Yano EM. Sexual Assault of Women in the U.S. Military – Population-based Prevalence and Health Consequences from the National Survey of Women Veterans. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA. [view]
16. Hamilton AB, Oishi SM, Klap RS, Yano EM. Strategies for delivering evidenced-based treatments to women Veterans with comorbid mental health conditions. Paper presented at: Addiction Health Services Research Conference; 2013 Oct 24; Portland, OR. [view]
17. Washington DL. The National Survey of Women Veterans – Enhancing Research-Clinical Partnerships for Improving the Care of Women Veterans. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 15; Washington, DC. [view]
18. Katon J, Zephyrin L, Cordasco KM, Reiber G, Yano EM, Washington DL. Use of Veterans Health Administration Prenatal Care and Likelihood of Post-partum Attrition from VA: Potential Missed Opportunities for Women Veterans’ Engagement in VA after Pregnancy. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 22; Baltimore, MD. [view]
19. Washington DL, Hamilton AB, Cordasco KM. Vulnerability for Healthcare Communication Gaps for Users of VA Purchased Care: Implications for the Veterans Choice Act. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA. [view]
20. Washington DL, Bean-Mayberry BA, Mor SS. Women Veterans’ Health Status, Risk Behavior, and Mental Health after Combat Exposure in Iraq and Afghanistan. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 22; Baltimore, MD. [view]

DRA: none
DRE: none
Keywords: none
MeSH Terms: none