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SDR 08-270 – HSR Study

SDR 08-270
Assessment of the Health Care Needs and Barriers to VA Use Experienced by Women
Donna L Washington, MD MPH
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: September 2008 - May 2009
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).

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.

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.

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.

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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