BACKGROUND/RATIONALE:
Women veterans are among the fastest growing segment of new VA users, yet their growing presence has highlighted gaps in VA access and quality. As a result, Congressional eligibility reforms profoundly changed the array of VA health care services to be made available to women veterans. Considerable debate remains about how best to organize VA care for women veterans to address legislative mandates of equitable access to a wide array of services. While VA facilities have adopted a variety of clinic models for delivering women’s health care, none dominates, and the quality and costs associated varying delivery models established to meet their needs is currently unknown.
OBJECTIVE(S):
Our objective was to inform practice and policy options for optimal delivery of VA care to women veterans by evaluating the quality of care and costs associated with the prevailing delivery models in VHA.
METHODS:
We undertook four main activities: (1) an expert panel to develop an evidence-based organizational taxonomy of delivery models for women veterans; (2) design and administration of a new national VHA Survey of Women Veterans Health Programs and Practices; (3) statistical analyses of merged organizational and performance data to evaluate quality of care associated with different VA care models; and (4) an exploration of costs associated with care model variants recommended by VHA policy. We use modified Delphi consensus development techniques for convening the expert panel comprised of representatives of the array of VA delivery models to arrive at essential management and clinical features needed to deliver high quality care to women veterans. We applied the resulting organizational taxonomy to standard survey development and field techniques for designing and administering multi-level survey modules targeting VISN, VAMC and geographically distinct practices. Concurrently, we combined a prior all-VA organizational survey with successive years of data from the VA Survey of Healthcare Experiences for Patients (SHEPs) and External Peer Review Program (EPRP), in addition to Austin data for patient-level covariates and Area Resource File (ARF) data for contextual measures. We used the VA Decision Support System (DSS) to estimate the costs associated with separate women’s health clinics for primary care (WHC/PC) vs. designating women's health providers in general primary care clinics (GEN/PC).
FINDINGS/RESULTS:
We have completed development of an evidence-based organizational taxonomy for use in classifying VA medical centers along a continuum of care features, which we then used to develop, pilot test, revise and field the 2006-07 VHA Survey of Women Veterans Health Programs & Practices (100%, 93% and 86% response rates at the VISN, VAMC and practice levels, respectively). Women veterans’ ratings of accessibility, continuity and coordination are significantly higher in VAs that have adopted WHC/PCs. Analyses of structural features associated with women’s chronic disease quality and preventive practices show mixed results for GEN/PC vs. WHC/PC, with distinguishable care features within respective care models demonstrating key associations (e.g., WHC/PCs perform better with higher staffmix). WHC/PC clinics had slightly more provider fulltime equivalents (FTEs) and more visits/provider but lower provider labor costs per visit than GEN/PCs.
IMPACT:
This project represents the first attempt in VHA to systematically evaluate the quality of care for women veterans in VA settings, filling a crucial gap in our ability to reduce gender disparities and to arm VA health care managers with an evidence-base for adapting care arrangements that optimize the outcomes and satisfaction of women veterans.
PUBLICATIONS:
Journal Articles
- Bean-Mayberry B, Yano EM, Bayliss N, Navratil J, Weisman CS, Scholle SH. Federally funded comprehensive women's health centers: leading innovation in women's healthcare delivery. Journal of Women's Health (2002). 2007; 16(9): 1281-90.
- Bean-Mayberry BA, Yano EM, Caffrey CD, Altman L, Washington DL. Organizational characteristics associated with the availability of women's health clinics for primary care in the Veterans Health Administration. Military Medicine. 2007; 172(8): 824-8.
- Yano EM, Goldzweig C, Canelo I, Washington DL. Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics. Women's Health Issues. 2006; 16(5): 226-35.
