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BACKGROUND/RATIONALE:
The current proposal builds on findings from an initial study of the Impact of Practice Structure on the Quality of Care for Women Veterans (what we are terming "Phase 1"), which was the first attempt in VHA to systematically evaluate the quality of care for women veterans in VA settings. The Phase 1 study characterized the quality associated with the prevailing VA primary care delivery models for women. It also highlighted the need to understand what factors influence adoption of different women's health care delivery features by VA sites. Accordingly, this Phase 2 study aims to improve our understanding of the changes in how VA care is organized in response to the recent and projected growth of women being seen in the VA, available resources for women's health, the local environment, and other organizational characteristics.
OBJECTIVE(S):
The primary objective of our research has been to inform the considerable debate about the best ways to organize care for women veterans. In an 18-month secondary analysis project, we propose:
AIM #1: To determine changes in how VA care is organized for women veterans (2001-2006).
AIM #2: To identify the environmental and organizational determinants of changes in how VA women's health care is being delivered.
AIM #3: To identify determinants of changes in resources over time for women's health care delivery in VA (i.e., have resources kept pace with changes in women veterans' caseload?).
METHODS:
We will conduct secondary analyses of existing data to address these aims. Aim #1 will rely on two waves of the VHA Survey of Women Veterans Health Programs & Practices (2001, 2006). Aim #2 will integrate the merged data from Aim #1 with environmental characteristics from the Area Resource File and Inter Study HMO penetration data and practice characteristics from the VHA Survey of Primary Care Practices (1999-00). Aim #2 will include patient-level utilization as dependent variables to examine how women's utilization varies as a function of how care is organized. Aim #3 will integrate the merged data from Aim #2 with caseload and workload data from the VA National Patient Care Database, specifically the Outpatient Clinic file.
FINDINGS/RESULTS:
Preliminary results suggest increases in use of women's clinics overall, but more for gender-specific exams rather than as medical homes for women veterans. Overall, 42% of VAs have designated women's health providers in general primary care clinics to whom women veterans are preferentially assigned (56% have one for the whole practice, 9% have one in each team, and 18% have a women's primary care team). These sites, however, lack adequate clinical expertise in women's health (p<.01), lack availability of same-gender providers (p<.01) and only have designated women's health providers available 6 half-day sessions/week. Other analyses are underway.
IMPACT:
An increasing proportion of the military, women are among the fastest growing segments of VA users, projected to be 14% of the total population of veteran users by 2010. Yet women still represent a substantial numerical minority and VA providers have limited exposure to them in predominantly male patient panels. The proposed research aims to fill an important gap in VA's ability to reduce gender disparities by arming VA health care managers with an evidence-base for adapting and implementing care arrangements that ultimately optimize the outcomes and satisfaction of women veterans.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Quality of Care
Keywords:
Organizational issues, Women - or gender differences
MeSH Terms:
none
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