Background
In response to concerns about the availability and quality of women’s health services
in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress
approved landmark legislation earmarking funds to enhance women’s health services.
A portion of the appropriation was used to launch Comprehensive Women’s Health Centers
as exemplars for the development of VA women’s health care throughout the system.
We report on the diffusion and characteristics of VA women’s health clinics (WHCs)
10 years later.
Methods
In 2001, we surveyed the senior women’s health clinician at each VA medical center
serving ≥400 women veterans (83% response rate) regarding their internal organizational
characteristics in relation to factors associated with organizational innovation (centralization,
complexity, formalization, interconnectedness, organizational slack, size). We evaluated
the comparability of WHCs (n = 66) with characteristics of the original comprehensive women’s health centers (CWHCs;
n = 8).
Results
Gender-specific service availability in WHCs was comparable to that of CWHCs with
important exceptions in mental health, mammography and osteoporosis management. WHCs
were less likely to have same-gender providers (p < .05), women’s health training programs (p < .01), separate women’s mental health clinics (p < .001), separate space (p < .05), or adequate privacy (p < .05); however, they were less likely to have experienced educational program closures
(p < .001) and staffing losses (p < .05) compared to CWHCs.
Conclusions
Diffusion of comprehensive women’s health care is as yet incomplete. More research
is needed to examine the quality of care associated with these models and to establish
the business case for managers faced with small female patient caseloads.
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Biography
Elizabeth Yano, PhD, MSPH, is the Deputy Director of the VA Greater Los Angeles HSR&D Center of Excellence and an Associate Professor of Health Services at the UCLA School of Public Health. She is a health care epidemiologist whose work focuses on the influence of organization factors on quality of care.
Biography
Caroline Goldzweig, MD, MPH, is the Acting Associate Chief of Staff for Clinical Informatics and an Associate Professor of Medicine at the Geffen-UCLA School of Medicine. She is a general internist and health services researcher whose work involves quality improvemnent interventions and informatics.
Biography
Ismelda Canelo, MPA, is a recent graduate of the MPA program at the California State University, the Tseng College of Extended Leaning. She is currently employed at the VA Greater Los Angeles HSR&D Center of Excellence at Sepulveda.
Biography
Donna L. Washington, MD, MPH, is an Advanced Research Career Development awardee at the VA Greater Los Angeles Healthcare System and an Associate Professor of Medicine at the David Geffen UCLA School of Medicine. She is also a general internist and staff physician whose work examines access to care among vulnerable populations, with an emphasis on women veterans.
Article info
Publication history
Accepted:
July 24,
2006
Received in revised form:
July 21,
2006
Received:
October 28,
2005
Footnotes
Supported by the Department of Veterans Affairs (VA), Veterans Health Administration (Project # XVA-65003) and the VA HSR&D Service (Project #04-036, E.M.Y., PI) and the VA Greater Los Angeles HSR&D Center of Excellence (Project #HFP 94-028). D.L.W. is funded by a VA HSR&D Advanced Research Career Development award (Project # RCD 00-017).
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Identification
Copyright
© 2006 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.
