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Diffusion of innovation in women’s health care delivery: The Department of Veterans Affairs’ adoption of women’s health clinics

  • Elizabeth M. Yano
    Correspondence
    Address correspondence to: Elizabeth M. Yano, PhD, MSPH, VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street (152), Sepulveda, CA 91343; Phone: 818-895-9449; Fax: 818-895-5838.
    Affiliations
    VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda and Los Angeles, California

    UCLA School of Public Health, Department of Health Services, Los Angeles, California
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  • Caroline Goldzweig
    Affiliations
    VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda and Los Angeles, California

    UCLA School of Medicine, Department of Medicine, Los Angeles, California
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  • Ismelda Canelo
    Affiliations
    VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda and Los Angeles, California
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  • Donna L. Washington
    Affiliations
    VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda and Los Angeles, California

    UCLA School of Medicine, Department of Medicine, Los Angeles, California
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      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.