Abstract
Purpose
This exploratory study investigated organizational factors associated with receipt
of military sexual trauma (MST) screening during an early timeframe of the Veterans
Health Administration’s (VHA) implementation of the universal MST screening policy.
Methods
The sample consisted of all VHA patients eligible for MST screening in fiscal year
2005 at 119 VHA facilities. Analyses were conducted separately by gender and by user
status (i.e., new patients to the VHA health care system in FY 2005 and continuing
users who had previously used the VHA health care system in the past year). Multivariate
generalized estimating equations were used to assess the effects of facility-level
characteristics and adjusted for person-level covariates.
Results
Facility-level mandatory universal MST screening policies were associated with increased
odds of receiving MST screening among new female patients and both continuing and
new male patients: Odds ratio (OR), 2.87 (95% confidence interval [CI], 1.39–5.89)
for new female patients; OR, 8.15 (95% CI, 2.93–22.69) for continuing male patients;
and OR, 4.48 (95% CI, 1.79–11.20) for new male patients. Facility-level audit and
feedback practices was associated with increased odds of receiving MST screening among
new patients: OR, 1.91 (95% CI, 1.26–2.91) for females and OR, 1.86 (95% CI, 1.22–2.84)
for males. Although the facility-level effect for women’s health clinic (WHC) did
not emerge as significant, patient-level effects indicated that among these facilities,
women who used a WHC had greater odds of being screened for MST compared with women
who had not used a WHC: OR, 1.79 (95% CI, 1.18–2.71) for continuing patients and OR,
2.20 (95% CI, 1.59–3.04) for new patients.
Conclusion
This study showed that facility policies that promote universal MST screening, as
well as audit and feedback practices at the facility, significantly improved the odds
of patients receiving MST screening. Women veterans’ utilization of a WHC was associated
with higher odds of receiving MST screening. This study provides empirical support
for the use of policies and audit and feedback practices which the VHA has used since
the implementation of the MST screening directive to encourage compliance with VHA’s
MST screening policy and is likely associated with the present-day success in MST
screening across all VHA facilities.
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Biography
Jenny Hyun is a Health Science Specialist at the National Center for Posttraumatic Stress Disorder, Dissemination and Training Division at VA Palo Alto Health Care System. Her research interests are in organizational research, women veterans, and military sexual trauma.
Biography
Rachel Kimerling is Clinical Psychologist at the National Center for Posttraumatic Stress Disorder, Dissemination and Training Division and an Investigator at the Center for Health Care Evaluation, VA Palo Alto Health Care System. She specializes in sexual trauma research.
Biography
Ruth Cronkite is a Research Health Science Specialist, Center for Health Care Evaluation, VA Palo Alto, and a Consulting Professor, Department of Sociology, Stanford University. She focuses on program evaluation, long-term course of psychiatric disorders, and continuity of care.
Biography
Susan McCutcheon is the National Mental Health Director for Family Services, Women’s Mental Health & Military Sexual Trauma. She focuses on policy and program development for her areas of responsibility. Her areas of research expertise include women’s issues and trauma.
Biography
Susan Frayne, at the Center for Health Care Evaluation, VA Palo Alto, directs the Women’s Health Practice-Based Research Network and Women’s Health Evaluation Initiative. She is Associate Director, VA Palo Alto Women’s Health Center, and Associate Professor of Medicine, Stanford University.
Article Info
Publication History
Published online: November 04, 2011
Accepted:
September 14,
2011
Received in revised form:
September 12,
2011
Received:
June 17,
2010
Footnotes
Funding for this study was provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development ( IAE 05-291 ).
Identification
Copyright
Published by Elsevier Inc.
