Original article| Volume 24, ISSUE 6, P605-612, November 2014

Association between Women Veterans' Experiences with VA Outpatient Health Care and Designation as a Women's Health Provider in Primary Care Clinics



      Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers.


      Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs.


      Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01–1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs.


      The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics.
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      Lori A. Bastian, MD, MPH, is a Senior Research Associate at VA Connecticut Healthcare System in health services research. She is also a Professor, Division Chief of General Internal Medicine, and Associate Dean for Career Development at the University of Connecticut Health Center.


      Mark Trentalange, MD, MPH, is an Associate Research Scientist in Medicine and Biostatistics, Program on Aging, Yale University.


      Terrence E. Murphy, PhD, is an Assistant Professor at the Yale University School of Medicine and a senior Biostatistician at the Yale Program on Aging.


      Cynthia Brandt, MD, MPH, is a Professor of Emergency Medicine at Yale School of Medicine and investigator at VA Connecticut Healthcare System. She focuses on informatics and health services research.


      Bevanne Bean-Mayberry, MD, MHS, is an Assistant Professor of Medicine in the HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist who focuses on gender differences in quality measures and patient satisfaction.


      Natalya C. Maisel, PhD, is a Research Health Science Specialist in the Center for Innovation to Implementation, VA Palo Alto Health Care System.


      Steven M. Wright, PhD, is Director, Performance Measurement, Office of Analytics and Business Intelligence, Department of Veterans Affairs.


      Vera S. Gaetano, MS, is a Program Coordinator at VA Connecticut Healthcare System.


      Heather Allore, PhD, is an Associate Professor of Medicine and Director of Yale Program on Aging Biostatistics Core, Yale University School of Medicine and an Associate Professor of Biostatistics, Yale University School of Public Health.


      Melissa Skanderson, MS, is a Programmer at VA Connecticut Healthcare System.


      Evelyn Reyes-Harvey, MS, is a Health Systems Specialist in the Office of Performance Measurement, Office of Analytics and Business Intelligence, Department of Veterans Affairs.


      Elizabeth M. Yano, PhD, MSPH, is Director of the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy at the VA Greater Los Angeles Healthcare System and Professor of Health Policy and Management at the UCLA Fielding School of Public Health. She is a VA Senior Research Career Scientist awardee and nationally recognized expert in women Veterans' research.


      Danielle E. Rose, PhD, is a health research scientist in the HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy at the VA Greater Los Angeles Healthcare System, where her research focuses on organizational influences on quality in primary care and women's health settings.


      Sally Haskell, MD, is the Deputy Chief Consultant for Women's Health Service and Director of Comprehensive Women's Health for the Veterans Health Administration. She is a General Internist, Women's Health Services Researcher, and Associate Professor of Medicine Yale School of Medicine.