Abstract
Background
Abnormal uterine bleeding (AUB) is common among primary care patients. We assessed
the extent to which Veterans Health Administration (VA) primary care patients with
AUB are receiving guideline-adherent primary care.
Methods
We identified women with AUB presenting to primary care providers across four VA health
care systems from June 2013 to September 2015. We performed a structured abstraction
of electronic medical record data for 15 indicators of guideline-adherent AUB care.
We determined whether documented care was guideline-adherent and compared adherence
of care by primary care providers by VA Designated Women's Health Provider status
and by volume of clinical encounters with women veterans.
Results
Across 305 episodes of AUB, 53% of the care was guideline adherent. There was high
adherence with documenting menopausal status (98%), ordering diagnostic studies and
referrals for postmenopausal women (92%), and documenting bleeding patterns (87%).
There was lower adherence with documenting whether there was active bleeding (55%),
performing thyroid testing (47%), performing a pelvic examination (42%), ordering
diagnostic studies and referrals in younger women with increased endometrial cancer
risk (40%), assessing for pregnancy (32%), assessing for cervical motion, uterine,
or adnexal tenderness in patients with intrauterine devices (30%), and assessing for
elevated endometrial cancer risk (6%). There were no significant differences in overall
guideline adherence between primary care providers who were, versus were not, VA Designated
Women's Health Providers, or by provider volume of encounters with women veterans.
Conclusions
VA primary care has high guideline adherence when caring for postmenopausal women
with AUB. Quality improvement and educational initiatives are needed to improve primary
care for AUB in younger women veterans.
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Biography
Kristina M. Cordasco, MD, MPH, MSHS, is a researcher and internal medicine physician with VA Greater Los Angeles Healthcare System, and Associate Clinical Professor of Medicine at The University of California, Los Angeles. Her research focuses on quality, care coordination, and organization of care.
Biography
Ellen F. Yee, MD, is an internal medicine physician with the New Mexico VA Healthcare System, and Professor of Medicine at The University of New Mexico. Her interests include women's health care, cancer screening and prevention, and education.
Biography
Marjorie J. Danz, MD, is a health care services researcher with VA Greater Los Angeles Healthcare System and an Associate Scientist (Adjunct) with the RAND Corporation. Her research focuses on assessing and improving quality of care and quality of care reporting.
Biography
Melissa M. Farmer, PhD, is a core investigator with VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy. Her research focuses on women's health, cardiovascular risk-reduction and disease prevention, organizational variations in care, and performance/quality measurement.
Biography
Anita H. Yuan, PhD, is a junior investigator and quantitative sociologist with VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy. She specializes in data management and analysis of surveys and electronic medical records.
Biography
LaShawnta Jackson, DrPH, is a research health scientist with VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy. Her interests include social determinants of health, health equity, and implementation research.
Biography
Donna L. Washington, MD, MPH, is Women's Health Focused Research Area Lead at VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Professor of Medicine at UCLA. Her research examines health care access, quality, and equity for women and vulnerable populations.
Article info
Publication history
Published online: February 02, 2019
Accepted:
December 21,
2018
Received in revised form:
December 18,
2018
Received:
April 27,
2018
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
