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Guideline Adherence of Veterans Health Administration Primary Care for Abnormal Uterine Bleeding

  • Kristina M. Cordasco
    Correspondence
    Correspondence to: Kristina M. Cordasco, MD, MPH, MSHS, 11301 Wilshire Boulevard, 111G, Los Angeles, CA 90073. Phone: 310-478-3711; fax: 310-268-4933.
    Affiliations
    VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California
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  • Anita H. Yuan
    Affiliations
    VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Marjorie J. Danz
    Affiliations
    VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California

    RAND Corporation, Santa Monica, California
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  • Melissa M. Farmer
    Affiliations
    VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • LaShawnta Jackson
    Affiliations
    VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Ellen F. Yee
    Affiliations
    New Mexico VA Healthcare System, Albuquerque, New Mexico

    Department of Medicine, University of New Mexico, Albuquerque, New Mexico
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  • Donna L. Washington
    Affiliations
    VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California
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Published:February 02, 2019DOI:https://doi.org/10.1016/j.whi.2018.12.004

      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.