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Development of Quality Indicators for the Care of Women with Abnormal Uterine Bleeding by Primary Care Providers in the Veterans Health Administration

  • Donna L. Washington
    Correspondence
    Correspondence to: Donna L. Washington, MD, MPH, Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, 111G, Los Angeles, CA 90073. Phone: 310-478-3711; fax: 310-268-4933.
    Affiliations
    VA Health Services Research & Development 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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  • Marjorie Danz
    Affiliations
    VA Health Services Research & Development 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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  • LaShawnta Jackson
    Affiliations
    VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Kristina M. Cordasco
    Affiliations
    VA Health Services Research & Development 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:December 15, 2018DOI:https://doi.org/10.1016/j.whi.2018.11.002

      Abstract

      Background

      Abnormal uterine bleeding (AUB) is a common women's health complaint. However, the quality of primary care (PC) management of AUB is unknown. Our objective was to develop quality indicators for Veterans Health Administration (VA) PC assessment and management of AUB.

      Methods

      We drafted candidate indicators based on comprehensive review of the scientific literature, including published consensus guidelines. Then, we convened a national panel of nine experts including PC providers, obstetrician-gynecologists, VA policy stakeholders, and quality measurement experts, and used a modified Delphi panel process. First, panelists individually rated 19 candidate indicators, using 9-point scales, on three metrics: consistency with established guidelines, importance to women's health, and reliability of measurement from VA electronic health records. Panelists then discussed the indicators. Finally, panelists re-rated revised indicators using the same metrics. Indicators were selected if final median ratings were ≥7 on each 9-point scale, without dispersion in ratings.

      Results

      Eighteen indicators were selected. Three focused on assessing need for emergency care (e.g., profuse bleeding or pregnancy). Three addressed ascertaining key aspects of the medical history (e.g., endometrial cancer risk). Two addressed performing a physical examination (e.g., pelvic examination). Six addressed indications for diagnostic studies and specialty care referrals, (e.g., transvaginal ultrasound examination). Four addressed initiation of treatment and counseling (e.g., hormone therapy).

      Conclusions

      We developed quality indicators for PC assessment and management of AUB that span reproductive and postmenopausal life phases. Applying these indicators in VA and other health systems with integrated electronic health records can assess need for, and effects of, AUB quality improvement programs.
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      Biography

      Donna L. Washington, MD, MPH, is Women's Health Focused Research Area Lead, 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/vulnerable populations.

      Biography

      Marjorie 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

      LaShawnta Jackson, DrPH, is a research health scientist with VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy. Her interests include social determinants of health, health equity, and implementation research.

      Biography

      Kristina M. Cordasco, MD, MPH, MSHS, is a researcher and internal medicine physician, VA Greater Los Angeles Healthcare System, and Associate Clinical Professor of Medicine, The University of California, Los Angeles. Her research focuses on quality, care coordination, and organization of care.