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Association Between Availability of Women's Health Services and Women Veterans' Care Experiences

  • Danielle E. Rose
    Correspondence
    Correspondence to: Danielle E. Rose, PhD, MPH, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer St (152), Los Angeles, CA 91343. Tel.: (818) 891-7711x36038.
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
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  • Sabine M. Oishi
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
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  • Melissa M. Farmer
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
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  • Bevanne Bean-Mayberry
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California

    Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
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  • Ismelda Canelo
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
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  • Donna L. Washington
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California

    Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
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  • Elizabeth M. Yano
    Affiliations
    VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California

    Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California

    Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
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Published:September 14, 2022DOI:https://doi.org/10.1016/j.whi.2022.07.005

      Abstract

      Introduction

      Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences.

      Methods

      In a cross-sectional analysis, we linked Fiscal Year (FY) 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (FY 2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient–provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics.

      Results

      A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01–1.10), provider communication (AOR, 1.08; 95% CI, 1.002–1.16), and primary care provider (AOR, 1.07; 95% CI, 1.02–1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88–0.99).

      Conclusion

      For the most part, routine availability of women's health services in VA primary care clinics enhanced women's healthcare experiences. These empirical findings offer healthcare leaders evidence-based approaches for improving women's care experiences.
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      Biography

      Danielle E. Rose, PhD, MPH, is a core investigator at Greater Los Angeles VA Healthcare System, VA HSR&D, Center for the Study of Healthcare Innovation, Implementation and Policy. Since joining the VA in 2008, Dr. Rose has been studying organizational characteristics and factors in primary care and women's health clinics, and particularly factors associated with adoption and implementation of innovations (e.g., use of tele-health for primary and mental healthcare), implementation of comprehensive care for women veterans, and impacts on quality of care, and patient outcomes.

      Biography

      Melissa M. Farmer, PhD, is a Core Investigator at VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. Her research focuses on prevention, women’s health, research methodology and implementation science, health equity, and complementary and integrative health.

      Biography

      Sabine M. Oishi, PhD, MSPH, served as a Research Health Scientist VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy with research interests in women veterans' healthcare delivery and primary care mental health integration.

      Biography

      Bevanne Bean-Mayberry, MD, MHS, is a Core Investigator at VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy and Clinical Professor of Medicine at UCLA. Her research targets primary care quality, prevention and cardiovascular risk reduction.

      Biography

      Donna L. Washington 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 focuses on healthcare needs of vulnerable and under-served populations.

      Biography

      Elizabeth M. Yano, PhD, MSPH, is Director, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Adjunct Professor of Public Health and Medicine at UCLA. Her research focuses on implementing research into evidence-based practice and policy.

      Biography

      Ismelda Canelo, MPA, is a Health Science Specialist, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. She has more than 20 years of experience managing VA primary care and women's health organizational and implementation research.