The Department of Veterans Affairs (VA) and other federal agencies require funded researchers to include women in their studies. Historically, many researchers have indicated they will include women in proportion to their VA representation or pointed to their numerical minority as justification for exclusion. However, women’s participation in the military—currently 14% of active military—is rapidly changing veteran demographics, with women among the fastest growing segments of new VA users. These changes will require researchers to meet the challenge of finding ways to adequately represent women veterans for meaningful analysis. We describe women veterans’ health and health-care use, note how VA care is organized to meet their needs, report gender differences in quality, highlight national plans for women veterans’ quality improvement, and discuss VA women’s health research. We then discuss challenges and potential solutions for increasing representation of women veterans in VA research, including steps for implementation research.

The Veterans Health Administration (VA) has undertaken a major initiative to transform primary care delivery through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home concept, PACTs aim to improve access, continuity, coordination, and comprehensiveness using teambased care that is patient driven and patient centered. However, how PACT principles should be applied to meet the needs of special populations, including women veterans, is not entirely clear. While historical differences in military participation meant women veterans were rarely seen in VA healthcare settings, they now represent the fastest growing segment of new VA users. They also have complex healthcare needs, adding gender-specific services and other needs to the spectrum of services that the VA must deliver. These trends are changing the VA landscape, introducing challenges to how VA care is organized, how VA providers need to be trained, and how VA considers implementation of new initiatives, such as PACT. We briefly describe the evolution of VA primary care delivery for women veterans, review VA policy for delivering gender-sensitive comprehensive primary care for women, and discuss the challenges that women veterans' needs pose in the context of PACT implementation. We conclude with recommendations for addressing some of these challenges moving forward.KEY WORDS: primary care; women's health; veterans.

No abstract

OBJECTIVE:To compare patient satisfaction in women's clinics (WCs) versus traditional primary care clinics (TCs).DESIGN: Anonymous, cross-sectional mailed survey.SETTING: Eight Department of Veterans Affairs (VA) medical centers in 3 states.PATIENTS: A random sample of women stratified by site and enrollment in WC versus TC (total response rate = 61%). MEASURES:Overall satisfaction and gender-specific satisfaction as measured by the Primary Care Satisfaction Survey for Women (PCSSW). ANALYSIS:We dichotomized the satisfaction scores (excellent versus all other), and compared excellent satisfaction in WCs versus TCs using logistic regression, controlling for demographics, health status, health care use, and location.RESULTS: Women enrolled in WCs were more likely than those in TCs to report excellent overall satisfaction (odds ratio, 1.42; 95% confidence interval, 1.00 to 2.02; P = .05). Multivariate models demonstrated that receipt of care in WCs was a significant positive predictor for all 5 satisfaction domains (i.e., getting care, privacy and comfort, communication, complete care, and follow-up care) with the gender-specific satisfaction instrument (PCSSW). CONCLUSIONS:This study is the first to consistently show higher satisfaction in WCs versus TCs despite age and race differences and comparable health status. Since these WCs show better quality in terms of satisfaction, other quality indicators should be evaluated. If WCs reduce fragmentation and improve health care delivery, the model will be applicable in VA and non-VA outpatient settings. 7 These programs vary in their organization, ranging from comprehensive gender-specific primary care delivered by women's health specialists to strictly reproductive care for women. 8 Despite the increasing numbers, few data demonstrate whether specialized women's health centers improve the quality of primary care for women. Two recent studies compared satisfaction, 1 aspect of quality, in specialized women's clinics (WCs) versus traditional primary care clinics (TCs) 1,9 and found similar ratings of overall satisfaction between patients in the 2 settings. While 1 study did find differences along items specific to patientphysician communication, 1 the findings did not impact overall outcomes. However, these studies were limited to a small number of academic practices in a single city serving primarily higher-income women.In contrast, medical centers within the Department of Veterans Affairs (VA) offer the opportunity to compare WCs and TCs in multiple locations with a less affluent population. Since 1992, when the VA began encouraging the development of specialized women's health programs to address disparities for women veterans, 10 a majority (62%) of VA sites report a women's health program or center. 11 We initiated this study to evaluate patient satisfaction among women veterans in WCs versus TCs. On the basis of the concept that comprehensive centers or single systems with multispecialty services 12 provide higher satisfaction, we hypothesized that patient satisf...