Associations Between Provider Designation and Female-specific Cancer Screening in Women Veterans

Abstract

Background In 2010, the Department of Veterans Affairs Healthcare System (VA) implemented policy to provide Comprehensive Primary Care (for acute, chronic, and female-specific care) from designated Women’s Health providers (DWHPs) at all VA sites. However, since that time no comparisons of quality measures have been available to assess the level of care for women Veterans assigned to these providers. Objectives To evaluate the associations between cervical and breast cancer screening rates among age-appropriate women Veterans and designation of primary-care provider (DWHP vs. non-DWHP). Research Design Cross-sectional analyses using the fiscal year 2012 data on VA women’s health providers, administrative files, and patient-specific quality measures. Subjects The sample included 37,128 women Veterans aged 21 through 69 years. Measures Variables included patient demographic and clinical factors (ie, age, race, ethnicity, mental health diagnoses, obesity, and site), and provider factors (ie, DWHP status, sex, and panel size). Screening measures were defined by age-appropriate subgroups using VA national guidelines. Results Female-specific cancer screening rates were higher among patients assigned to DWHPs (cervical cytology 94.4% vs. 91.9%, P < 0.0001; mammography 86.3% vs. 83.3%, P < 0.0001). In multivariable models with adjustment for patient and provider characteristics, patients assigned to DWHPs had higher odds of cervical cancer screening (odds ratio, 1.26; 95% confidence interval, 1.07–1.47; P < 0.0001) and breast cancer screening (odds ratio, 1.24; 95% CI, 1.10–1.39; P < 0.0001). Conclusions As the proportion of women Veterans increases, assignment to DWHPs may raise rate of female-specific cancer screening within VA. Separate evaluation of sex neutral measures is needed to determine whether other measures accrue benefits for patients with DWHPs.

Patient Perception of Enough Time Spent With Provider Is a Mechanism for Improving Women Veterans’ Experiences With VA Outpatient Health Care

“…We also caution that satisfaction scores, while important measures of patient care, are not objective measures of quality or costs. It has been separately reported that patients seen by DWHPs report higher rates of certain quality measures of women’s health care, that is, indicators regarding mammography and cervical cancer screening (Bean-Mayberry et al, 2015). Like this study, the latter study focused on women only.…”

Coordinating Care for Reproductive Health Malignancies in the Veterans' Health Administration: Promising Practices, Ongoing Challenges, and Future Research

“…In a national sample of women Veterans aged 21 to 64 years, who were assigned VA PCPs in Fiscal Year 2012, 93% received cervical cancer screening over a 3-year interval. 39 In this same study, 87% of women aged 50 to 69 had received a mammogram over a 2-year interval. These high rates in screening have been achieved, in large part, due to VA investing in performance measurement, informatics support for decision support and panel management, and organizational change initiatives.…”

“…Women Veterans assigned to WH-PCPs are more likely, compared with those assigned to VA PCPs who are not WH-PCPs, to have received needed breast and cervical cancer screening. 39 It is unknown the extent to which this observed difference is due to differences in PCP knowledge regarding screening guidelines or use of provider or clinic-based systems for coordinating and supporting screening.…”

Differences in Burnout and Intent to Leave Between Women’s Health and General Primary Care Providers in the Veterans Health Administration

“…Despite these challenges, WH-PCPs are of benefit to women Veterans. Those who are cared for by WH-PCPs receive better preventative care 20 and have higher patient satisfaction 21 than women Veterans cared for by PCPs without the WH designation (referred to hereafter as general PCPs). Similar patterns hold for women patients inside and outside the VHA who receive care in women's health clinics [22][23][24] compared to general primary care clinics.…”