The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration

Reddy, Shivani M.; Rose, Danielle E.; Burgess, James; Charns, Martin P.; Yano, Elizabeth M.

doi:10.1016/j.whi.2016.09.001

Cited by 18 publications

(30 citation statements)

References 44 publications

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“…; Reddy et al. ) may impact women Veterans' experience and thereby the rate of uptake of VA gender‐specific benefits such as maternity coverage. External social and policy factors likely also affect the generalizability of our single‐state study.…”

Section: Discussionmentioning

confidence: 99%

“…Second, California's Veterans' care patterns and needs may not be generalizable to other states. Internal factors, such as regional and local variation in the degree to which VA facilities have implemented gender-specific Veteran care (Oishi et al 2011;Reddy et al 2016) may impact women Veterans' experience and thereby the rate of uptake of VA gender-specific benefits such as maternity coverage. External social and policy factors likely also affect the generalizability of our single-state study.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Shaw

Joyce

Schmitt

et al. 2018

Health Services Research

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Shaw

Joyce

Schmitt

et al. 2018

Health Services Research

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“…For Years 2 and 3, we will re-administer the same surveys, adapting selected domains in relation to EBQI targets of participating VAs. We will include measures of leadership support (22), local resources (e.g., sufficiency of time, personnel, equipment) (23), practice structure (e.g., women's health care model, staff mix, referral arrangements), service availability (24), care coordination arrangements (within and outside VA), ability to engage in QI (e.g., barriers to QI, data access by gender), gender-sensitivity of environment (e.g., privacy), local challenges (e.g., provider shortages, hiring difficulties, practice chaos) (25,26), facility type (e.g., size, academic affiliation, urban/rural), and EBQI activities (17). We will field surveys through REDCap, a VA-approved web survey vendor.…”

Section: Data Sources and Measuresmentioning

confidence: 99%

Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

Hamilton

Olmos-Ochoa²,

Canelo³

et al. 2020

Preprint

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Abstract Background : Women’s Health Services (WHS) in the Veterans Health Administration (VA) has long partnered with VA researchers to evaluate how VA care is organized for women Veterans. This partnership has yielded substantial evidence of 1) variations in women Veterans’ access to comprehensive healthcare services that contribute to disparities in quality and patient experience, and 2) the positive impacts of gender-specific care models for women Veterans’ quality and satisfaction. In an effort to provide support specifically to sites that were low-performing in women’s health, WHS and the VA Quality Enhancement Research Initiative co-funded an effort to roll out and evaluate evidence-based quality improvement (EBQI), an implementation strategy with demonstrated effectiveness in a prior cluster randomized trial in women’s health clinics. Methods : We will identify 21 low-performing VA facilities through a combination of WATCH data, VA quality metrics (by gender) and other indicators. In partnership with WHS, an EBQI contractor will deliver the EBQI “package” – local consensus-development and priority-setting using stakeholder panels, multilevel stakeholder engagement, practice facilitation, local EBQI team training, and formative feedback – to participating sites. We propose a dynamic wait-listed design to evaluate the WHS plans for seven EBQI launches per year over three years. The goal is to evaluate: (1) barriers and facilitators to achieving delivery of comprehensive women’s health care in low-performing VA facilities; (2) effectiveness of EBQI in supporting low-performing VA facilities achieve improved practice features (e.g., level of comprehensive services available, care coordination arrangements, Patient Aligned Care Team (PACT) features implemented, environment of care improvements), provider/staff attitudes (e.g., improved gender awareness, women’s health knowledge and practice), quality of care, and patient experience; and (3) contextual factors, local implementation processes, and organizational changes over time. Discussion : Access to comprehensive women’s health care reduces fragmentation of care, improves patient satisfaction and results in better patient outcomes. We hypothesize that EBQI implementation will result in changes in leadership awareness and buy-in, multilevel engagement in problem-solving, an enhanced culture of quality improvement, structural changes in care, improved provider/staff attitudes, and better quality and patient experience.

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“…Eight manuscripts addressed delivery of reproductive healthcare, including three qualitative studies (Supplementary Table 7). [66][67][68][69][70][71][72][73] Manuscripts addressed reproductive health program development and needs assessment and determinants of reproductive health services, policies, and programs within VA. Five manuscripts addressed program development for improving and integrating reproductive healthcare within VA. [66][67][68][69][70] These included successful development of a women's health training program for resident physicians 66 and identification of key challenges for coordination of gynecology-oncology. 68 In terms of reproductive healthcare needs from the patient perspective, findings highlighted the impact of past trauma on care, the need for additional peer and provider support, 67 knowledge gaps regarding VA coverage of reproductive health services, the desire for additional coverage of infertility and newborn care, and experiences with gender discrimination.…”

Section: Menopausementioning

confidence: 99%

“…69 Three manuscripts examined determinants of reproductive healthcare in VA. Factors associated with increased availability of reproductive healthcare services in primary care and the emergency department included having a women's health clinic (aOR, 3.22; 95% CI, 1.12-9.24), being a metropolitan hospital-based clinic (aOR, 0.33; 95% CI, 0.14-0.74), and having gynecologists on staff (gynecology consultation for emergency department aOR, 10.9; 95% CI, 3.2-36.6). [71][72][73]…”

Section: Menopausementioning

confidence: 99%

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017

et al. 2018

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The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.

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The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration

Cited by 18 publications

References 44 publications

Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data

Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017

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