Project Background: Women Veterans'numerical minority in VA healthcare settings has created logistical challenges to delivering gender-sensitive comprehensive services. These challenges have only grown as more WVs have enrolled in VA care. The quality of care they receive continues to lag behind that of male veterans, while gender sensitivity, including adequate attention to privacy/safety and awareness of WVs'military roles and experiences, is often lacking. On-site availability of gender-specific services has also not kept pace, with WVs more likely to be outsourced for gender-specific care now than they were ten years ago. Further, while the proportion of VA facilities having WH clinics has increased, 44% of them do not deliver comprehensive primary care (PC) services, instead focusing only on gender-specific exams. Lack of gender-sensitive, comprehensive WH care delivery has also demonstrated consequences for patient ratings of access, continuity and coordination, and technical quality. Project Objectives:
We aim to assess the effectiveness of EBQI methods for developing a WH-PACT model using a cluster randomized trial design (Aim #1);examine impacts of receipt of WH-PACT concordant care on women veterans'outcomes (Aim #2);evaluate processes of EBQI-supported WH-PACT implementation (Aim #3);and develop implementation and evaluation tools for use in EBQI-supported WH-PACT model adaptation, implementation, sustainability and spread to additional VA facilities (Aim #4). Project Methods: EBQI is a systematic approach to developing a multi-level research-clinical partnership approach to engaging local organizational senior leaders and QI teams in adapting and implementing new care models in the context of prior evidence, local practice context, and provider behavior change methods, with researchers providing technical support and practice facilitation. In a cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider and practice surveys, in addition to analyses of secondary data, in addition to intermediate changes in provider, staff and team knowledge and attitudes. We will also explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, utilization and costs. Using mixed methods, we will assess pre-post EBQI practice context;document EBQI methods and their relationship to provider/staff and team actions/attitudes;document WH-PACT implementation;and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data.
VA has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team- based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women veterans, is yet to be worked out. The main goal of this study is to develop and test an evidence-based quality improvement approach (EBQI) to implementing a Women's Health (WH) PACT, incorporating comprehensive WH care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women veterans and reducing persistent gender disparities in VA quality of care.