Comprehensive Care
Conditions
Keywords
women's health, primary health care, mental health, Veterans, quality improvement
Brief summary
Gaps in delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women seen in VA. VA policy action providing guidance on delivery of comprehensive healthcare services for women Veterans was disseminated nationally in 2010, followed by annual assessments and site visits evaluating local VA efforts. While substantial inroads have been made, policy implementation, even when leveraged by field-based women's health leaders, has not been uniformly successful in achieving delivery of comprehensive care by designated providers in gender-sensitive care environments that ensure women's privacy, dignity and safety, all tenets of the original guidance and the updated directive (2017). Building on prior effectiveness of an evidence-based quality improvement (EBQI) approach to tailoring VA's medical home model -- Patient Aligned Care Teams (PACT) -- to the needs of women Veterans, VA leaders in women's health adopted EBQI to help low-performing VAs systematically improve services. The objectives of the resulting Partnered Evaluation Initiative (PEI) funded by VA's Quality Enhancement Research Initiative and VA Office of Women's Health were: 1. To evaluate barriers and facilitators to achieving delivery of comprehensive women's health care in the identified low-performing VAs; 2. To evaluate effectiveness of EBQI in supporting low-performing VA facilities achieve improved organizational features, provider/staff attitudes, quality of care, and patient experiences among women Veteran patients; and, 3. To evaluate contextual factors, local implementation processes, and organizational changes in the participating facilities over time.
Detailed description
Gaps in delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women seen in VA. VA policy action providing guidance on delivery of comprehensive healthcare services for women Veterans was disseminated nationally in 2010, followed by annual assessments and site visits evaluating local VA efforts. While substantial inroads have been made, policy implementation, even when leveraged by field-based women's health leaders, has not been uniformly successful in achieving delivery of comprehensive care by designated providers in gender-sensitive care environments that ensure women's privacy, dignity and safety, all tenets of the original guidance and the updated VA directive (2017). In collaboration with VA Women's Health Services (WHS), VA researchers developed a series of studies to better understand and help improve comprehensive care implementation through the Women Veterans' Healthcare CREATE Initiative. Among these, one focused on testing an evidence-based quality improvement (EBQI) approach to tailoring VA's medical home model -- Patient Aligned Care Teams (PACT) -- to the needs of women Veterans, which has yielded significant local improvements in women Veterans' care. EBQI emphasizes a multilevel partnered approach to building capacity for innovation, implementation and spread of evidence-based practice. With its demonstrated success in the CREATE PACT study and several other EBQI trials, WHS adopted EBQI as a strategy to help low-performing VA facilities systematically improve services. The objectives of the WHS/QUERI Partnered Evaluation Initiative that this project represents are: 1. To evaluate the barriers and facilitators to achieving delivery of comprehensive women's health care in the identified low-performing VA facilities; 2. To evaluate the effectiveness of EBQI in supporting low-performing VA facilities achieve improved: 1. Organizational features (e.g., level of comprehensive services available; care coordination arrangements; PACT features implemented; environment of care improvements); 2. Provider/staff attitudes (e.g., improved gender awareness; women's health knowledge and practice); d) Quality of care and patient experiences among women Veteran patients using secondary data; and, 3. To evaluate contextual factors, local implementation processes, and organizational changes in the participating facilities over time. Results of the evaluation have been used to provide feedback to stakeholders, including women Veterans, at the local, network and national levels, while also being used to continuously refine EBQI implementation processes. The evaluation is also helping inform optimal strategies for ongoing improvements in women Veterans' care in the 21 participating VA facilities, other VA facilities and for other improvement initiatives in this and other national program offices.
Interventions
Multilevel research-clinical partnership approach to supporting local strategic planning, priority setting, skill building and engagement in addressing targeted healthcare delivery problems. Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI education/training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Dynamic waitlist control design with a group of 7 VA facilities was randomly allocated to Evidence-Based Quality Improvement (EBQI) in Year 1 (while 14 VA facilities serving as waitlist controls), the second group of 7 VA facilities was randomly allocated to EBQI in Year 2 (while the 7 remaining VA facilities and the first 7 EBQI sites serving as control), and the final group of 7 VA facilities was randomly allocated to EBQI in Year 3 (while the first 14 EBQI facilities subsequently serving as control). By the end of the three year study period, a total of 21 VA facilities received at least 1 year of EBQI.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Unit of randomization: VA healthcare facilities (VA medical center or community-based outpatient clinic) * Subset of VA healthcare facilities identified as low-performing on the basis of composites of access/wait times, gender disparities in quality, e.g.: * depression screening * diabetic blood sugar control * Presence/absence of VA-required structural facets of care, e.g.: * designated women's health providers * mammography coordinator * gynecology access * Women Veteran Program Manager (WVPM) * 3:1 staffing ratio for PACT teamlets Key Stakeholder Inclusion Criteria (qualitative interviews): * Veteran Integrated Service Network (VISN) level leader (Director or Chief Medical Officer) * VISN level WVPM Lead, VISN level primary care director, VISN level QI/system redesign lead) * VA facility leader (Director or other member of senior leadership) * Chief of Staff * primary care director * women's health medical director * WVPM * local EBQI champion * other key personnel Provider/Staff Survey Inclusion Criteria: * Primary care providers (medical doctor \[MD\], doctor of osteopathy \[DO\], nurse practitioner \[NP\], physician assistant \[PA\]) delivering primary care in general primary care and/or women's health clinics * PACT teamlet members (registered nurse \[RN\] care managers, licensed vocational nurse/licensed practical nurse \[LVN/LPN\]/health technicians, and clerks) * larger PACT team members, e.g.: * social workers * dieticians * health coaches * integrated mental health
Exclusion criteria
* Facility-level exclusion: Facilities not identified in the initial sample of VA facilities (sample not renewed over time).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gender-sensitive Care Environment | 12-month change in gender-sensitive care environment | Multi-item scale score reflecting survey items (from The Women's Assessment Tool for Comprehensive Health (WATCH)) on availability of same-gender providers, availability of same-gender staff, privacy of physical layout, availability of privacy curtains, level of implementation of local culture campaign that values and treats Women Veterans with respect. The score ranges from 0 to 7, with a higher score reflecting greater gender-sensitive care environment. |
| Gender Awareness | 12-month change in gender awareness among VA primary care and women's health providers and staff. | A 12-item score reflecting primary care and women's health providers' and staff's awareness and knowledge of women Veterans' military background and healthcare needs. The score ranges from 1 to 5 with higher scores reflecting greater gender awareness. |
| Quality Improvement Experience | 12-month change | The count of quality improvement activities reported by providers and staff in primary care and women's health settings; including 1) training in quality improvement methods, 2) collaboration with other VA facilities to identify best practices, 3) working with Women Veteran Program Manager to identify and/or solve local problems in caring for women Veterans, 4) using of VA performance data, 5) using of VA survey data by gender, 6) working on a quality improvement project focused on women Veterans, 7) involving in small tests of change for quality improvement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gender-specific Preventive Care Delivery | 12-month change | Rate of cervical cancer screening using the VA External Peer Review Program (EPRP) chart-based quality metrics. |
| Accessibility of Care | 12-month change in accessibility | Women Veterans' ratings of accessibility based on the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded always to validated survey items measuring accessibility, the higher percentage representing better access. |
| Coordination of Care | 12-month change | Women Veterans' ratings of care coordination from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded always to validated survey items measuring care coordination, the higher percentage representing better coordination. |
| Gender-neutral Guideline-concordant Preventive Care Receipt | 12-month change | Percentage of women Veterans' obtaining recommended preventive care based on eligibility for service (e.g., meet eligibility guidelines for timely eye exams for diabetes, flu vaccination, colorectal cancer screening) using VA External Peer Review Program (EPRP) chart-based quality metrics. |
| Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | 12-month change | Percentage of women Veterans assigned to a designated women's health provider in a general primary care and/or women's health primary care setting. |
| Provider Rating | 12 month change | Percent of women patients who rated 9 or 10 on a scale of 0 to 10 for the provider rating question on the Survey of Healthcare Experiences of Patients (SHEP). Higher scores are better. |
Countries
United States
Participant flow
Recruitment details
Cross-sectional surveys were sent to primary care providers and staff at 21 VA Medical Centers at baseline, 12 months, and 24 months.
Pre-assignment details
Twenty one VA facilities were randomized to receive evidence-based quality improvement (EBQI) in a dynamic waitlist control design in which seven facilities received EBQI per year while the remaining 14 facilities were assigned as control.
Participants by arm
| Arm | Count |
|---|---|
| Evidence-Based Quality Improvement (EBQI) EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines. | 124 |
| Evidence-Based Quality Improvement (EBQI) EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines. | 7 |
| Waitlist Controls Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care. | 217 |
| Waitlist Controls Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care. | 14 |
| Total | 362 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| 12-month | non-response | 296 | 669 |
| 12-month | partial completion | 23 | 37 |
| 24-month | non-response | 287 | 594 |
| 24-month | partial completion | 8 | 31 |
| Baseline | non-response | 372 | 669 |
| Baseline | Partial completion | 17 | 48 |
| Overall | non-response | 955 | 1,920 |
| Overall | partial completion | 48 | 68 |
Baseline characteristics
| Characteristic | Evidence-Based Quality Improvement (EBQI) | Waitlist Controls | Total |
|---|---|---|---|
| Age, Customized age 20-29 | 1 Participants | 8 Participants | 9 Participants |
| Age, Customized age 30-39 | 16 Participants | 39 Participants | 55 Participants |
| Age, Customized age 40-49 | 23 Participants | 53 Participants | 76 Participants |
| Age, Customized age 50-59 | 51 Participants | 64 Participants | 115 Participants |
| Age, Customized age 60+ | 16 Participants | 26 Participants | 42 Participants |
| Age, Customized age missing | 17 Participants | 27 Participants | 44 Participants |
| Primary care provider and staff Primary care providers | 23 Participants | 50 Participants | 73 Participants |
| Primary care provider and staff staff | 101 Participants | 167 Participants | 268 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Sex/Gender, Customized Gender Female | 91 Participants | 163 Participants | 254 Participants |
| Sex/Gender, Customized Gender Male | 17 Participants | 30 Participants | 47 Participants |
| Sex/Gender, Customized Gender missing | 16 Participants | 24 Participants | 40 Participants |
| Years worked in VA | 9.85 years STANDARD_DEVIATION 8.4 | 6.96 years STANDARD_DEVIATION 7.24 | 8.01 years STANDARD_DEVIATION 7.79 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Gender Awareness
A 12-item score reflecting primary care and women's health providers' and staff's awareness and knowledge of women Veterans' military background and healthcare needs. The score ranges from 1 to 5 with higher scores reflecting greater gender awareness.
Time frame: 12-month change in gender awareness among VA primary care and women's health providers and staff.
Population: Primary care and women's health providers and staff. The analysis was based on cases with non-missing outcome data. There are 19 missing cases in the EBQI arm and 39 missing in the control arm.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender Awareness | baseline | 3.66 score on a scale | Standard Deviation 0.53 |
| Evidence-Based Quality Improvement (EBQI) | Gender Awareness | 12- month | 3.67 score on a scale | Standard Deviation 0.61 |
| Waitlist Controls | Gender Awareness | baseline | 3.63 score on a scale | Standard Deviation 0.49 |
| Waitlist Controls | Gender Awareness | 12- month | 3.62 score on a scale | Standard Deviation 0.52 |
Comparison: Change in gender awareness score between EBQI and control from baseline to 12-monthp-value: 0.36495% CI: [-0.17, 0.35]Regression, Linear
Primary
Gender Awareness
A 12-item score reflecting primary care and women's health providers' and staff's awareness and knowledge of women Veterans' military roles and healthcare needs . The score ranges from 1 to 5 with higher scores reflecting greater gender awareness.
Time frame: 24-month change in gender awareness among VA primary care and women's health providers and staff
Population: Primary care and women's health providers and staff. The analysis was based on cases with non-missing outcome data. There are 22 missing cases in the EBQI arm and 32 in the control arm.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender Awareness | 24-month | 3.64 score on a scale | Standard Deviation 0.51 |
| Evidence-Based Quality Improvement (EBQI) | Gender Awareness | Baseline | 3.66 score on a scale | Standard Deviation 0.53 |
| Waitlist Controls | Gender Awareness | Baseline | 3.63 score on a scale | Standard Deviation 0.49 |
| Waitlist Controls | Gender Awareness | 24-month | 3.74 score on a scale | Standard Deviation 0.54 |
Comparison: Change in gender awareness score between EBQI and control from baseline to 24-monthp-value: 0.2995% CI: [-0.33, 0.1]Regression, Linear
Primary
Gender-sensitive Care Environment
Multi-item scale score reflecting survey items (from The Women's Assessment Tool for Comprehensive Health (WATCH)) on availability of same-gender providers, availability of same-gender staff, privacy of physical layout, availability of privacy curtains, level of implementation of local culture campaign that values and treats Women Veterans with respect. The score ranges from 0 to 7, with a higher score reflecting greater gender-sensitive care environment.
Time frame: 12-month change in gender-sensitive care environment
Population: One Women Veteran Program Manger per VA Medical Center responded to the survey about the site's Women's Health Program on WATCH.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender-sensitive Care Environment | Baseline | 4.2 score on a scale | Standard Deviation 2.3 |
| Evidence-Based Quality Improvement (EBQI) | Gender-sensitive Care Environment | 12 month | 1.6 score on a scale | Standard Deviation 1.9 |
| Waitlist Controls | Gender-sensitive Care Environment | Baseline | 3.3 score on a scale | Standard Deviation 1.9 |
| Waitlist Controls | Gender-sensitive Care Environment | 12 month | 1.4 score on a scale | Standard Deviation 1.7 |
p-value: 0.62395% CI: [-3.3, 2]ANOVA
Primary
Gender-sensitive Care Environment
Multi-item scale score reflecting survey items (from The Women's Assessment Tool for Comprehensive Health (WATCH)) on availability of same-gender providers, availability of same-gender staff, privacy of physical layout, availability of privacy curtains, level of implementation of local culture campaign that values and treats Women Veterans with respect. The score ranges from 0 to 7, with a higher score reflecting greater gender-sensitive care environment.
Time frame: 24-month change in gender-sensitive care environment
Population: One Women Veteran Program Manger per VA Medical Center responded to the survey about the site's Women's Health Program on WATCH.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender-sensitive Care Environment | Baseline | 4.2 score on a scale | Standard Deviation 2.3 |
| Evidence-Based Quality Improvement (EBQI) | Gender-sensitive Care Environment | 24 month | 3.2 score on a scale | Standard Deviation 0.8 |
| Waitlist Controls | Gender-sensitive Care Environment | Baseline | 3.3 score on a scale | Standard Deviation 1.9 |
| Waitlist Controls | Gender-sensitive Care Environment | 24 month | 2.8 score on a scale | Standard Deviation 1.6 |
p-value: 0.67895% CI: [-2.8, 1.8]ANOVA
Primary
Quality Improvement Experience
The count of quality improvement activities reported by providers and staff in primary care and women's health settings; including 1) training in quality improvement methods, 2) collaboration with other VA facilities to identify best practices, 3) working with Women Veteran Program Manager to identify and/or solve local problems in caring for women Veterans, 4) using of VA performance data, 5) using of VA survey data by gender, 6) working on a quality improvement project focused on women Veterans, 7) involving in small tests of change for quality improvement.
Time frame: 12-month change
Population: Primary care and women's health providers and staff at 21 VA Medical Centers. The analysis was based on cases with non-missing outcome data. There were 31 missing in the EBQI arm and 43 missing in the control arm.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 4 activities | 14 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 0 activity | 26 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 2 activities | 17 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 1 activity | 16 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 5 activities | 3 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 2 activities | 13 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 1 activity | 17 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 3 activities | 5 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 6 activities | 8 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 4 activities | 6 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 3 activities | 11 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 5 activities | 2 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 7 activities | 2 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 6 activities | 2 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | 7 activities | 3 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 0 activity | 29 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 12-month | missing | 8 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | missing | 23 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | missing | 18 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 0 activity | 70 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 1 activity | 46 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 2 activities | 29 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 3 activities | 19 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 4 activities | 13 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 5 activities | 4 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 6 activities | 7 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 7 activities | 4 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | missing | 25 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 0 activity | 54 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 1 activity | 41 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 2 activities | 38 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 3 activities | 22 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 4 activities | 11 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 5 activities | 12 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 7 activities | 4 Participants |
| Waitlist Controls | Quality Improvement Experience | 12-month | 6 activities | 5 Participants |
p-value: 0.195% CI: [-1.52, 0.13]Difference-in-Differences analysis
Primary
Quality Improvement Experience
The count of quality improvement activities reported by provider and staff in primary care and women's health settings; including 1) training in quality improvement methods \[e.g., LEAN\], 2) collaboration with other VA facilities to identify best practices, 3) working with Women Veteran Program Manager to identify and/or solve local problems in caring for women Veterans, 4) using of VA performance data, 5) using of VA survey data by gender, 6) working on a quality improvement project focused on women Veterans, 7) involving in small tests of change for quality improvement.
Time frame: 24-month change
Population: Primary care and women's health providers and staff at 21 VA Medical Centers. The analysis was based on cases with non-missing outcome data. There were 27 missing in the EBQI arm and 32 missing in the control arm.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 4 activities | 14 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 0 activity | 44 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 2 activities | 17 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 1 activity | 19 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 5 activities | 3 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 2 activities | 22 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 1 activity | 17 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 3 activities | 18 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 6 activities | 8 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 4 activities | 7 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 3 activities | 11 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 5 activities | 2 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 6 activities | 3 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 7 activities | 2 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | 7 activities | 3 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | 0 activity | 29 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | 24-month | missing | 4 Participants |
| Evidence-Based Quality Improvement (EBQI) | Quality Improvement Experience | Baseline | missing | 23 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | missing | 7 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 0 activity | 70 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 1 activity | 46 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 2 activities | 29 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 3 activities | 19 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 4 activities | 13 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 5 activities | 4 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 6 activities | 7 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | 7 activities | 4 Participants |
| Waitlist Controls | Quality Improvement Experience | Baseline | missing | 25 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 0 activity | 66 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 1 activity | 43 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 2 activities | 39 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 3 activities | 27 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 4 activities | 16 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 6 activities | 12 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 7 activities | 3 Participants |
| Waitlist Controls | Quality Improvement Experience | 24-month | 5 activities | 9 Participants |
p-value: 0.2295% CI: [-1.25, 0.29]Regression, Logistic
Secondary
Accessibility of Care
Women Veterans' ratings of accessibility from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded always to validated survey items measuring accessibility, the higher percentage representing better access.
Time frame: 24-month change in accessibility
Population: The analysis population size is extracted from SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Accessibility of Care | Baseline | 46.7 Percent always | Standard Deviation 9.3 |
| Evidence-Based Quality Improvement (EBQI) | Accessibility of Care | 24month | 42.7 Percent always | Standard Deviation 13.7 |
| Waitlist Controls | Accessibility of Care | Baseline | 43.0 Percent always | Standard Deviation 17.8 |
| Waitlist Controls | Accessibility of Care | 24month | 42.3 Percent always | Standard Deviation 14.7 |
p-value: 0.70895% CI: [-24.89, 17.08]ANOVA
Secondary
Accessibility of Care
Women Veterans' ratings of accessibility based on the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded always to validated survey items measuring accessibility, the higher percentage representing better access.
Time frame: 12-month change in accessibility
Population: The analysis population size is extracted from SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Accessibility of Care | baseline | 48.6 percent always | Standard Deviation 12.2 |
| Evidence-Based Quality Improvement (EBQI) | Accessibility of Care | 12month | 41.1 percent always | Standard Deviation 24.5 |
| Waitlist Controls | Accessibility of Care | baseline | 44.4 percent always | Standard Deviation 18.5 |
| Waitlist Controls | Accessibility of Care | 12month | 37.1 percent always | Standard Deviation 8 |
p-value: 0.98795% CI: [-21.45, 21.11]ANOVA
Secondary
Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass
Percentage of women Veterans assigned to a designated women's health provider in a general primary care and/or women's health primary care setting.
Time frame: 12-month change
Population: The analysis population was extracted from the Patient Aligned Care Teams (PACT) Compass, developed to meet the needs for VA PACT implementation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | Baseline | 65.8 percentage of female patients | Standard Deviation 17.2 |
| Evidence-Based Quality Improvement (EBQI) | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | 12 month | 74.0 percentage of female patients | Standard Deviation 6.3 |
| Waitlist Controls | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | Baseline | 65.8 percentage of female patients | Standard Deviation 17.2 |
| Waitlist Controls | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | 12 month | 73.8 percentage of female patients | Standard Deviation 13.7 |
p-value: 0.71195% CI: [-13.7, 19.9]ANOVA
Secondary
Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass
Percentage of women Veterans assigned to a designated women's health provider in a general primary care and/or women's health primary care setting
Time frame: 24-month change
Population: The analysis population was extracted from the Patient Aligned Care Teams (PACT) Compass, developed to meet the needs for VA PACT implementation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | Baseline | 65.8 percentage of female patients | Standard Deviation 17.2 |
| Evidence-Based Quality Improvement (EBQI) | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | 24 month | 78.6 percentage of female patients | Standard Deviation 11.3 |
| Waitlist Controls | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | Baseline | 68.7 percentage of female patients | Standard Deviation 11.3 |
| Waitlist Controls | Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass | 24 month | 73.1 percentage of female patients | Standard Deviation 13.8 |
p-value: 0.33595% CI: [-9.1, 26.1]ANOVA
Secondary
Coordination of Care
Women Veterans' ratings of care coordination from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded always to validated survey items measuring care coordination, the higher percentage representing better coordination.
Time frame: 12-month change
Population: The analysis population size is unknown and reported at the level of the VA Medical Centers. SHEP randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Coordination of Care | baseline | 54.60 percent always | Standard Deviation 12.43 |
| Evidence-Based Quality Improvement (EBQI) | Coordination of Care | 12 month | 52.95 percent always | Standard Deviation 19.3 |
| Waitlist Controls | Coordination of Care | baseline | 55.78 percent always | Standard Deviation 14.05 |
| Waitlist Controls | Coordination of Care | 12 month | 58.65 percent always | Standard Deviation 9.67 |
p-value: 0.61395% CI: [-22.43, 13.4]ANOVA
Secondary
Coordination of Care
Women Veterans' ratings of care coordination from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded always to validated survey items measuring care coordination, the higher percentage representing better coordination.
Time frame: 24-month change
Population: The analysis population size is extracted SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Coordination of Care | baseline | 53.0 percent always | Standard Deviation 9.3 |
| Evidence-Based Quality Improvement (EBQI) | Coordination of Care | 24 month | 51.4 percent always | Standard Deviation 13.7 |
| Waitlist Controls | Coordination of Care | baseline | 54.7 percent always | Standard Deviation 13.4 |
| Waitlist Controls | Coordination of Care | 24 month | 51.2 percent always | Standard Deviation 15.2 |
p-value: 0.92295% CI: [-18.26, 20.13]ANOVA
Secondary
Gender-neutral Guideline-concordant Preventive Care Receipt
Percentage of women Veterans' obtaining recommended preventive care based on eligibility for service (e.g., meet eligibility guidelines for timely eye exams for diabetes, flu vaccination, colorectal cancer screening) using VA External Peer Review Program (EPRP) chart-based quality metrics.
Time frame: 12-month change
Population: The analysis population is extracted from EPRP, which randomly selected VA women patients aged 18-75 whose charts were reviewed for preventive care measures.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender-neutral Guideline-concordant Preventive Care Receipt | Baseline | 78.8 percentage of female patients | Standard Deviation 2.2 |
| Evidence-Based Quality Improvement (EBQI) | Gender-neutral Guideline-concordant Preventive Care Receipt | 12 month | 75.9 percentage of female patients | Standard Deviation 4.7 |
| Waitlist Controls | Gender-neutral Guideline-concordant Preventive Care Receipt | Baseline | 78.6 percentage of female patients | Standard Deviation 2.9 |
| Waitlist Controls | Gender-neutral Guideline-concordant Preventive Care Receipt | 12 month | 75.1 percentage of female patients | Standard Deviation 3.1 |
p-value: 0.78995% CI: [-3.74, 4.89]ANOVA
Secondary
Gender-neutral Guideline-concordant Preventive Care Receipt
Percentage of women Veterans' obtaining recommended preventive care based on eligibility for service (e.g., meet eligibility guidelines for timely eye exams for diabetes, flu vaccination, colorectal cancer screening) using VA External Peer Review Program (EPRP) chart-based quality metrics
Time frame: 24-month change
Population: The analysis population is extracted from EPRP, which randomly selected women patients aged 18-75 whose charts were reviewed for preventive care metrics.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender-neutral Guideline-concordant Preventive Care Receipt | Baseline | 78.8 percentage of female patients | Standard Deviation 2.23 |
| Evidence-Based Quality Improvement (EBQI) | Gender-neutral Guideline-concordant Preventive Care Receipt | 24 month | 75.9 percentage of female patients | Standard Deviation 4.7 |
| Waitlist Controls | Gender-neutral Guideline-concordant Preventive Care Receipt | Baseline | 78.6 percentage of female patients | Standard Deviation 2.75 |
| Waitlist Controls | Gender-neutral Guideline-concordant Preventive Care Receipt | 24 month | 75.0 percentage of female patients | Standard Deviation 3 |
p-value: 0.5195% CI: [-6.6, 3.33]ANOVA
Secondary
Gender-specific Preventive Care Delivery
Rate of cervical cancer screening using the VA External Peer Review Program (EPRP) chart-based quality metrics.
Time frame: 24-month change in gender-specific preventive care delivery
Population: The analysis population size is extracted from EPRP reported denominators. EPRP randomly selected women patients aged 21-64and reviewed their charts for cervical cancer screening with a Pap test in the past three years.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender-specific Preventive Care Delivery | Baseline | 87.5 percentage of women patients | Standard Deviation 4.12 |
| Evidence-Based Quality Improvement (EBQI) | Gender-specific Preventive Care Delivery | 24 month | 84.6 percentage of women patients | Standard Deviation 3.98 |
| Waitlist Controls | Gender-specific Preventive Care Delivery | Baseline | 87.2 percentage of women patients | Standard Deviation 4.3 |
| Waitlist Controls | Gender-specific Preventive Care Delivery | 24 month | 85.8 percentage of women patients | Standard Deviation 4.83 |
p-value: 0.6195% CI: [-7.35, 4.35]ANOVA
Secondary
Gender-specific Preventive Care Delivery
Rate of cervical cancer screening using the VA External Peer Review Program (EPRP) chart-based quality metrics.
Time frame: 12-month change
Population: The analysis population size was extracted from EPRP reported denominators. EPRP randomly selected women patients aged 21-64and reviewed their charts for cervical cancer screening with a Pap test in the past three years.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Gender-specific Preventive Care Delivery | Baseline | 87.5 percentage of women patients | Standard Deviation 4.1 |
| Evidence-Based Quality Improvement (EBQI) | Gender-specific Preventive Care Delivery | 12 month | 87.5 percentage of women patients | Standard Deviation 3.9 |
| Waitlist Controls | Gender-specific Preventive Care Delivery | Baseline | 87.2 percentage of women patients | Standard Deviation 4.3 |
| Waitlist Controls | Gender-specific Preventive Care Delivery | 12 month | 88.1 percentage of women patients | Standard Deviation 6.11 |
p-value: 0.78895% CI: [-7.1, 5.4]ANOVA
Secondary
Provider Rating
Percent of women patients who rated 9 or 10 on a scale of 0 to 10 for the provider rating question on the Survey of Healthcare Experiences of Patients (SHEP). Higher scores are better.
Time frame: 12 month change
Population: Analysis population size was extracted SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Provider Rating | Baseline | 65.9 percentage of women patients | Standard Deviation 13.5 |
| Evidence-Based Quality Improvement (EBQI) | Provider Rating | 12 Month | 59.9 percentage of women patients | Standard Deviation 32.5 |
| Waitlist Controls | Provider Rating | Baseline | 63.6 percentage of women patients | Standard Deviation 16.7 |
| Waitlist Controls | Provider Rating | 12 Month | 71.3 percentage of women patients | Standard Deviation 13.4 |
p-value: 0.26895% CI: [-38.7, 11.1]ANOVA
Secondary
Provider Rating
Percent of women patients who rated 9 or 10 on a scale of 0 to 10 for the provider rating question from the Survey of Healthcare Experiences of Patients (SHEP). Higher scores are better.
Time frame: 24-month change
Population: The analysis population size is extracted SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Evidence-Based Quality Improvement (EBQI) | Provider Rating | Baseline | 65.9 percentage of women patients | Standard Deviation 13.5 |
| Evidence-Based Quality Improvement (EBQI) | Provider Rating | 24 months | 59.7 percentage of women patients | Standard Deviation 14.2 |
| Waitlist Controls | Provider Rating | Baseline | 63.6 percentage of women patients | Standard Deviation 16.7 |
| Waitlist Controls | Provider Rating | 24 months | 57.5 percentage of women patients | Standard Deviation 14.2 |
p-value: 0.99195% CI: [-25.6, 25.3]ANOVA