Predictors of VA Primary Care Use by Women Veterans
EM Yano, VA Greater Los Angeles Healthcare System, DL Washington, VA Greater Los Angeles Healthcare System, C Goldzweig, VA Greater Los Angeles Healthcare System, B Simon, VA Greater Los Angeles Healthcare System
legislation dictates increased outreach, equitable access and comprehensive
service availability for women veterans. A
National Women Veterans Health Strategic Work Group was charged by the VA Under
Secretary for Health to develop evidence-based strategic recommendations for
enhancing women’s healthcare delivery in support of these goals.
We report on an evaluation of the Women Veterans Health Program that was
undertaken as part of this effort. Our
objective for this analysis was to determine the women’s health program
organizational features that are associated with women veterans’ VA primary
Methods: We extracted
facility-level primary care (PC) visit rates for women veterans from VA
administrative data, using stopcodes for general primary care and women’s
health. In a VA-wide census of
chiefs-of-staff at all VA facilities serving 400 or more women veterans, we
assessed characteristics of the women’s health practice organization,
structure, and management.
number of VA PC visits per 1000 women veterans ranged from 6 to 5,066 (mean
1,242; s.d. 737). Facility tracking
of women veterans’ satisfaction, having a separate women’s health budget,
and an increase in the prior two years in resources for women’s health were
independently associated with a greater women veteran PC visit rate (all
p<.05). Southern region,
semi-rural location, and facility tracking of number of unique women, though
associated in bivariate analyses, were not independent predictors.
The number of unique women veterans at that site, the proportion of
patients that are female, having Tri-Care arrangements, degree of separation or
integration of women’s PC services with services for men, and degree of
managed care penetration in the surrounding area were not associated with PC
veterans’ primary care visit rate is independent of the women’s healthcare
delivery model or of women veteran volume at that site.
Rather, it is linked to tracking women veterans’ satisfaction with care
and with increased resources for women’s health.
Impact: The number of women veterans is expected to increase substantially over the next decade. Our findings suggest that as facilities continue to adapt to this changing demographic, models of care should continue to evolve based on local VA and women veteran preferences.