Bean-Mayberry BA (VA Greater Los Angeles HSR&D Center of Excellence), Fine MJ
(Center for Health Equity Research and Promotion (CHERP)), Mor M
(Center for Health Equity Research and Promotion (CHERP)), Rose DE
(VA Greater Los Angeles HSR&D Center of Excellence), Wright S
(VA Office of Quality and Performance), Yano EM
(VA Greater Los Angeles HSR&D Center of Excellence)
Although women veterans are among the most rapidly growing populations in the VA, limited research is available on the quality of care women receive in ambulatory care settings. The objective of this study is to evaluate a range of quality measures by gender among a national sample of outpatient users age 50-85 to inform quality improvement efforts within VA.
We used a national sample of outpatient VA users (n = 91,570) identified by the VA Office of Quality and Performance in fiscal years 2001-2003, and focused our analyses on patients aged 50-85. To evaluate the effect of gender on 10 key quality measures for prevention and chronic disease control, we performed multiple logistic regressions, while adjusting for patient demographics, utilization, and region, with clustering at the VA facility level.
Within our analytic sample, 13% of the population was female, 81% was white race, and mean age was 66 years (SD 9) for men, and 67 years (SD 11) for women. We found no difference in screening by gender for documentation of tobacco smoking status (OR 0.82, 95%CI 0.67-1.03), tobacco counseling at least once in the prior year (OR 1.03, 95%CI 0.80-1.31), tobacco counseling at least three times in the past year (OR 0.84, 95%CI 0.66-1.06), or in depression screening (0.94, 95%CI 0.85-1.04). For alcohol (OR 0.80, 95%CI 0.71-0.90), colorectal screening (OR 0.87, 95%CI 0.82-0.91), influenza vaccine (OR 0.88, 95%CI 0.83-0.92), pneumococcal vaccine (OR 0.80, 95%CI 0.75-0.86), and the intermediate outcomes of lipid control (LDL-cholesterol < 130; OR 0.64, 95%CI 0.60-0.68) and blood pressure control (< 140/90; OR 0.89, 95%CI 0.84-0.94), women had significantly lower odds for each respective measure.
Women and men veterans had equal odds of screening for smoking and depression. For more complex quality measures, women had lower levels of prevention and disease control. The etiology of this inequity with more complex quality measures is not clear and requires further elucidation for how men and women use the VA system and how VA organizational features impact their healthcare.
Understanding the influences on quality measures by gender will provide insight for consistent quality treatment of women veterans as their VA numbers increase.