Lead/Presenter: Claire Than, COIN - Los Angeles
All Authors: Than CT (VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System), Rose DE (VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System), Washington DL (VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System) Needleman J (University of California Los Angeles, Fielding School of Public Health) Chuang E (University of California Los Angeles, Fielding School of Public Health) Canelo I (VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System) Yano EM (VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System)
Objectives:
Women Veterans (WVs) are the fastest growing Veteran group, yet early evidence shows that about 25% of them discontinues VA care within 3 years of initial VA use and that the workforce gender sensitivity may be contributing to WV experiences with care. Over the last decade, the Department of Veterans Affairs has invested in enhancing its workforce gender sensitivity through training, and transforming primary care (PC) for WVs through Women's Health Patient-Aligned Care Teams (WH-PACTs). Little is known about the impact of these VA efforts on care discontinuity. We evaluated whether care from WH-PACTs and PC provider (PCP) and staff gender sensitivity were associated with care discontinuity in PC among WVs.
Methods:
Care discontinuity in PC was defined as having no PC-related visits for three years after the patient's last PC visit between 2013 and 2014 (data was available up to 2017). We merged cross-sectional surveys of PCPs and staff, to administrative data identifying WVs and their PC use. We surveyed all PCPs and staff practicing in WH-PACTs or mixed-gender PACTs at 12 VA Medical Centers between September 2014 and June 2015, and measured their gender sensitivity using 10 survey items. We identified 8,343 WVs who were cared for by 85 PCPs and 105 staff between 2013 and 2014. We categorized care from WH-PACTs, PACTs, or both PACTs and WH-PACTs based on where PCPs and staff worked in. Logistic regression included WVs age, comorbidities, service-connected disabilities, driving time to the PC site, and baseline utilization.
Results:
Within three years, 35% of WVs discontinued primary care, with the discontinuity rate being the highest in mixed-gender PACTs (62%), followed by WH-PACTs (35%) and PACTs/WH-PACTs (24%). Overall, 71% of WVs received care in WH-PACTs, 12% in mixed-gender PACTs, and 17% in both PACTs/WH-PACTs. Compared with mixed-gender PACTs, WH-PACTs and PACTs/WH-PACTs were associated with lower odds of PC discontinuity among WVs. PCP and staff gender sensitivity were not associated with PC discontinuity.
Implications:
Primary care through WH-PACTs, rather than gender sensitivity, was associated with lower care discontinuity for WVs.
Impacts:
Gender-sensitive medical homes, in addition to improving workforce gender sensitivity, can help achieve care continuity for female patients.