March 2017

In this Issue: VA Healthcare for Women Veterans
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Evaluating Outsourced Care for Women Veterans

Feature Article

While the number of women Veterans utilizing VA care is rising, many specialized, gender-specific services (e.g. mammography and prenatal care) are not widely available within the VA healthcare system. In these instances, federal law enables VA to pay for Veterans' care at outside facilities. This ongoing study examines providers' and fee-basis managers' strategies for the provision, coordination, and oversight of outsourced care. Investigators also are assessing the perceptions and experiences of women Veterans with non-VA care. Follow-up of abnormal mammograms is used as a case example for evaluating gender-specific non-VA care.

Study investigators used the Women's Health Evaluation Initiative Database (WHEI) to ascertain the top 24 VA sites nationally for non-VA care referrals for women Veterans — and to identify women Veterans from each of those facilities that received non-VA care from FY2010-FY2012. In addition, women's health providers and fee-basis managers from the 24 facilities were interviewed to understand their perceptions and experiences with non-VA care. Investigators also conducted a retrospective electronic medical chart review to identify women (ages 40-74) at 8 sites with either non-VA or in-house mammograms in FY12. They then evaluated whether the results of mammograms were appropriately acknowledged in the patient's medical record, and whether abnormal mammograms received appropriate and timely follow-up. Abnormal mammogram results were defined by the existing Breast Imaging Reporting and Data System Atlas (BI-RADS) scoring system, using BI-RADS categories of 0 (indeterminate), 3 (probably benign), 4 (suspicious for cancer), and 5 (highly suspicious for cancer). Thus far, findings show that 6,800 completed mammogram were requested in FY2012: 643 (10%) mammograms were missing BI-RADS scoring from administrative data, in addition to 848 (13%) with a BI-RADS score of 0, 48 (0.7. %) with a score of 3, and 17 (0.3%) with scores of 4 or 5.

Impact: Given that the use of non-VA care is increasing within the VA system and due to the Veterans Choice Program, understanding the provision, coordination, and perceived quality of this type of care is of utmost importance as VA continues to understand how to provide the best comprehensive healthcare for women Veterans.

Principal Investigators: Lori Bastian, MD, MPH, is Director of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center in West Haven, CT, and Principal Investigator (PI) with the Women Veterans Healthcare CREATE, and Kristin Mattocks, PhD, MPH, also a PI with the Women Veterans Healthcare CREATE, and part of the VA Central Western Massachusetts Healthcare System.

Mattocks K, Mengeling M, Sadler A, et al. The Veterans Choice Act: A qualitative examination of rapid policy implementation in the Department of Veterans Affairs. Medical Care. In press.

Evaluating Outsourced Care for Women Veterans project abstract