Organizational Predictors of VA Primary Care Use by Women Veterans

Yano EM, Washington DL, Goldzweig C, Simon BF. Organizational Predictors of VA Primary Care Use by Women Veterans. Paper presented at: VA HSR&D National Meeting; 2003 Feb 13; Washington, DC.

Objectives: Federal 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 care use. 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. Results: The 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 visit rate. Conclusions: Women 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.