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Yano EM, Goldzweig C, Canelo I, Washington DL. Diffusion of innovation: the VA's experiment in delivering comprehensive women's health care. Paper presented at: VA HSR&D National Meeting; 2006 Feb 1; Arlington, VA.
Objectives:In response to concerns about the availability and quality of women's health services in VA medical centers, Congress approved landmark legislation earmarking funds to enhance women's health services. The VA used a portion of the appropriation to launch 8 Comprehensive Women's Health Centers, designed to serve as exemplars for the development of VA women's health care throughout the system. We evaluated the evolution of VA women's health centers 10 years since the inception of the first programs.Methods:We surveyed the medical directors and senior women's health clinicians at all geographically distinct VA health care facilities serving 400 or more women veterans regarding the organizational structure, available services, and practice arrangements for delivering primary care and gender-specific services (83% response rate). We compared results for the original VA Comprehensive Women's Health Centers (n = 8) and sites that had subsequently adopted Women's Health Clinics (WHCs) (n = 66).Results:Gender-specific service availability in WHCs is roughly comparable to that of the original centers with important exceptions in mental health care, mammography services, and osteoporosis management. Comprehensive WHCs are more likely to have same-gender providers (p < .05), women's health training programs (p < .01), separate women's mental health clinics (p < .001), and separate space and greater privacy (p < .05); however, they are also more likely to have seen program closures in education (p < .001) and staffing losses (p < .05). They were also open more half-days per week (7.9 vs. 5.4), had on average an additional MD (2.9 vs. 1.8), and were more likely to integrate OB-GYN MDs (2.4 vs. 0.8, p < .0001), as well as other specialty MDs and trainees compared to WHCs. Implications:VA's investment in establishing comprehensive women's health care in VA settings has led to a substantial expansion of access to women's clinics over the past decade, though not of comparable size or scope.Impacts:While substantial progress has been made, diffusion of comprehensive women's health care is as yet incomplete. More research is needed to examine the incremental differences in quality and patient satisfaction associated with different care models and features, while the business case for managers faced with relatively small female patient caseloads should also be examined.
