Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VAs
Completed · Not applicable
Conditions studied: Comprehensive Care
In brief
Gaps in delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women seen in VA. VA policy action providing guidance on delivery of comprehensive healthcare services for women Veterans was disseminated nationally in 2010, followed by annual assessments and site visits evaluating local VA efforts. While substantial inroads have been made, policy implementation, even when leveraged by field-based women's health leaders, has not been uniformly successful in achieving delivery of comprehensive care by designated providers in gender-sensitive care environments that ensure women's privacy, dignity and safety, all tenets of the original guidance and the updated directive (2017). Building on prior effectiveness of an evidence-based quality improvement (EBQI) approach to tailoring VA's medical home model -- Patient Aligned Care Teams (PACT) -- to the needs of women Veterans, VA leaders in women's health adopted EBQI to help low-performing VAs systematically improve services. The objectives of the resulting Partnered Evaluation Initiative (PEI) funded by VA's Quality Enhancement Research Initiative and VA Office of Women's Health were: 1. To evaluate barriers and facilitators to achieving delivery of comprehensive women's health care in the identified low-performing VAs; 2. To evaluate effectiveness of EBQI in supporting low-performing VA facilities achieve improved organizational features, provider/staff attitudes, quality of care, and patient experiences among women Veteran patients; and, 3. To evaluate contextual factors, local implementation processes, and organizational changes in the participating facilities over time.
Key facts
- Study ID
- NCT03238417
- Run by
- VA Office of Research and Development
- People needed
- 21
- Starts
- 2017-01-09
- Expected to finish
- 2020-11-30
- Last updated by the study team
- 2023-07-27
Who can join
Age: 18 and older. Sex: any. Healthy volunteers: not accepted.
You may qualify if…
- Unit of randomization: VA healthcare facilities (VA medical center or community-based outpatient clinic)
- Subset of VA healthcare facilities identified as low-performing on the basis of composites of access/wait times, gender disparities in quality, e.g.:
- depression screening
- diabetic blood sugar control
- Presence/absence of VA-required structural facets of care, e.g.:
- designated women's health providers
- mammography coordinator
- gynecology access
- Women Veteran Program Manager (WVPM)
- 3:1 staffing ratio for PACT teamlets
- Key Stakeholder Inclusion Criteria (qualitative interviews):
- Veteran Integrated Service Network (VISN) level leader (Director or Chief Medical Officer)
- VISN level WVPM Lead, VISN level primary care director, VISN level QI/system redesign lead)
- VA facility leader (Director or other member of senior leadership)
- Chief of Staff
- primary care director
- women's health medical director
- WVPM
- local EBQI champion
- other key personnel
- Provider/Staff Survey Inclusion Criteria:
- Primary care providers (medical doctor [MD], doctor of osteopathy [DO], nurse practitioner [NP], physician assistant [PA]) delivering primary care in general primary care and/or women's health clinics
- PACT teamlet members (registered nurse [RN] care managers, licensed vocational nurse/licensed practical nurse [LVN/LPN]/health technicians, and clerks)
- larger PACT team members, e.g.:
- social workers
You may not qualify if…
- Facility-level exclusion: Facilities not identified in the initial sample of VA facilities (sample not renewed over time).
Where it is running
- Central Alabama Veterans Health Care System West Campus, Montgomery, AL — Montgomery, Alabama, United States
- Northern Arizona VA Health Care System, Prescott, AZ — Prescott, Arizona, United States
- VA Northern California Health Care System, Mather, CA — Sacramento, California, United States
- VA Greater Los Angeles Healthcare System, Sepulveda, CA — Sepulveda, California, United States
- VA Eastern Colorado Health Care System, Denver, CO — Denver, Colorado, United States
- North Florida/South Georgia Veterans Health System, Gainesville, FL — Gainesville, Florida, United States
- Miami VA Healthcare System, Miami, FL — Miami, Florida, United States
- Atlanta VA Medical and Rehab Center, Decatur, GA — Decatur, Georgia, United States
- Carl Vinson VA Medical Center, Dublin, GA — Dublin, Georgia, United States
- Marion VA Medical Center, Marion, IL — Marion, Illinois, United States
- Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center, Wichita, KS — Wichita, Kansas, United States
- Overton Brooks VA Medical Center, Shreveport, LA — Shreveport, Louisiana, United States
- Rehabilitation R&D Service, Baltimore, MD — Baltimore, Maryland, United States
- Battle Creek VA Medical Center, Battle Creek, MI — Battle Creek, Michigan, United States
- Harry S. Truman Memorial, Columbia, MO — Columbia, Missouri, United States
- VA Southern Nevada Healthcare System, North Las Vegas, NV — Las Vegas, Nevada, United States
- Bath VA Medical Center, Bath, NY — Bath, New York, United States
- Salisbury W.G. (Bill) Hefner VA Medical Center, Salisbury, NC — Salisbury, North Carolina, United States
- Chalmers P. Wylie Ambulatory Care Center, Columbus, OH — Columbus, Ohio, United States
- VA Black Hills Health Care System Fort Meade Campus, Fort Meade, SD — Fort Meade, South Dakota, United States
- Tennessee Valley Healthcare System Nashville Campus, Nashville, TN — Nashville, Tennessee, United States
- South Texas Health Care System, San Antonio, TX — San Antonio, Texas, United States
- Central Texas Veterans Health Care System, Temple, TX — Temple, Texas, United States
- Hampton VA Medical Center, Hampton, VA — Hampton, Virginia, United States
- Jonathan M. Wainwright Memorial VA Medical Center, Walla Walla, WA — Walla Walla, Washington, United States
Full record on ClinicalTrials.gov
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