Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| University of California, Los Angeles | OTHER |
| RAND | OTHER |
Not provided
Not provided
Not provided
VA has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans, is yet to be worked out. The main goal of this study was to develop and test an evidence-based quality improvement (EBQI) approach to adapting and implementing PACT for women Veterans, incorporating comprehensive women's health care in gender-sensitive care environments, thereby accelerating achievement of PACT tenets for women Veterans and reducing persistent gender disparities in VA quality of care.
Women Veterans' numerical minority in VA healthcare settings has created logistical challenges to delivering gender-sensitive comprehensive services. These challenges only grew as more women Veterans enrolled in VA care. Access and quality lagged behind that of male Veterans, while gender sensitivity, including adequate attention to privacy/safety and awareness of women's military roles and experiences, were often lacking. On-site availability of gender-specific services had also not kept pace, with women Veterans more likely to be outsourced for gender-specific care than they were ten years previously. Further, while the proportion of VA facilities having women's health (WH) clinics had increased, prior research demonstrated that as many as 40% of them were not delivering comprehensive primary care services, instead focusing only on gender-specific exams. Lack of gender-sensitive, comprehensive care for women has also been associated with measurable decrements in women's ratings of VA access, continuity and coordination, as well as measures of technical quality.
The investigators aimed to assess the effectiveness of evidence-based quality improvement (EBQI) methods for developing a WH PACT model using a cluster randomized controlled trial (cRCT) design (Aim #1); examine impacts of receipt of WH-PACT concordant care on women Veterans' outcomes (Aim #2); evaluate processes of EBQI-supported WH-PACT implementation (Aim #3); and develop implementation and evaluation tools for use in EBQI-supported WH-PACT model adaptation, implementation, sustainability and spread to additional VA facilities (Aim #4).
EBQI is a systematic approach to developing a multi-level research-clinical partnership approach to engaging local organizational senior leaders and quality improvement teams in adapting and implementing new care models in the context of prior evidence, local practice context, and provider behavior change methods, with researchers providing technical support and practice facilitation. In a cluster randomized trial, the investigators evaluated WH-PACT model achievement using patient, provider and practice surveys. The investigators examined intermediate changes in provider, staff and team knowledge and attitudes. Using analyses of secondary administrative and performance data, the investigators also explored impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, and utilization. Using mixed methods, the investigators assessed pre-post EBQI practice context; documented WH-PACT implementation; and examined barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and formative progress narratives and administrative data review.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| EBQI-Supported WH-PACT Implementation | Experimental | Evidence-based Quality Improvement (EBQI) is a structured research-clinical partnership approach to facilitating implementation of new care models, including multilevel stakeholder engagement, quality improvement (QI) education/training, technical support, formative feedback, external practice facilitation, and national policy guidance. |
|
| Routine WH-PACT Implementation | Active Comparator | National policy guidance |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Multilevel stakeholder engagement | Other | Structured, in-person stakeholder panel meeting of VA network, VA medical center, and primary care and women's health leaders using modified Delphi panel techniques to come to consensus on a quality improvement (QI) roadmap within each participating VA network, followed by intermittent progress reporting and post-24 months in-person capstone stakeholder panel meetings |
| Measure | Description | Time Frame |
|---|---|---|
| WH-PACT Achievement | The Women's Health Patient-Aligned Care Team achievement, based on four patient-reported measures of access to care, patient-provider communication, comprehensiveness of care, and gender-appropriateness of care. The WH-PACT achievement is an aggregate score from -4 to +4, with the higher score meaning better PACT achievement. | Baseline to 24-month |
| Measure | Description | Time Frame |
|---|---|---|
| Providers' and Staff Gender Sensitivity | Gender sensitivity score based on 10 survey items related to providers' and staff's sensitivity towards women Veterans during patient care. The score ranged from 1 to 5 with the higher score reflecting greater gender sensitivity toward women Veterans. | Baseline to 24-month |
Not provided
Inclusion Criteria:
Facility inclusion criteria:
Key Stakeholder (interviews) inclusion criteria:
Provider (surveys and interviews) inclusion criteria:
Staff (surveys and interviews) inclusion criteria:
Patient inclusion criteria:
- Women Veterans seen in participating VAMCs with 3+ primary care visits in general primary care and/or women's health clinics in the past year
Exclusion Criteria:
Facility exclusion criteria:
Key Stakeholder (interviews) exclusion criteria:
- Stakeholders outside of the participating VISNs (1, 4, 12, 23) and VAMCs (see study sites)
Provider (surveys and interviews) exclusion criteria:
Staff (surveys and interviews) exclusion criteria:
Patient exclusion criteria:
Only the patient survey component is gender-based (includes women Veterans only). Eligibility for provider/staff surveys or key stakeholder interviews is not gender-based.
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Elizabeth M. Yano, PhD MSPH | VA Greater Los Angeles Healthcare System, Sepulveda, CA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Greater Los Angeles Healthcare System, Sepulveda, CA | Sepulveda | California | 91343 | United States | ||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24715407 | Background | Yano EM, Bair MJ, Carrasquillo O, Krein SL, Rubenstein LV. Patient Aligned Care Teams (PACT): VA's journey to implement patient-centered medical homes. J Gen Intern Med. 2014 Jul;29 Suppl 2(Suppl 2):S547-9. doi: 10.1007/s11606-014-2835-8. No abstract available. | |
| 24715395 | Background | Yano EM, Haskell S, Hayes P. Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams. J Gen Intern Med. 2014 Jul;29 Suppl 2(Suppl 2):S703-7. doi: 10.1007/s11606-013-2699-3. |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Random samples of women Veteran clinic users (patient surveys) and census of each VAMC's primary care and women's health providers and staff in PACT and WH-PACT (web surveys) at 12 participating VAMCs recruited through the WH Practice Based Research Network
| ID | Title | Description |
|---|---|---|
| FG000 | EBQI-Supported WH-PACT Implementation | Evidence-based Quality Improvement (EBQI) is a structured research-clinical partnership approach to facilitating implementation of new care models, including multilevel stakeholder engagement, quality improvement (QI) education/training, technical support, formative feedback, external practice facilitation, and national policy guidance. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
Not provided
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 15, 2014 |
Not provided
Cluster randomized controlled trial (cRCT) among 12 VAMCs with unbalanced allocation (2:1) blocked on VA network (Veterans Integrated Service Network or VISN)
Not provided
Not provided
Not provided
Not provided
|
| Quality improvement (QI) education/training | Other | Initial in-person and ongoing virtual team training in QI principles, methods, and project proposal development and refinement |
|
| Technical support | Other | Research team provided technical review of and feedback on local QI project proposals, helped develop and/or recommend process/outcome measures, identified and shared relevant published literature (e.g., measures, interventions), and provided general technical support (e.g., how to analyze local data, how to conduct a local focus group) |
|
| Formative feedback | Other | Research team provided aggregated all-site and local data from baseline patient and provider/staff surveys, 12-month patient surveys, and other data and findings to local teams for ongoing and new QI project idea development |
|
| External practice facilitation | Other | Within and across site calls with local teams to review progress, identify needs, help solve problems, discuss current and new projects, as well as potential for spread |
|
|
| National policy guidance | Other | VA Handbooks on policy and practice for PACT implementation guidance and on delivery of comprehensive women's health services disseminated to all VA facilities |
|
| Team Functioning |
Perceived team functioning of primary care and women's health providers and staff, measured based on responses to 7 survey items. The team functioning score ranged from 1 to 5 , with the higher score indicating better team functioning. |
| Baseline to 24-month |
| Providers and Staff Burnout | Burnout was measured using one item: "How often does the following statement apply to you: I feel burned out from my work" with options for 1.Never, 2. A few times a year, 3. Every month, 4. A few times a month, 5. Every week, 6. A few times a week, 7. Every day. We recoded the responses into a binary value: never/less than a few times a month (1-4) and every week-to-everyday (5-7). | 24-month |
| Patient VA Primary Care Visits Per Year | Average number of visits to VA primary care per year | Baseline to 24month |
| Patient VA Women's Health Care Visits Per Year | Average number of patient visits to VA women's health care per year | Baseline to 24month |
| Patient VA Hospitalization | Average number of patient hospitalization for any cause in a year | Baseline to 24-month |
| Patient Emergency Room Visits | Average number of patient emergency room visits for any cause in a year | baseline to 24-month |
| VA Connecticut Healthcare System West Haven Campus, West Haven, CT |
| West Haven |
| Connecticut |
| 06516 |
| United States |
| Jesse Brown VA Medical Center, Chicago, IL | Chicago | Illinois | 60612 | United States |
| Edward Hines Jr. VA Hospital, Hines, IL | Hines | Illinois | 60141-5000 | United States |
| Iowa City VA Health Care System, Iowa City, IA | Iowa City | Iowa | 52246-2208 | United States |
| VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA | Boston | Massachusetts | 02130 | United States |
| VA Central Western Massachusetts Healthcare System, Leeds, MA | Leeds | Massachusetts | 01053-9764 | United States |
| Minneapolis VA Health Care System, Minneapolis, MN | Minneapolis | Minnesota | 55417 | United States |
| Fargo VA Healthcare System, Fargo, ND | Fargo | North Dakota | 58102 | United States |
| Philadelphia VA Medical Center, Philadelphia, PA | Philadelphia | Pennsylvania | 19104 | United States |
| VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA | Pittsburgh | Pennsylvania | 15240 | United States |
| Clarksburg Louis A. Johnson VA Medical Center, Clarksburg, WV | Clarksburg | West Virginia | 26301 | United States |
| William S. Middleton Memorial Veterans Hospital, Madison, WI | Madison | Wisconsin | 53705 | United States |
| 28063848 | Result | Chuang E, Brunner J, Mak S, Hamilton AB, Canelo I, Darling J, Rubenstein LV, Yano EM. Challenges with Implementing a Patient-Centered Medical Home Model for Women Veterans. Womens Health Issues. 2017 Mar-Apr;27(2):214-220. doi: 10.1016/j.whi.2016.11.005. Epub 2017 Jan 4. |
| 28585163 | Result | Hamilton AB, Brunner J, Cain C, Chuang E, Luger TM, Canelo I, Rubenstein L, Yano EM. Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women's health primary care. Transl Behav Med. 2017 Sep;7(3):478-485. doi: 10.1007/s13142-017-0501-5. |
| 28711505 | Result | Goldstein KM, Vogt D, Hamilton A, Frayne SM, Gierisch J, Blakeney J, Sadler A, Bean-Mayberry BM, Carney D, DiLeone B, Fox AB, Klap R, Yee E, Romodan Y, Strehlow H, Yosef J, Yano EM. Practice-based research networks add value to evidence-based quality improvement. Healthc (Amst). 2018 Jun;6(2):128-134. doi: 10.1016/j.hjdsi.2017.06.008. Epub 2017 Jul 13. |
| 28754476 | Result | Meredith LS, Azhar G, Okunogbe A, Canelo IA, Darling JE, Street AE, Yano EM. Primary Care Providers with More Experience and Stronger Self-Efficacy Beliefs Regarding Women Veterans Screen More Frequently for Interpersonal Violence. Womens Health Issues. 2017 Sep-Oct;27(5):586-591. doi: 10.1016/j.whi.2017.06.003. Epub 2017 Jul 25. |
| 28087130 | Result | Meredith LS, Wang Y, Okunogbe A, Bergman AA, Canelo IA, Darling JE, Yano EM. Attitudes, Practices, and Experiences with Implementing a Patient-Centered Medical Home for Women Veterans. Womens Health Issues. 2017 Mar-Apr;27(2):221-227. doi: 10.1016/j.whi.2016.11.008. Epub 2017 Jan 10. |
| 28945449 | Result | Yano EM, Hamilton AB. Accelerating delivery of trauma-sensitive care: Using multilevel stakeholder engagement to improve care for women veterans. Fam Syst Health. 2017 Sep;35(3):373-375. doi: 10.1037/fsh0000288. |
| 28929322 | Result | Hamilton AB, Yano EM. The importance of symbolic and engaged participation in evidence-based quality improvement in a complex integrated healthcare system: response to "The science of stakeholder engagement in research". Transl Behav Med. 2017 Sep;7(3):492-494. doi: 10.1007/s13142-017-0528-7. |
| 29339012 | Result | Brunner J, Chuang E, Washington DL, Rose DE, Chanfreau-Coffinier C, Darling JE, Canelo IA, Yano EM. Patient-Rated Access to Needed Care: Patient-Centered Medical Home Principles Intertwined. Womens Health Issues. 2018 Mar-Apr;28(2):165-171. doi: 10.1016/j.whi.2017.12.001. Epub 2018 Jan 12. |
| 29475630 | Result | Narain K, Bean-Mayberry B, Washington DL, Canelo IA, Darling JE, Yano EM. Access to Care and Health Outcomes Among Women Veterans Using Veterans Administration Health Care: Association With Food Insufficiency. Womens Health Issues. 2018 May-Jun;28(3):267-272. doi: 10.1016/j.whi.2018.01.002. Epub 2018 Feb 21. |
| 29489045 | Result | Hoggatt KJ, Simpson T, Schweizer CA, Drexler K, Yano EM. Identifying women veterans with unhealthy alcohol use using gender-tailored screening. Am J Addict. 2018 Mar;27(2):97-100. doi: 10.1111/ajad.12689. |
| 27435723 | Result | Yano EM, Darling JE, Hamilton AB, Canelo I, Chuang E, Meredith LS, Rubenstein LV. Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. Implement Sci. 2016 Jul 19;11(1):101. doi: 10.1186/s13012-016-0461-z. |
| 30455089 | Result | Brunner J, Cain CL, Yano EM, Hamilton AB. Local Leaders' Perspectives on Women Veterans' Health Care: What Would Ideal Look Like? Womens Health Issues. 2019 Jan-Feb;29(1):64-71. doi: 10.1016/j.whi.2018.10.005. Epub 2018 Nov 16. |
| 30686577 | Result | Klap R, Darling JE, Hamilton AB, Rose DE, Dyer K, Canelo I, Haskell S, Yano EM. Prevalence of Stranger Harassment of Women Veterans at Veterans Affairs Medical Centers and Impacts on Delayed and Missed Care. Womens Health Issues. 2019 Mar-Apr;29(2):107-115. doi: 10.1016/j.whi.2018.12.002. Epub 2019 Jan 25. |
| 31027706 | Result | Bergman AA, Hamilton AB, Chrystal JG, Bean-Mayberry BA, Yano EM. Primary Care Providers' Perspectives on Providing Care to Women Veterans with Histories of Sexual Trauma. Womens Health Issues. 2019 Jul-Aug;29(4):325-332. doi: 10.1016/j.whi.2019.03.001. Epub 2019 Apr 23. |
| 31253247 | Result | Dyer KE, Potter SJ, Hamilton AB, Luger TM, Bergman AA, Yano EM, Klap R. Gender Differences in Veterans' Perceptions of Harassment on Veterans Health Administration Grounds. Womens Health Issues. 2019 Jun 25;29 Suppl 1:S83-S93. doi: 10.1016/j.whi.2019.04.016. |
| 38424344 | Derived | Yano EM, Than C, Brunner J, Canelo IA, Meredith LS, Rubenstein LV, Hamilton AB. Impact of Evidence-Based Quality Improvement on Tailoring VA's Patient-Centered Medical Home Model to Women Veterans' Needs. J Gen Intern Med. 2024 Jun;39(8):1349-1359. doi: 10.1007/s11606-024-08647-4. Epub 2024 Feb 29. |
| 36042076 | Derived | Sheahan KL, Goldstein KM, Than CT, Bean-Mayberry B, Chanfreau CC, Gerber MR, Rose DE, Brunner J, Canelo IA, Darling Mshs JE, Haskell S, Hamilton AB, Yano EM. Women Veterans' Healthcare Needs, Utilization, and Preferences in Veterans Affairs Primary Care Settings. J Gen Intern Med. 2022 Sep;37(Suppl 3):791-798. doi: 10.1007/s11606-022-07585-3. Epub 2022 Aug 30. |
| 35367107 | Derived | Carlson GC, Than CT, Rose D, Brunner J, Chanfreau-Coffinier C, Canelo IA, Klap R, Bean-Mayberry B, Agrawal A, Hamilton AB, Gerber MR, Yano EM. What Drives Women Veterans' Trust in VA Healthcare Providers? Womens Health Issues. 2022 Sep-Oct;32(5):499-508. doi: 10.1016/j.whi.2022.02.004. Epub 2022 Mar 30. |
| 35049381 | Derived | Danan ER, Brunner J, Bergman A, Spoont M, Chanfreau C, Canelo I, Krebs EE, Yano EM. The Relationship Between Sexual Assault History and Cervical Cancer Screening Completion Among Women Veterans in the Veterans Health Administration. J Womens Health (Larchmt). 2022 Jul;31(7):1040-1047. doi: 10.1089/jwh.2021.0237. Epub 2022 Jan 18. |
| 29979640 | Derived | Shipherd JC, Darling JE, Klap RS, Rose D, Yano EM. Experiences in the Veterans Health Administration and Impact on Healthcare Utilization: Comparisons Between LGBT and Non-LGBT Women Veterans. LGBT Health. 2018 Jul;5(5):303-311. doi: 10.1089/lgbt.2017.0179. |
| 29766383 | Derived | Narain K, Jeffers KS, Bean-Mayberry B, Canelo I, Darling JE, Yano EM. The Association of Food Insufficiency with Patient Activation Among Women Veterans Using Veterans Administration Healthcare: a Cross-Sectional Analysis. J Gen Intern Med. 2018 Sep;33(9):1417-1418. doi: 10.1007/s11606-018-4476-9. No abstract available. |
| 29620391 | Derived | Brunner J, Schweizer CA, Canelo IA, Leung LB, Strauss JL, Yano EM. Timely access to mental health care among women veterans. Psychol Serv. 2019 Aug;16(3):498-503. doi: 10.1037/ser0000226. Epub 2018 Apr 5. |
| FG001 | Routine WH-PACT Implementation | PACT implementation is a nationally mandated VA initiative for medical home implementation in VA primary care and women's health clinics, supported by VA Handbooks on PACT and Women's Health policy and practice guidance from national VA primary care and women's health program offices that are disseminated nationally to all VA facilities. |
| Baseline Started - Patients |
|
| Baseline Completed - Patients |
|
| Baseline Started - Providers/Staff |
|
| Baseline Completed -Providers/Staff |
|
| Total Baseline Completed |
|
| 12-month Started-patients |
|
| 12-month Completed- Patients |
|
| 12-month Providers/Staff |
|
| 24-month Started |
|
| 24-month Started - Patients |
|
| 24-month Completed - Patients |
|
| 24-month Started Providers/Staff |
|
| 24-month Completed Providers/Staff |
|
| Total 24-month Completed |
|
| COMPLETED |
|
| NOT COMPLETED |
|
|
Not provided
| ID | Title | Description |
|---|---|---|
| BG000 | EBQI-Supported WH-PACT Implementation | Evidence-based Quality Improvement (EBQI) is a structured research-clinical partnership approach to facilitating implementation of new care models, including multilevel stakeholder engagement, quality improvement (QI) education/training, technical support, formative feedback, external practice facilitation, and national policy guidance. |
| BG001 | Routine WH-PACT Implementation | VA Handbooks on policy and practice for PACT implementation guidance and on delivery of comprehensive women's health services disseminated to all VA facilities |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Patients only: Age obtained from surveys and VA administrative data during sampling as well as from birth date verified by patients as part of computer-assisted telephone interviews (CATI) | There are 4 patients with missing age information, 1 in the EBQI arm and 3 in the control arm. | Mean | Standard Deviation | years |
| |||||||||||||
| Age, Customized | Providers/staff only: Age obtained from the surveys | There are 27 providers and staff with missing age information; 15 in the EBQI arm and 12 in the control arm. | Count of Participants | Participants |
| ||||||||||||||
| Sex: Female, Male | Provider/staff specification of sex based on self-report data in web surveys | Providers/staff | Count of Participants | Participants |
| ||||||||||||||
| Sex: Female, Male | Only female patients were sampled for participation in the computer-assisted telephone interview (CATI) survey using VA administrative data; self-reported sex/gender identity questions were then asked of survey participants. | Patients only | Count of Participants | Participants |
| ||||||||||||||
| Race/Ethnicity, Customized | Providers/staff | Count of Participants | Participants |
| |||||||||||||||
| Race/Ethnicity, Customized | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Post-traumatic stress disorder (PTSD) | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Military Sexual Trauma (MST) | Patients only | Count of Participants | Participants |
| |||||||||||||||
| VA care utilization | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Education | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Employment | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Stranger harassment from male veterans | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Marital status | Patients only | Count of Participants | Participants |
| |||||||||||||||
| Are you currently working in WH-PACT? | Providers/staff | Count of Participants | Participants |
| |||||||||||||||
| Proportion of time interacting with patients | Providers/staff | Count of Participants | Participants |
| |||||||||||||||
| Full-time VA employee | Providers/staff | Count of Participants | Participants |
| |||||||||||||||
| How often do you see or care for women patients in the clinic? | Providers/staff | Count of Participants | Participants |
| |||||||||||||||
| Years of service at VA | Providers/staff | Mean | Standard Deviation | years |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | WH-PACT Achievement | The Women's Health Patient-Aligned Care Team achievement, based on four patient-reported measures of access to care, patient-provider communication, comprehensiveness of care, and gender-appropriateness of care. The WH-PACT achievement is an aggregate score from -4 to +4, with the higher score meaning better PACT achievement. | The analysis included the patients who had completed the 24-month survey. One patient in the EBQI arm had missing data for outcome measure and was excluded from the analysis. | Posted | Count of Participants | Participants | Baseline to 24-month |
|
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Providers' and Staff Gender Sensitivity | Gender sensitivity score based on 10 survey items related to providers' and staff's sensitivity towards women Veterans during patient care. The score ranged from 1 to 5 with the higher score reflecting greater gender sensitivity toward women Veterans. | Primary care and women's health providers and staff. The analysis was based on cases with non-missing outcome data. There were 28 missing cases in the EBQI arm and 9 missing in the control arm. | Posted | Mean | Standard Deviation | score on a scale | Baseline to 24-month |
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Team Functioning | Perceived team functioning of primary care and women's health providers and staff, measured based on responses to 7 survey items. The team functioning score ranged from 1 to 5 , with the higher score indicating better team functioning. | Primary care and women's health providers and staff. The analysis was based on cases with non-missing outcome data. There are 80 missing cases in the EBQI arm and 74 in the control arm. | Posted | Mean | Standard Deviation | score on a scale | Baseline to 24-month |
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Providers and Staff Burnout | Burnout was measured using one item: "How often does the following statement apply to you: I feel burned out from my work" with options for 1.Never, 2. A few times a year, 3. Every month, 4. A few times a month, 5. Every week, 6. A few times a week, 7. Every day. We recoded the responses into a binary value: never/less than a few times a month (1-4) and every week-to-everyday (5-7). | Primary care and women's health providers and staff. The analysis was based on cases with non-missing burnout data. There were 30 missing cases in the EBQI arm and 10 in the control arm. | Posted | Count of Participants | Participants | 24-month |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Patient VA Primary Care Visits Per Year | Average number of visits to VA primary care per year | Patients only. One patient in the EBQI arm had missing outcome information and was excluded from the analysis. | Posted | Mean | Standard Deviation | average visits per year for all patients | Baseline to 24month |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Patient VA Women's Health Care Visits Per Year | Average number of patient visits to VA women's health care per year | Patients only. One patient in the EBQI arm had missing outcome information and was excluded from the analysis. | Posted | Mean | Standard Deviation | Average visits per year for all patients | Baseline to 24month |
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Patient VA Hospitalization | Average number of patient hospitalization for any cause in a year | Patients only. One patient in the EBQI arm had missing outcome information and was excluded from the analysis. | Posted | Mean | Standard Deviation | Average visits per year for all patients | Baseline to 24-month |
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Patient Emergency Room Visits | Average number of patient emergency room visits for any cause in a year | Patients only. One patient in the EBQI arm had missing outcome information and was excluded from the analysis. | Posted | Mean | Standard Deviation | Average visits per year for all patients | baseline to 24-month |
|
No adverse events were expected for EBQI-supported WH-PACT implementation (target of action is VA employees). However, we did collect data from women Veteran routine primary care patients. Eligible patients were considered low-risk, so a formal suicidality assessment was not included. However, in an abundance of caution, any survey respondent who endorsed feeling down, depressed or hopeless at baseline, 12-months or 24-months received information about VA's suicide hotline.
Patients were not directly involved in this research other than to participate in a survey.
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | EBQI-Supported WH-PACT Implementation | Evidence-based Quality Improvement (EBQI) is a structured research-clinical partnership approach to facilitating implementation of new care models, including multilevel stakeholder engagement, quality improvement (QI) education/training, technical support, formative feedback, external practice facilitation, and national policy guidance. | 5 | 2,720 | 0 | 2,720 | 0 | 2,720 |
| EG001 | Routine WH-PACT Implementation | National policy guidance including VA Handbooks on policy and practice for PACT implementation guidance and on delivery of comprehensive women's health services disseminated to all VA facilities. | 3 | 1,180 | 0 | 1,180 | 0 | 1,180 |
Not provided
Not provided
Control arm VAMCs are active controls given national mandates to implement PACT and WH PACT. Low response rates among providers/staff may have resulted in under- or over-estimation of effects, despite weighting for non-response.
Not provided
Not provided
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Elizabeth M. Yano, PhD, MSPH | VA Greater Los Angeles Healthcare System | (818) 891-7711 | 36031 | elizabeth.yano@va.gov |
| Jun 18, 2019 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D058996 | Quality Improvement |
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D004738 | Engineering |
| D013676 | Technology, Industry, and Agriculture |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
Not provided
Not provided
|
| 30-39 years |
|
|
| 40-49 years |
|
|
| 50-59 years |
|
|
| 60+ years |
|
|
| missing |
|
|
|
|
|
| Asian |
|
|
| Black or African American |
|
|
| White |
|
|
| More than one race |
|
|
| Hispanic or Latino |
|
|
| Unknown or Not Reported |
|
|
|
| Black or African American |
|
|
| White |
|
|
| Hispanic or Latino |
|
|
| More than one race |
|
|
| Unknown or Not Reported |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| -2 |
|
| -1 |
|
| 0 |
|
| +1 |
|
| +2 |
|
| +3 |
|
| +4 |
|
| 24 month |
|
| OG001 |
| Routine WH-PACT Implementation |
National policy guidance National policy guidance: VA Handbooks on policy and practice for PACT implementation guidance and on delivery of comprehensive women's health services disseminated to all VA facilities |
|
|
|
| Routine WH-PACT Implementation |
National policy guidance National policy guidance: VA Handbooks on policy and practice for PACT implementation guidance and on delivery of comprehensive women's health services disseminated to all VA facilities |
|
|
|
| OG001 | Routine WH-PACT Implementation | National policy guidance National policy guidance: VA Handbooks on policy and practice for PACT implementation guidance and on delivery of comprehensive women's health services disseminated to all VA facilities |
|
|
|
|
|
|
|
|
|
|
|
|
|
|