Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VA Facilities



Status:Enrolling by invitation
Healthy:No
Age Range:18 - Any
Updated:1/16/2019
Start Date:January 9, 2017
End Date:June 30, 2020

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Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VA Facilities (PEC 16-352)

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 sites 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 VHA
Directive (2017).

In collaboration with VA Women's Health Services (WHS), VA researchers developed a series of
studies to better understand and help improve comprehensive care implementation through the
Women Veterans' Healthcare CREATE Initiative. Among these, one focused on testing an
evidence-based quality improvement (EBQI) approach to tailoring VA's medical home model --
Patient Aligned Care Teams or PACT -- to the needs of women Veterans, which has yielded
significant local improvements in women Veterans' care. EBQI emphasizes a multilevel
partnered approach to building capacity for innovation, implementation and spread of
evidence-based practice. With its demonstrated success in the CREATE PACT study and several
other EBQI trials, WHS adopted EBQI as a strategy to help low-performing VA facilities
systematically improve services.

The objectives of the WHS/QUERI Partnered Evaluation Initiative that this project represents
are:

1. To evaluate the barriers and facilitators to achieving delivery of comprehensive women's
health care in the identified low-performing VA facilities;

2. To evaluate the effectiveness of EBQI in supporting low-performing VA facilities achieve
improved:

1. Organizational features (e.g., level of comprehensive services available; care
coordination arrangements; PACT features implemented; environment of care
improvements);

2. Provider/staff attitudes (e.g., improved gender awareness; women's health knowledge
and practice);

d) Quality of care and patient experiences among women Veteran patients using secondary
data; and,

3. To evaluate contextual factors, local implementation processes, and organizational
changes in the participating facilities over time.

Results of the evaluation will be used to provide feedback to stakeholders, including women
Veterans, at the local, network and national levels, while also being used to continuously
refine EBQI implementation processes. The evaluation will also help inform optimal strategies
for ongoing improvements in women Veterans' care in the 24 participating VA facilities, other
VA facilities and for other improvement initiatives in this and other program offices.


Inclusion Criteria:

- 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

- 3:1 staffing ratio for PACT teamlets

Key Stakeholder Inclusion Criteria (qualitative interviews):

- 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 quadrad member)

- 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 (MD, DO, NP, PA) delivering primary care in general primary
care and/or women's health clinics

- PACT teamlet members (RN care managers, LVN/LPN/health technicians, and clerks)

- larger PACT team members, e.g.:

- social workers

- dieticians

- health coaches

- integrated mental health

Exclusion Criteria:

- Facility-level exclusion: Facilities not identified in the initial sample of VA
facilities (sample not renewed over time).
We found this trial at
25
sites
500 State Highway 89
Prescott, Arizona 86313
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Baltimore, Maryland 21202
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Baltimore, MD
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76 Veterans Avenue
Bath, New York 14810
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Bath, NY
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Battle Creek, MI
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Columbia, Missouri 65201
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Columbia, MO
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420 North James Road
Columbus, Ohio 43203
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Columbus, OH
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Decatur, GA
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Denver, CO
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1826 Veterans Boulevard
Dublin, Georgia 31021
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Dublin, GA
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Fort Meade, SD
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Gainesville, FL
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Hampton, Virginia 23667
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Hampton, VA
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Las Vegas, NV
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2401 West Main Street
Marion, Illinois 62959
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Marion, IL
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Miami, FL
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215 Perry Hill Road
Montgomery, Alabama 36109
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Montgomery, AL
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Nashville, TN
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Sacramento, CA
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Salisbury, NC
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San Antonio, TX
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Sepulveda, CA
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Shreveport, LA
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Temple, TX
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77 Wain Wright Drive
Walla Walla, Washington 99362
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Wichita, KS
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