QUERI – Quality Enhancement Research Initiative

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

Los Angeles, CA


Women Veterans continue to be among the fastest growing segments of new users of VA healthcare, however, their needs and current numerical minority have, at times, presented challenges to ensuring uniform delivery of gender-sensitive comprehensive care. VA's national policy on Health Care Services for Women Veterans (VHA Handbook 1330.01, May 2010) lays out standards for access to comprehensive healthcare services delivered by proficient providers and staff in safe and secure environments. Substantial progress has been made nationwide, however, traditional policy implementation, even when leveraged by women's health champions, has not been uniformly successful in achieving delivery of comprehensive care by designated providers in gender-sensitive care environments. In parallel, VA researchers have been testing evidence-based quality improvement (EBQI) strategies for accelerating the tailoring of VA's patient-centered medical home model (Patient-Aligned Care Teams or PACTs) to the needs of women Veterans. Early successes prompted VA Women's Health Services (WHS) to adapt the EBQI approach to help broadly strengthen the women's health programs in lower-performing VA facilities in FY2017.


  • To evaluate the barriers and facilitators to achieving delivery of comprehensive healthcare for women Veterans in the identified low-performing VA facilities.
  • To evaluate the effectiveness of EBQI in supporting low-performing VA facilities achieve improved:
    • Organizational features (e.g., level of comprehensive services available, care coordination arrangements, PACT features implemented, and environment of care improvements);
    • Provider/staff attitudes (e.g., improved gender awareness, women's health knowledge and practice);
    • Quality of care and patient experience among women Veteran patients using secondary data; and
  • To evaluate contextual factors, local implementation processes, and organizational changes in the participating facilities over time.

Evaluation results will inform strategies for optimizing future policy deployment and multilevel engagement strategies with the field, while informing best practice diffusion. The focus on low-performing VAs will offer new insights, as these less-studied facilities may require uniquely concentrated and/or tailored efforts.


QUERI investigators will conduct a mixed-methods evaluation in the context of a wait-listed design to evaluate the effectiveness of EBQI implementation on achievement of comprehensive women's healthcare in up to eight low-performing VA facilities per year over three years. They also will use key stakeholder interviews at the VA medical center and VISN levels, key informant organizational surveys, provider, and staff surveys as well as VA administrative data for the evaluation. The EBQI "package" will include local site visits, multi-level stakeholder engagement, practice facilitation, local EBQI team training, and formative feedback.

Operations Partner:

VA Women's Health Services in the Office of Patient Care Services (PCS) oversees services for women Veterans in the VA, and is the primary partner for the evaluation and EBQI implementation.

Principal Investigators: Elizabeth M. Yano, PhD, MSPH, contact at Elizabeth.yano@va.gov, and Alison Hamilton, PhD, MPH, contact at Alison.hamilton@va.gov.