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


Gaps in the delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women seen in the VA healthcare system. VA policy action providing guidance on delivery of comprehensive healthcare services for women Veterans was disseminated nationally in 2010, followed by annual assessments of progress and site visits evaluating local 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 VA policy guidance.

As part of a multi-year effort to use research to accelerate the implementation of comprehensive care for women Veterans, a VA research team tested an evidence-based quality improvement (EBQI) approach to tailoring VA’s medical home model (Patient-Aligned Care Teams or PACTs)  to the needs of women Veterans. The EBQI strategy yielded significant local improvements in women Veterans’ care, improved team function and provider gender sensitivity, decreased provider burnout, and was adopted by VA Women’s Health Services for facilities that might benefit the most. EBQI builds capacity for innovation and implementation and spreads evidence-based practice through training, provider/staff engagement in structured improvement plans, measurement, evidence review, and facilitation in the context of VA policy priorities.

The QUERI Women’s Health National Partnered Evaluation Initiative is working to evaluate:

  • Factors that help or hinder delivery of comprehensive women’s healthcare.
  • EBQI effectiveness in improving:
  • How VA women’s healthcare is organized (e.g., level of comprehensive services available);
  • Frontline provider/staff women’s health knowledge and attitudes; and
  • Women Veterans’ quality of care and patient experience.
  • Local factors (people, processes, places) that influence what EBQI can accomplish.

Expected Findings and Intended Impacts

Results from this evaluation will inform VA planning and policy and improve diffusion of best practices VA-wide. For example, lower performing VAs, many of which are less-studied, may require uniquely concentrated and tailored efforts to support systematic and sustainable improvements in women Veterans’ care. According to key stakeholders interviewed at baseline (n=160), factors that help the delivery of comprehensive women’s healthcare include:

  • Strong and consistent women’s health teams,
  • Well-trained support staff,
  • Leadership support,
  • Access to gender-stratified data and data analysis support,
  • Engaged specialty care,
  • Strong facility-level quality improvement orientation,
  • National attention to women Veterans and to women’s health, and
  • Innovative facilitators, such as expanded availability of complementary and integrative health services for women.

Factors that hinder delivery of comprehensive women’s health care include:

  • Space and equipment challenges,
  • Turnover and long vacancies,
  • Insufficient staffing,
  • Outsourced services,
  • Provider resistance to women’s health,
  • Low leadership support, and
  • Changing national priorities.

Key stakeholders at sites that participated in the first EBQI initiative reported that EBQI resulted in staff empowerment, improved communication (both within and across teams, service lines, and levels of leadership), greater attention to women’s health clinical care, and overall culture change.

Corresponding PIs: Elizabeth M. Yano, PhD, MSPH and Alison B. Hamilton, PhD, MPH
Elizabeth.Yano@va.gov and Alison.Hamilton@va.gov

Operations’ Partner
VA Women’s Health Services addresses the healthcare needs of women Veterans and works to ensure that timely, equitable, high-quality, comprehensive healthcare services are provided in a sensitive and safe environment at VA healthcare facilities nationwide.