Tailoring VA Primary Care to Women Veterans: Association with Patient-Rated Quality and Satisfaction
Tailoring VA Primary Care to Women Veterans: Association with Patient-Rated Quality and Satisfaction
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DOI：
10.1016/j.whi.2011.04.004
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发表时间：
2011-07-01
影响因子：
3.2
通讯作者：
Yano, Elizabeth M.
中科院分区：
文献类型：
--
作者：
Washington, Donna L.;Bean-Mayberry, Bevanne;Yano, Elizabeth M.
背景：为妇女的需要和偏好量身定做的初级保健提供模式与更高的质量和满意度相关。因此，美国退伍军人事务部(VA)建议在初级保健诊所或妇女健康中心为妇女指定提供者，作为妇女初级保健的最佳模式。我们评估了退伍军人对退伍军人的医疗质量、与性别相关的满意度、性别适当性和退伍军人服务提供者在治疗女性方面的技能的评分，并与全国退伍军人服务点的初级保健模式进行了比较。退伍军人管理局的管理数据确定了每个受访者的主要保健地点。设施数据确定了该网站为妇女提供的初级保健模式。我们进行了多水平建模，比较了服务于300名或更多女性退伍军人的网站(收养者网站)、非收养者网站和较少女性退伍军人的网站(收养者网站)的医疗评级，并对患者特征进行了调整。结果：收养者网站的性别相关满意度和对退伍军人服务提供者技能的看法调整后的评分高于非收养者和小型网站。与小型网站相比，采用者网站也获得了更高的性别适当性调整评级。调整后的护理质量评分没有因网站类型而异。结论：具有为女性量身定做的初级护理模式的退伍军人管理局网站在大多数护理维度上的评分较高。促进在其他地点建立这些最佳护理模式是改善退伍军人女性退伍军人护理体验的一项战略。确定与质量相关的护理的其他特征的研究可能会为正在进行的退伍军人管理局质量转变努力提供信息。由爱思唯尔公司出版。
Background: Primary care delivery models tailored to women's needs and preferences are associated with higher quality and satisfaction. Therefore, the U.S. Department of Veterans Affairs (VA) recommends adoption of designated providers for women in primary care clinics or women's health centers as the optimal models for women's primary care. We assessed women veterans' ratings of their VA health care quality, gender-related satisfaction, gender appropriateness, and VA provider skills in treating women, in relation to primary care model at VA sites nationwide.Methods: Health care ratings were obtained from VA users in the 2008-2009 National Survey of Women Veterans. VA administrative data identified the site for each respondent's primary care. Facility data identified the site's primary care model for women. We conducted multilevel modeling to compare health care ratings for sites serving 300 or more women veterans who had adopted VA recommendations for women's primary care models (adopter sites), with non-adopter sites, and with small sites serving fewer women veterans, adjusting for patient characteristics.Results: Adopter sites received higher adjusted ratings of gender-related satisfaction and perceptions of VA provider skills than non-adopter and small sites. Adopter sites also received higher adjusted ratings of gender appropriateness than small sites. Adjusted ratings of quality of care did not differ by type of site.Conclusion: VA sites with primary care models tailored to women were rated higher on most dimensions of care. Facilitating establishment of these optimal care models at other sites is one strategy for improving women veterans' experiences with VA care. Research to identify other features of care associated with quality could inform ongoing VA quality transformation efforts. Published by Elsevier Inc.