Development and Validation of a Patient Reported Experience Measure for VA Women's Health Care

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Background: Patient-reported experience measures (PREMs) are process measures that focus on the interpersonal aspects of the care, and increasingly used to measure care quality and address inequities. The number of women Veterans using VA health care continues to increase. In fiscal year 2015 over 400,000 women Veterans used VA health care. Women Veterans using VA health care are increasingly diverse in terms of race/ethnicity and sexual orientation and gender identity, have complex medical and mental health care needs, and a high prevalence of sexual trauma, including military sexual trauma (MST). These characteristics and experiences, which are often overlapping, shape their experiences of health care within VA , which in turn influence patient-reported and clinical outcomes of care. Significance: The proposed study will develop the first patient-reported experiences measure (PREM) designed specifically to quantify women Veterans’ experiences with VA health care (WV_PREM). WV_PREM can be used to monitor and inform on-going patient-centered quality improvement efforts such as the Women’s Health PACT and anti-harrassment initiative in VA through partnerships with API and WHS. It will also enable examination of equity in VA care across a variety of patient demographics including race/ethnicity and gender/sexual orientation. Innovation & Impact: This proposal is innovative due to its focus on patient experience and active engagement of Veterans in the measure development process, and by intentionally incorporating diverse voices of women Veterans, particularly those with marginalized identities. Unlike current PREMs used in VA, WV_PREM will include domains of patient experience in VA that are uniquely important to women Veterans such as safety, respect, and discrimination. WV_PREM will be a unique tool for monitoring the quality and equity of VA reproductive health care and informing and accelerating quality improvement efforts. Specific Aims: 1. Identify constructs salient to the experience of women Veterans using VA health care through a series of semi-structured interviews with diverse women Veterans with different health care needs. 2. Generate a preliminary WV_PREM instrument based on findings from Aim 1 and literature review of existing measures. Consensus on items and content validity will be reached using review and feedback from Veterans and VA stakeholders; clarity will be determined via cognitive interviews. 3. Psychometrically evaluate WV_PREM in a cohort of 600 women Veterans receiving health care at VA to refine the measure, assess and confirm the factor structure, and test construct validity. Methodology: This proposal will use a sequential mixed methods approach. Aim 1 involves a series of semi- structured interviews with women Veterans who used VA health care. Aim 2 will in clude development of a preliminary PREM based on Aim 1 findings, and refinement based on iterative review and feedback from Veteran focus groups, review by VA stakeholders, and cognitive interviews. Aim 3 will psychometrically validate the final PREM from Aim 2 in a cohort of 600 women Veterans by assessing and confirming the factor structure and testing for construct validity. Next Steps/Implementation: Throughout the project, we will prepare briefings for our operational partners to share key preliminary and final results, and with support of the VA Women’s Health Research Network pres ent results to various Veteran’s groups. Findings will be presented to the VA and non -VA scientific community through participation in national meetings and publication in peer reviewed journals. Starting in year four, we will work with our operational partners to implement the final validated version of WV_PREM as a regular tool for VA health care quality surveillance.