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Mattocks K, Marteeny V, Walker L, Wallace K, Goldstein KM, Deans E, Brewer E, Bean-Mayberry B, Kroll-Desrosiers A. Experiences and Perceptions of Maternal Autonomy and Racism Among BIPOC Veterans Receiving Cesarean Sections. Womens Health Issues 2024:S1049-3867(24)00028-8. [PMID: 38760279 DOI: 10.1016/j.whi.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Previous studies of pregnant veterans enrolled in Department of Veterans Affairs (VA) care reveal high rates of cesarean sections among racial/ethnic minoritized groups, particularly in southern states. The purpose of this study was to better understand contributors to and veteran perceptions of maternal autonomy and racism among veterans receiving cesarean sections. METHODS We conducted semi-structured interviews to understand perceptions of maternal autonomy and racism among 27 Black, Indigenous, People of Color (BIPOC) veterans who gave birth via cesarean section using VA maternity care benefits. RESULTS Our study found that a substantial proportion (67%) of veterans had previous cesarean sections, ultimately placing them at risk for subsequent cesarean sections. More than 60% of veterans with a previous cesarean section requested a labor after cesarean (LAC) but were either refused by their provider or experienced complications that led to another cesarean section. Qualitative findings revealed the following: (1) differences in treatment by veterans' race/ethnicity may reduce maternal agency, (2) many veterans felt unheard and uninformed regarding birthing decisions, (3) access to VA-paid doula care may improve maternal agency for BIPOC veterans during labor and birth, and (4) BIPOC veterans face substantial challenges related to social determinants of health. CONCLUSION Further research should examine veterans' perceptions of racism in obstetrical care, and the possibility of VA-financed doula care to provide additional labor support to BIPOC veterans.
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Affiliation(s)
- Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Valerie Marteeny
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Lorrie Walker
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Kate Wallace
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Karen M Goldstein
- VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Elizabeth Deans
- Duke University, Durham, North Carolina; Women's Health Clinic, Durham VA Health Care System, Durham, North Carolina
| | - Erin Brewer
- VA Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Clair KS, Bean-Mayberry B, Schweizer CA, Chanfreau C, Jackson L, Than CT, Finley EP, Hamilton A, Farmer MM. Factors Associated with Delayed Care Among Women Veterans Actively Engaged in Primary Care. J Womens Health (Larchmt) 2024. [PMID: 38386795 DOI: 10.1089/jwh.2023.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background: Delaying needed medical care contributes to greater health risks and higher long-term medical costs. Women Veterans with complex medical and mental health needs face increased barriers to timely care access. Objectives: In a sample of women Veterans with recent engagement in Veterans Administration (VA) primary care, we aimed to compare characteristics of women Veterans who delayed care in the past 6 months with those who did not and examine factors associated with self-reported delayed care. Our study aims to inform interventions focused on eliminating health care access disparities among women Veterans. Materials and Methods: An innovation to improve women Veterans' engagement and retention in evidence-based health care for cardiovascular (CV) risk reduction (CV Toolkit) was implemented across five primary care sites within the VA. Women Veterans who were exposed to at least one CV Toolkit component participated in a mailed survey (n = 253). We used multivariate logistic regression to model factors associated with delaying care, including trust in VA providers, positive mental health screening (i.e., positive screen for either depression or anxiety), traumatic experience, self-rated health, and age. Results: Women with any mental health symptoms (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.23-4.74) and women who had experienced a traumatic event (OR 2.61, 95%CI: 1.11-6.14) were significantly more likely to report delaying care. Conclusions: Our study identified high rates of delayed care-over one-third of respondents-among women Veterans with recent primary care engagement. Mental health symptoms were the most common reported reason for delay among those who delayed care. Clinical Trial registration: NCT02991534.
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Affiliation(s)
- Kimberly S Clair
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Bevanne Bean-Mayberry
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - C Amanda Schweizer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - LaShawnta Jackson
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Claire T Than
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Erin P Finley
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Alison Hamilton
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Melissa M Farmer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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3
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Than CT, Bean-Mayberry B, Schweizer CA, Lee M, Chanfreau-Coffinier C, Clair K, Hamilton AB, Farmer MM. Ask and Ask Again: Repeated Screening for Smoking Increases Likelihood of Prescription for Cessation Treatment Among Women Veterans. J Gen Intern Med 2023; 38:2553-2559. [PMID: 37277666 PMCID: PMC10465439 DOI: 10.1007/s11606-023-08227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/05/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Preventive screening at the point of care can increase desired clinical outcomes. However, the impact of repeated screening for tobacco use on receiving smoking cessation treatment among women Veteran population has not been documented. OBJECTIVE To examine screening for tobacco use using clinical reminders and the association between the number of screenings and prescription for cessation treatment. DESIGN A retrospective analysis using data from a 5-year implementation trial for cardiovascular risk identification conducted between December 2016 and March 2020. SUBJECTS Women patients who had at least one primary care visit with a women's health provider during the study period at five primary care clinics in the Veterans Affairs (VA) Healthcare System. MEASURES The outcome is prescription of pharmacotherapy or referral to behavioral counseling for smoking cessation on or after the screening date. The exposure is the number of screenings for tobacco use from the trial and the annual VA national clinical reminders during the study period. RESULTS Of 6009 eligible patients, 5788 (96.3%) were screened at least once for tobacco use over five calendar years, and 2784 of those screened (48.1%) were reported as current and former smokers. Among current and former smokers, 709 (25.5%) received a prescription and/or referral for smoking cessation. In the adjusted model, the average predicted probability of prescription and/or referral for smoking cessation was 13.7% among current and former smokers screened once over 5 years, 18.6% among screened twice, 26.5% among screened thrice, 32.9% among screened four times, and 41.7% among screened five or six times. CONCLUSIONS Repeated screening was associated with higher predicted probabilities of being prescribed smoking cessation treatment.
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Affiliation(s)
- Claire T Than
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA.
| | - Bevanne Bean-Mayberry
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - C Amanda Schweizer
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA
| | - Martin Lee
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA
| | | | - Kimberly Clair
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA
| | - Alison B Hamilton
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Melissa M Farmer
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Building 25, North Hills, Los Angeles, CA, 91343, USA
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4
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Bernstein EL, DeRycke EC, Han L, Farmer MM, Bastian LA, Bean-Mayberry B, Bade B, Brandt C, Crothers K, Skanderson M, Ruser C, Spelman J, Bazan IS, Justice AC, Rentsch CT, Akgün KM. Racial, Ethnic, and Rural Disparities in US Veteran COVID-19 Vaccine Rates. AJPM Focus 2023; 2:100094. [PMID: 37362395 PMCID: PMC10038675 DOI: 10.1016/j.focus.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Race, ethnicity, and rurality-related disparities in coronavirus disease 2019 (COVID-19) vaccine uptake have been documented in the United States (US). Objective We determined whether these disparities existed among patients at the Department of Veterans Affairs (VA), the largest healthcare system in the US. Design Settings Participants Measurements Using VA Corporate Data Warehouse data, we included 5,871,438 patients (9.4% women) with at least one primary care visit in 2019 in a retrospective cohort study. Each patient was assigned a single race/ethnicity, which were mutually exclusive, self-reported categories. Rurality was based on 2019 home address at the zip code level. Our primary outcome was time-to-first COVID-19 vaccination between December 15, 2020-June 15, 2021. Additional covariates included age (in years), sex, geographic region (North Atlantic, Midwest, Southeast, Pacific, Continental), smoking status (current, former, never), Charlson Comorbidity Index (based on ≥1 inpatient or two outpatient ICD codes), service connection (any/none, using standardized VA-cutoffs for disability compensation), and influenza vaccination in 2019-2020 (yes/no). Results Compared with unvaccinated patients, those vaccinated (n=3,238,532; 55.2%) were older (mean age in years vaccinated=66.3, (standard deviation=14.4) vs. unvaccinated=57.7, (18.0), p<.0001)). They were more likely to identify as Black (18.2% vs. 16.1%, p<.0001), Hispanic (7.0% vs. 6.6% p<.0001), or Asian American/Pacific Islander (AA/PI) (2.0% vs. 1.7%, P<.0001). In addition, they were more likely to reside in urban settings (68.0% vs. 62.8, p<.0001). Relative to non-Hispanic White urban Veterans, the reference group for race/ethnicity-urban/rural hazard ratios reported, all urban race/ethnicity groups were associated with increased likelihood for vaccination except American Indian/Alaskan Native (AI/AN) groups. Urban Black groups were 12% more likely (Hazard Ratio (HR)=1.12 [CI 1.12-1.13]) and rural Black groups were 6% more likely to receive a first vaccination (HR=1.06 [1.05-1.06]) relative to white urban groups. Urban Hispanic, AA/PI and Mixed groups were more likely to receive vaccination while rural members of these groups were less likely (Hispanic: Urban HR=1.17 [1.16-1.18], Rural HR=0.98 [0.97-0.99]; AA/PI: Urban HR=1.22 [1.21-1.23], Rural HR=0.86 [0.84-0.88]). Rural White Veterans were 21% less likely to receive an initial vaccine compared with urban White Veterans (HR=0.79 [0.78-0.79]). AI/AN groups were less likely to receive vaccination regardless of rurality: Urban HR=0.93 [0.91-0.95]; AI/AN-Rural HR=0.76 [0.74-0.78]. Conclusions Urban Black, Hispanic, and AA/PI Veterans were more likely than their urban White counterparts to receive a first vaccination; all rural race/ethnicity groups except Black patients had lower likelihood for vaccination compared with urban White patients. A better understanding of disparities and rural outreach will inform equitable vaccine distribution.
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Affiliation(s)
- Ethan L. Bernstein
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Eric C. DeRycke
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ling Han
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Melissa M. Farmer
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Lori A. Bastian
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of General Internal Medicine, School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brett Bade
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Cynthia Brandt
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kristina Crothers
- VA Puget Sound Health Care, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Melissa Skanderson
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christopher Ruser
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Juliette Spelman
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Isabel S. Bazan
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, Connecticut
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of General Internal Medicine, School of Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
| | - Christopher T. Rentsch
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kathleen M. Akgün
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
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Hamilton AB, Finley EP, Bean-Mayberry B, Lang A, Haskell SG, Moin T, Farmer MM. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 QUERI: study protocol for a cluster-randomized hybrid type 3 effectiveness-implementation trial. Implement Sci Commun 2023; 4:23. [PMID: 36890587 PMCID: PMC9994412 DOI: 10.1186/s43058-022-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Women Veterans are the fastest-growing segment of Veterans Health Administration (VA) users. The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored. However, gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and the rate of perinatal depression among women Veterans is higher than that among civilian women. Challenges such as distance, rurality, negative perception of VA, discrimination (e.g., toward sexual and/or gender minority individuals), and harassment on VA grounds can further impede women's regular use of VA care. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 builds on work to date by expanding access to evidence-based, telehealth preventive and mental health services for women Veterans with high-priority health conditions in rural and urban-isolation areas. METHODS EMPOWER 2.0 will evaluate two implementation strategies, Replicating Effective Practices (REP) and Evidence-Based Quality Improvement (EBQI), in supporting the implementation and sustainment of three evidence-based interventions (Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching Program; and Reach Out, Stay Strong Essentials) focused on preventive and mental health care for women Veterans. We will conduct a mixed-methods implementation evaluation using a cluster-randomized hybrid type 3 effectiveness-implementation trial design to compare the effectiveness of REP and EBQI on improved access to and rates of engagement in telehealth preventive lifestyle and mental health services. Other outcomes of interest include (a) VA performance metrics for telehealth care delivery and related clinical outcomes; (b) progression along the Stages of Implementation Completion; (c) adaptation, sensemaking, and experiences of implementation among multilevel stakeholders; and (d) cost and return on investment. We will also generate implementation playbooks for program partners to support scale-up and spread of these and future evidence-based women's health programs and policies. DISCUSSION EMPOWER 2.0 provides a model for mixed-methods hybrid type 3 effectiveness-implementation trial design incorporating evaluation of performance metrics, implementation progress, stakeholder experience, and cost and return on investment, with the ultimate goal of improving access to evidence-based preventive and mental telehealth services for women Veterans with high-priority health conditions. TRIAL REGISTRATION ClinicalTrials.gov, NCT05050266 . Registered on 20 September 2021.
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Affiliation(s)
- Alison B Hamilton
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Departments of Medicine and Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ariel Lang
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sally G Haskell
- VA HSR&D Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Tannaz Moin
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Melissa M Farmer
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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6
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Goulet JL, Warren AR, Workman TE, Skanderson M, Farmer MM, Gordon KS, Abel EA, Akgün KM, Bean-Mayberry B, Zeng-Treitler Q, Haderlein TP, Haskell SG, Bastian LA, Womack JA, Post LA, Hwang U, Brandt CA. Variation in firearm screening and access by LGBT status. Acad Emerg Med 2023; 30:420-423. [PMID: 36661348 DOI: 10.1111/acem.14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Joseph L Goulet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Allison R Warren
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - T Elizabeth Workman
- Biomedical Informatics Center, The George Washington University, Washington, DC, USA
| | | | - Melissa M Farmer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica A Abel
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Akgün
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, UCLA-David Geffen School of Medicine, Los Angeles, California, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, The George Washington University, Washington, DC, USA.,Washington DC VA Medical Center, Washington, DC, USA
| | - Taona P Haderlein
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Veterans Affairs, Veterans Emergency Management Evaluation Center (VEMEC), North Hills, California, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julie A Womack
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Yale School of Nursing, VA Connecticut, West Haven, Connecticut, USA
| | - Lori A Post
- Northwestern University, Chicago, Illinois, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Cynthia A Brandt
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
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7
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Fenwick KM, Dyer KE, Klap R, Oishi K, Moreau JL, Yano EM, Bean-Mayberry B, Sadler AG, Hamilton AB. Expert Recommendations for Designing Reporting Systems to Address Patient-Perpetrated Sexual Harassment in Healthcare Settings. J Gen Intern Med 2022; 37:3723-3730. [PMID: 35266124 PMCID: PMC9585114 DOI: 10.1007/s11606-022-07467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient-perpetrated sexual harassment toward staff and patients is prevalent in Veterans Affairs and other healthcare settings. However, many healthcare facilities do not have adequate systems for reporting patient-perpetrated harassment, and there is limited evidence to guide administrators in developing them. OBJECTIVE To identify expert recommendations for designing effective systems for reporting patient-perpetrated sexual harassment of staff and patients in Veterans Affairs and other healthcare settings. DESIGN We conducted qualitative interviews with subject matter experts in sexual harassment prevention and intervention during 2019. PARTICIPANTS We used snowball sampling to recruit subject matter experts. Participants included researchers, clinicians, and administrators from Veterans Affairs/other healthcare, academic, military, and non-profit settings (n = 33). APPROACH We interviewed participants via telephone using a semi-structured guide and analyzed interview data using a constant comparative approach. KEY RESULTS Expert recommendations for designing reporting systems to address patient-perpetrated sexual harassment focused on fostering trust, encouraging reporting, and deterring harassment. Recommendations included the following: (1) promote a climate in which harassment is not tolerated; (2) take proportional, corrective actions in response to reports; (3) minimize adverse outcomes for reporting parties; (4) facilitate and simplify reporting processes; and (5) hold the reporting system accountable. Specific strategies related to each recommendation were also identified. CONCLUSIONS This qualitative study generated initial recommendations to guide healthcare administrators and policy makers in assessing, developing, and improving systems for reporting patient-perpetrated sexual harassment toward staff and other patients. Results indicate that proactive, careful design and ongoing evaluation are essential for ensuring that reporting systems have their intended effects and mitigating the risks of inadequate systems. Additional research is needed to evaluate strategies that effectively address patient-perpetrated harassment while balancing patients' clinical needs.
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Affiliation(s)
- Karissa M. Fenwick
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Karen E. Dyer
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Ruth Klap
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Kristina Oishi
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Jessica L. Moreau
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Elizabeth M. Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Bevanne Bean-Mayberry
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Anne G. Sadler
- VA Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Alison B. Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA USA
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Rose DE, Oishi SM, Farmer MM, Bean-Mayberry B, Canelo I, Washington DL, Yano EM. Association Between Availability of Women's Health Services and Women Veterans' Care Experiences. Womens Health Issues 2022; 32:623-632. [PMID: 36115812 DOI: 10.1016/j.whi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences. METHODS In a cross-sectional analysis, we linked Fiscal Year 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Health care Experiences of Patients-Patient Centered Medical Home (2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient-provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics. RESULTS A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01-1.10), provider communication (AOR, 1.08; 95% CI, 1.002-1.16), and primary care provider (AOR, 1.07; 95% CI, 1.02-1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88-0.99). CONCLUSION For the most part, routine availability of women's health services in VA primary care clinics enhanced women's health care experiences. These empirical findings offer health care leaders evidence-based approaches for improving women's care experiences.
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Affiliation(s)
- Danielle E Rose
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California.
| | - Sabine M Oishi
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Melissa M Farmer
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Bevanne Bean-Mayberry
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Ismelda Canelo
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Donna L Washington
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
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9
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Sheahan KL, Goldstein KM, Than CT, Bean-Mayberry B, Chanfreau CC, Gerber MR, Rose DE, Brunner J, Canelo IA, Darling Mshs JE, Haskell S, Hamilton AB, Yano EM. Women Veterans' Healthcare Needs, Utilization, and Preferences in Veterans Affairs Primary Care Settings. J Gen Intern Med 2022; 37:791-798. [PMID: 36042076 PMCID: PMC9481772 DOI: 10.1007/s11606-022-07585-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/01/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Veterans Health Administration (VA) is the largest integrated health system in the US and provides access to comprehensive primary care. Women Veterans are the fastest growing segment of new VA users, yet little is known about the characteristics of those who routinely access VA primary care in general or by age group. OBJECTIVE Describe healthcare needs, utilization, and preferences of women Veterans who routinely use VA primary care. PARTICIPANTS 1,391 women Veterans with 3+ primary care visits within the previous year in 12 VA medical centers (including General Primary Care Clinics, General Primary Care Clinics with designated space for women, and Comprehensive Women's Health Centers) in nine states. METHODS Cross-sectional survey (45% response rate) of sociodemographic characteristics, health status (including chronic disease, mental health, pain, and trauma exposure), utilization, care preferences, and satisfaction. Select utilization data were extracted from administrative data. Analyses were weighted to the population of routine users and adjusted for non-response in total and by age group. KEY RESULTS While 43% had health coverage only through VA, 62% received all primary care in VA. In the prior year, 56% used VA mental healthcare and 78% used VA specialty care. Common physical health issues included hypertension (42%), elevated cholesterol (39%), pain (35%), and diabetes (16%). Many screened positive for PTSD (41%), anxiety (32%), and depression (27%). Chronic physical and mental health burdens varied by age. Two-thirds (62%) had experienced military sexual trauma. Respondents reported satisfaction with VA women's healthcare and preference for female providers. CONCLUSIONS Women Veterans who routinely utilize VA primary care have significant multimorbid physical and mental health conditions and trauma histories. Meeting women Veterans' needs across the lifespan will require continued investment in woman-centered primary care, including integrated mental healthcare and emphasis on trauma-informed, age-specific care, guided by women's provider preferences.
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Affiliation(s)
- Kate L Sheahan
- JSI, Inc., 2733 Crystal Dr 4th floor, Arlington, VA, 22202, USA.
| | - Karen M Goldstein
- JSI, Inc., 2733 Crystal Dr 4th floor, Arlington, VA, 22202, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Claire T Than
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Bevanne Bean-Mayberry
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, University of California, Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA
| | - Catherine C Chanfreau
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Affairs Informatics and Computing Infrastructure (VINCI), Salt Lake City, UT, USA
| | - Megan R Gerber
- Albany Stratton VA Medical Center, Albany, NY, USA
- Division of General Internal Medicine, Albany Medical College, Albany, NY, USA
| | - Danielle E Rose
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Julian Brunner
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ismelda A Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jill E Darling Mshs
- Center for Economic and Social Research (CESR), University of Southern California, Los Angeles, CA, USA
| | - Sally Haskell
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Division of General Internal Medicine, Department of Medicine, Yale University School of Medicine, West Haven, CT, USA
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, University of California, Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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10
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Carlson GC, Than CT, Rose D, Brunner J, Chanfreau-Coffinier C, Canelo IA, Klap R, Bean-Mayberry B, Agrawal A, Hamilton AB, Gerber MR, Yano EM. What Drives Women Veterans' Trust in VA Healthcare Providers? Womens Health Issues 2022; 32:499-508. [PMID: 35367107 PMCID: PMC9522916 DOI: 10.1016/j.whi.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Little is known about women veterans' trust in Veterans Affairs (VA) health care and what factors promote trust in VA providers. We examined provider behaviors and characteristics of women veterans associated with trust in their VA providers. METHODS We used a 2015 survey of women veterans who were routine users of primary care at 12 VA medical centers (n = 1,395). Patient trust in their VA provider was measured on a seven-item scale. We used multiple logistic regression to examine associations of patient-provider communication and gender appropriateness with complete trust in VA provider (100 [complete trust] vs. <100 [less than complete trust]), controlling for patient characteristics. RESULTS On average, 39.7% of women veterans reported complete trust in their VA providers. Those with complete trust reported greater patient-provider communication and gender appropriateness of VA services than those with less-than-complete trust (all ps ≤ .001). In multiple logistic regression models, higher ratings of provider communication (adjusted odds ratio, 2.37), gender-appropriate care (adjusted odds ratio, 1.93), and trauma-sensitive communication (adjusted odds ratios, 1.79-6.08) were associated with a higher likelihood of reporting complete trust in their VA provider. CONCLUSIONS Women veterans reported high levels of trust in their VA providers. Provider communication, gender-appropriate care, and trauma-sensitive communication were associated with greater patient trust. Although it is important to highlight the steps already taken by VA to increase the quality of care for women veterans, current findings suggest that women veterans' trust may be further increased by interventions to improve trauma-informed care by VA providers.
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Affiliation(s)
- Gwendolyn C Carlson
- Department of Mental Health, VA Greater Los Angeles Healthcare System, North Hills, California; VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California.
| | - Claire T Than
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Danielle Rose
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Julian Brunner
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Catherine Chanfreau-Coffinier
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; VA Informatics and Computing Infrastructure (VINCI), Salt Lake City VA Healthcare System, Salt Lake City, Utah
| | - Ismelda A Canelo
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Ruth Klap
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
| | - Bevanne Bean-Mayberry
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Alpna Agrawal
- Department of Mental Health, VA Greater Los Angeles Healthcare System, North Hills, California; VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
| | - Alison B Hamilton
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
| | - Megan R Gerber
- Albany Medical College, Albany Stratton VA Medical Center, Albany, New York
| | - Elizabeth M Yano
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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11
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Agrawal A, Moghtaderi I, Kelly M, Carlson G, Lee D, Mitchell M, Zeidler M, Alessi C, Sung Y, Hamilton A, Bean-Mayberry B, Yano E, Washington D, Martin J. 0331 Intersectional discrimination and sleep health among women veterans: a pilot study. Sleep 2022. [DOI: 10.1093/sleep/zsac079.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Structural inequalities perpetuate poor health outcomes. Sleep inequality, which is the disproportionate burden of sleep problems among marginalized groups compared to historically advantaged groups, is poorly understood. While racial discrimination is associated with chronic health outcomes, few studies have examined the health impact of discrimination stemming from multiple social vulnerabilities. The current study assessed women veterans’ experiences of intersectional discrimination, specifically the combined impact of gender and racial/ethnic discrimination on sleep health.
Methods
Data were from the WISE (Women Improving Sleep through Education) study. Participants were women veterans with a previous diagnosis of sleep apnea or 1 or more risk factors for sleep disordered breathing (n=39). Data collection was from 3/2021–11/2021. The 9-item Major Discrimination Scale (MDS) and 10-item Everyday Discrimination Scale (EDS) were employed. The MDS included items such as “have you ever been unfairly stopped, searched, questioned, physically threatened or abused by police?” and the EDS, “how often on a day-to-day basis are you treated with less courtesy than other people?”. Items were adapted to assess discrimination related to respondents' gender and race/ethnicity separately. Major intersectional discrimination (MDS-gender + MDS-race/ethnicity) and everyday intersectional discrimination (EDS-gender + EDS-race/ethnicity) were computed. Sleep health was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Descriptive statistics and correlational analyses were performed.
Results
Racial/ethnic minority women veterans comprised 54% of the study sample. Prevalence of major intersectional discrimination was 67% and everyday intersectional discrimination, 92%. Compared to other racial/ethnic groups, the proportion of Black women veterans reporting major intersectional discrimination was highest (78%). Major intersectional discrimination was positively correlated with ISI (p=0.04) and PSQI (p=0.01). Everyday intersectional discrimination was not correlated with sleep health (p>0.05).
Conclusion
Pilot study findings highlight the potential role of discrimination on sleep health, particularly multiple forms of discrimination. High prevelence of intersectional discrimination related to women veterans' gender and racial/ethnic identities was observed. Major intersectional discrimination, not everyday intersectional discrimination, was associated with higher insomnia severity and poorer sleep quality.
Support (If Any)
LIP VA HSRD IIR16-244, RCSA20-191, LIP65-177, NIH/NHLBI K24HL143055, VAGLAHS GRECC, VAGLAHS CSHIIP, RCS 21-135, CIN 13-417, RCS 05-195
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Affiliation(s)
| | | | | | | | - Diane Lee
- VA Greater Los Angeles Healthcare System
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12
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Lumsden RH, Goldstein KM, Shephard-Banigan M, Kroll-Desrosiers A, Bean-Mayberry B, Farmer MM, Mattocks KM. Racial Differences in Nontraditional Risk Factors Associated with Cardiovascular Conditions in Pregnancy Among U.S. Women Veterans. J Womens Health (Larchmt) 2022; 31:706-714. [PMID: 35072546 DOI: 10.1089/jwh.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pregnancy-related cardiovascular (CV) conditions are important predictors of future cardiovascular disease (CVD). Nontraditional factors, such as depression and chronic stress, have been associated with CVD, but their role in pregnancy-related CVD conditions (pCVD) remains unknown. To determine the association between nontraditional factors and CV conditions in pregnancy, and to explore if this risk varies by race. Methods: Using data from a prospective study of pregnant women within the veterans affairs health system (COMFORT study), we described the prevalence of nontraditional factors (e.g., depression, post-traumatic stress disorder [PTSD], chronic stress) and used logistic regression to determine the association between nontraditional factors and pregnancy-related CV conditions (pre-eclampsia/eclampsia, gestational hypertension, gestation diabetes, or preterm delivery). Analyses were then stratified by race. Results: Among 706 enrollees, 26% had pregnancy-related CV conditions. These women had significantly higher rates of depression (62% vs. 45%, p < 0.01), anxiety (50% vs. 37%, p = 0.01), PTSD (44% vs. 29%, p < 0.01), and high stress levels before pregnancy (22% vs. 16%, p = 0.05) compared with women with normal pregnancies. Overall, these factors were not associated with increased adjusted odds of pCVD. Overall, Black women had disproportionately higher rates of prepregnancy hypertension compared with White women (22% vs. 6%, p < 0.01). Conclusions: Women Veterans with pCVD are a high-risk group for future CVD, with disproportionately high rates of depression, anxiety, PTSD, and chronic stress. Racial disparities exist in pregnancy-related CV risk factors, which may further compound existing racial disparities in CVD among women Veterans.
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Affiliation(s)
- Rebecca H Lumsden
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Goldstein
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA healthcare system, Durham, North Carolina, USA
| | - Megan Shephard-Banigan
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Duke University Durham, North Carolina, USA
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Melissa M Farmer
- VA Greater Los Angeles Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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13
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Gandhi PU, Runels T, Skanderson M, Bastian L, Brandt C, Hauser RG, Feder SL, Rodwin B, Farmer M, Bean-Mayberry B, Akgun K. SEX DIFFERENCES IN NATRIURETIC PEPTIDE TESTING IN PATIENTS HOSPITALIZED WITH HEART FAILURE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Brunner J, Farmer MM, Bean-Mayberry B, Chanfreau-Coffinier C, Than CT, Hamilton AB, Finley EP. Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake. Front Health Serv 2022; 2:946802. [PMID: 36925876 PMCID: PMC10012802 DOI: 10.3389/frhs.2022.946802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022]
Abstract
Evaluations of clinical decision support (CDS) implementation often struggle to measure and explain heterogeneity in uptake over time and across settings, and to account for the impact of context and adaptation on implementation success. In 2017-2020, the EMPOWER QUERI implemented a cardiovascular toolkit using a computerized template aimed at reducing women Veterans' cardiovascular risk across five Veterans Healthcare Administration (VA) sites, using an enhanced Replicating Effective Programs (REP) implementation approach. In this study, we used longitudinal joint displays of qualitative and quantitative findings to explore (1) how contextual factors emerged across sites, (2) how the template and implementation strategies were adapted in response to contextual factors, and (3) how contextual factors and adaptations coincided with template uptake across sites and over time. We identified site structure, staffing changes, relational authority of champions, and external leadership as important contextual factors. These factors gave rise to adaptations such as splitting the template into multiple parts, pairing the template with a computerized reminder, conducting academic detailing, creating cheat sheets, and using small-scale pilot testing. All five sites exhibited variability in utilization over the months of implementation, though later sites exhibited higher template utilization immediately post-launch, possibly reflecting a "preloading" of adaptations from previous sites. These findings underscore the importance of adaptive approaches to implementation, with intentional shifts in intervention and strategy to meet the needs of individual sites, as well as the value of integrating mixed-method data sources in conducting longitudinal evaluation of implementation efforts.
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Affiliation(s)
- Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Melissa M Farmer
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Claire T Than
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Erin P Finley
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
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15
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Bean-Mayberry B, Chanfreau C, Clair K, Than C, Brunner J, Schweizer CA, Finley E, Hamilton A, Farmer MM. WHAT DRIVES PRIMARY CARE PROVIDERS TO SCREEN WOMEN VETERANS FOR CARDIOVASCULAR RISKS WITH COMPETING DEMANDS AND LIMITED TIME? PATIENT FACTORS ASSOCIATED WITH TEMPLATE USE IN THE VA. Am J Prev Cardiol 2021. [DOI: 10.1016/j.ajpc.2021.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Brandt CA, Workman TE, Farmer MM, Akgün KM, Abel EA, Skanderson M, Bean-Mayberry B, Zeng-Treitler Q, Mason M, Bastian LA, Goulet JL, Post LA. Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study. West J Emerg Med 2021; 22:525-532. [PMID: 34125022 PMCID: PMC8203018 DOI: 10.5811/westjem.2021.4.51203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. METHODS The study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. RESULTS The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). CONCLUSION Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.
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Affiliation(s)
- Cynthia A. Brandt
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - T. Elizabeth Workman
- The George Washington University, Biomedical Informatics Center, Washington, District of Columbia
- VA Medical Center, Washington, District of Columbia
| | - Melissa M. Farmer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kathleen M. Akgün
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Erica A. Abel
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut
| | | | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
- UCLA David Geffen School of Medicine, Department of Medicine, Los Angeles, California
| | - Qing Zeng-Treitler
- The George Washington University, Biomedical Informatics Center, Washington, District of Columbia
- VA Medical Center, Washington, District of Columbia
| | - Maryann Mason
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Joseph L. Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lori A. Post
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
- Northwestern University, Department of Geriatric Medicine, Chicago, Illinois
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Mattocks KM, Kroll-Desrosiers A, Kinney R, Bastian LA, Bean-Mayberry B, Goldstein KM, Shivakumar G, Copeland L. Racial Differences in the Cesarean Section Rates Among Women Veterans Using Department of Veterans Affairs Community Care. Med Care 2021; 59:131-138. [PMID: 33201084 DOI: 10.1097/mlr.0000000000001461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Racial disparities in maternal morbidity and mortality remain a pressing public health problem. Variations in cesarean section (C-section) rates among racial and ethnic groups have been well documented, though reasons for these variations remain unknown. In the Department of Veterans Affairs (VA), nearly half of all women Veterans are of reproductive age and >40% of these women are racial and ethnic minorities. Because the VA does not provide obstetrical services, all obstetrical care is provided by community obstetrical providers under the auspices of the VA Community Care Network. However, little is known regarding the rates and correlates of C-sections among women Veterans receiving community obstetrical care. OBJECTIVE To examine predictors of C-section deliveries among a cohort of racially diverse pregnant Veterans enrolled in VA care at 15 VA medical facilities nationwide. RESEARCH DESIGN Cross-sectional analysis of a longitudinal, prospective, multisite, observational cohort study of pregnant, and postpartum Veterans receiving community-based obstetrical care. RESULTS Overall, 659 Veterans delivered babies during the study period, and 35% of the deliveries were C-sections. Predictors of C-section receipt included being a woman of color [adjusted odds ratio (AOR), 1.76; 95% confidence interval (CI), 1.19-2.60], having an Edinburgh Postnatal Depression Scale score ≥10 (AOR, 1.71; 95% CI, 1.11-2.65), having a higher body mass indexes (AOR, 1.07; 95% CI, 1.04-1.11), and women who were older (AOR, 1.08; 95% CI, 1.03-1.13). There was a substantial racial variation in C-section rates across our 15 study sites, with C-section rates meeting or exceeding 50% for WOC in 8 study sites. CONCLUSIONS There is substantial racial and geographic variation in C-section rates among pregnant Veterans receiving obstetrical care through VA community care providers. Future research should carefully examine variations in C-sections by the hospital, and which providers and hospitals are included in VA contracts. There should also be an increased focus on the types of providers women Veterans have access to for obstetrical care paid for by the VA and the quality of care delivered by those providers.
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Affiliation(s)
- Kristin M Mattocks
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- VA Central Western Massachusetts Healthcare System, Leeds, MA
| | - Aimee Kroll-Desrosiers
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- VA Central Western Massachusetts Healthcare System, Leeds, MA
| | - Rebecca Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Karen M Goldstein
- Durham VA Health Care System-Center for Health Services Research in Primary Care
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Geetha Shivakumar
- Mental Health, VA North Texas Health Care System
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Laurel Copeland
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- VA Central Western Massachusetts Healthcare System, Leeds, MA
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Mattocks K, Casares J, Brown A, Bean-Mayberry B, Goldstein KM, Driscoll M, Haskell S, Bastian L, Brandt C. Women Veterans’ Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care. Womens Health Issues 2020; 30:113-119. [DOI: 10.1016/j.whi.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/20/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022]
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Dyer KE, Moreau JL, Finley E, Bean-Mayberry B, Farmer MM, Bernet D, Kress A, Lewis JL, Batuman FK, Haskell SG, Hamilton AB, Moin T. Tailoring an evidence-based lifestyle intervention to meet the needs of women Veterans with prediabetes. Women Health 2020; 60:748-762. [PMID: 31959089 DOI: 10.1080/03630242.2019.1710892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prediabetes affects one-third of U.S. adults. Lifestyle change interventions, such as the Diabetes Prevention Program (DPP), can significantly lower type 2 diabetes risk, but little is known about how the DPP could be best adapted for women. This mixed-methods study assessed the impact of gender-tailoring and modality choice on DPP engagement among women Veterans with prediabetes. Participants were offered women-only groups and either in-person/peer-led or online modalities. Implementation outcomes were assessed using attendance logs, recruitment calls, and semi-structured interviews about patient preferences. Between June 2016 and March 2017, 119 women Veterans enrolled in the DPP (n = 51 in-person, n = 68 online). We conducted 22 interviews between August and September 2016 (n = 10 early-implementation) and March and July 2017 (n = 12 follow-up). Most interviewees preferred women-only groups, citing increased comfort, camaraderie, and mutual understanding of gender-specific barriers to lifestyle change. More women preferred online DPP, and those using this modality participated at higher rates. Most endorsed the importance of modality choice and were satisfied with their selection; however, selection was frequently based on participants' personal circumstances and access barriers and not on a "preferred choice" of two equally accessible options. Patient engagement and program reach can be expanded by tailoring the DPP for population-specific needs.
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Affiliation(s)
- Karen E Dyer
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Jessica L Moreau
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Erin Finley
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,Veterans Evidence-based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Healthcare System , San Antonio, Texas, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center , San Antonio, Texas, USA
| | - Bevanne Bean-Mayberry
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Melissa M Farmer
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Dorothy Bernet
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Arthur Kress
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Jackie L Lewis
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Fatma K Batuman
- UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Sally G Haskell
- Women's Health Services, Veterans Health Administration , Washington, District of Columbia, USA.,VA Connecticut Healthcare System , West Haven, Connecticut, USA.,Yale University School of Medicine , New Haven, Connecticut, USA
| | - Alison B Hamilton
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA
| | - Tannaz Moin
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
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Bade BC, DeRycke EC, Skanderson M, Crothers K, Haskell S, Bean-Mayberry B, Cain HC, Brandt C, Bastian LA, Akgün KM. Underutilization of Pulmonary Function Testing in Veterans Hospitalized for Chronic Obstructive Pulmonary Disease Exacerbation: Who are We Missing? COPD 2020; 17:15-21. [DOI: 10.1080/15412555.2019.1711036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Brett C. Bade
- Section of Pulmonary, Critical Care, and Sleep Medicine, Veterans Administration (VA) Connecticut Health Care System, West Haven, CT, USA
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Eric C. DeRycke
- Department of Veterans Affairs, Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Melissa Skanderson
- Department of Veterans Affairs, Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kristina Crothers
- Section of Pulmonary and Critical Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Sally Haskell
- Department of Veterans Affairs, Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New, Haven, CT, USA
| | - Bevanne Bean-Mayberry
- VA Center for Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Hilary C. Cain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Veterans Administration (VA) Connecticut Health Care System, West Haven, CT, USA
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cynthia Brandt
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Lori A. Bastian
- Department of Veterans Affairs, Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New, Haven, CT, USA
| | - Kathleen M. Akgün
- Section of Pulmonary, Critical Care, and Sleep Medicine, Veterans Administration (VA) Connecticut Health Care System, West Haven, CT, USA
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Whitehead AM, Maher NH, Goldstein K, Bean-Mayberry B, Duvernoy C, Davis M, Safdar B, Saechao F, Lee J, Frayne SM, Haskell SG. Sex Differences in Veterans' Cardiovascular Health. J Womens Health (Larchmt) 2019; 28:1418-1427. [DOI: 10.1089/jwh.2018.7228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Alison M. Whitehead
- Department of Veterans Affairs, Central Office, Washington, District of Columbia
| | - Nancy H. Maher
- Department of Veterans Affairs, Central Office, Washington, District of Columbia
| | - Karen Goldstein
- Durham VA and Duke University School of Medicine, Durham, North Carolina
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles and Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Claire Duvernoy
- VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, Michigan
| | - Melinda Davis
- Department of Medicine, Cardiology Clinic, University of Michigan, Ann Arbor, Michigan
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Fay Saechao
- VA Health Services Research and Development (HSR&D) Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Jimmy Lee
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Susan M. Frayne
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Sally G. Haskell
- Department of Veterans Affairs, Central Office, Washington, District of Columbia
- VA Connecticut Healthcare System and Yale University, West Haven, Connecticut
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22
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Schweizer CA, Hoggatt KJ, Washington DL, Bean-Mayberry B, Yano EM, Mitchell MN, Alessi CA, Martin JL. Use of alcohol as a sleep aid, unhealthy drinking behaviors, and sleeping pill use among women veterans. Sleep Health 2019; 5:495-500. [PMID: 31416799 PMCID: PMC6801087 DOI: 10.1016/j.sleh.2019.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Sleep complaints, such as insomnia and sleep disturbances caused by posttraumatic stress disorder (PTSD), are more common among women veterans than nonveteran women. Alcohol use among some women may be partially motivated by the desire to improve sleep. This study evaluated rates of alcohol use as a sleep aid among women veterans and explored the relationship between alcohol use to aid sleep and drinking frequency and sleeping pill use. DESIGN AND SETTING National cross-sectional population-based residential mail survey on sleep and other symptoms. PARTICIPANTS Random sample of women veteran VA users who completed a postal survey (N = 1533). INTERVENTIONS None. MEASUREMENTS The survey included demographics, Insomnia Severity Index, Primary Care PTSD screen, and items on alcohol use frequency (days/week), use of prescription or over-the-counter sleep medications, and use of alcohol as a sleep aid (yes/no for each item) over the past month. RESULTS A total of 14.3% of respondents endorsed using alcohol to aid sleep. Logistic regression models showed more severe insomnia (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.01-1.06) and PTSD (OR = 2.11; 95% CI: 1.49-2.97) were associated with increased odds of using alcohol to aid sleep. Alcohol use to aid sleep was associated with increased odds of daily drinking (OR = 8.46; 95% CI: 4.00-17.87) and prescription (OR = 1.79; 95% CI: 1.34-2.38) and over-the-counter sleep aid use (OR = 1.54; 95% CI: 1.12-2.11). CONCLUSIONS Insomnia and PTSD may increase risk for using alcohol as a sleep aid, which may increase risk for unhealthy drinking and for mixing alcohol with sleep medications. Findings highlight the need for alcohol use screening in the context of insomnia and for delivery of cognitive-behavioral therapy for insomnia to women veterans with insomnia.
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Affiliation(s)
- C Amanda Schweizer
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
| | - Katherine J Hoggatt
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Donna L Washington
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles; Department of Medicine, VA Greater Los Angeles Healthcare System
| | - Bevanne Bean-Mayberry
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
| | - Elizabeth M Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Cathy A Alessi
- David Geffen School of Medicine, University of California, Los Angeles; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System.
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Finley EP, Huynh AK, Farmer MM, Bean-Mayberry B, Moin T, Oishi SM, Moreau JL, Dyer KE, Lanham HJ, Leykum L, Hamilton AB. Periodic reflections: a method of guided discussions for documenting implementation phenomena. BMC Med Res Methodol 2018; 18:153. [PMID: 30482159 PMCID: PMC6258449 DOI: 10.1186/s12874-018-0610-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnography has been proposed as a valuable method for understanding how implementation occurs within dynamic healthcare contexts, yet this method can be time-intensive and challenging to operationalize in pragmatic implementation. The current study describes an ethnographically-informed method of guided discussions developed for use by a multi-project national implementation program. METHODS The EMPOWER QUERI is conducting three projects to implement innovative care models in VA women's health for high-priority health concerns - prediabetes, cardiovascular risk, and mental health - utilizing the Replicating Effective Programs (REP) implementation strategy enhanced with stakeholder engagement and complexity science. Drawing on tenets of ethnographic research, we developed a lightly-structured method of guided "periodic reflections" to aid in documenting implementation phenomena over time. Reflections are completed as 30-60 min telephone discussions with implementation team members at monthly or bi-monthly intervals, led by a member of the implementation core. Discussion notes are coded to reflect key domains of interest and emergent themes, and can be analyzed singly or in triangulation with other qualitative and quantitative assessments to inform evaluation and implementation activities. RESULTS Thirty structured reflections were completed across the three projects during a 15-month period spanning pre-implementation, implementation, and sustainment activities. Reflections provide detailed, near-real-time information on projects' dynamic implementation context, including characteristics of implementation settings and changes in the local or national environment, adaptations to the intervention and implementation plan, and implementation team sensemaking and learning. Reflections also provide an opportunity for implementation teams to engage in recurring reflection and problem-solving. CONCLUSIONS To implement new, complex interventions into dynamic organizations, we must better understand the implementation process as it unfolds in real time. Ethnography is well suited to this task, but few approaches exist to aid in integrating ethnographic insights into implementation research. Periodic reflections show potential as a straightforward and low-burden method for documenting events across the life cycle of an implementation effort. They offer an effective means for capturing information on context, unfolding process and sensemaking, unexpected events, and diverse viewpoints, illustrating their value for use as part of an ethnographically-minded implementation approach. TRIAL REGISTRATION The two implementation research studies described in this article have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans (NCT02991534); and Implementation of Tailored Collaborative Care for Women Veterans (NCT02950961).
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Affiliation(s)
- Erin P. Finley
- South Texas Veterans Health Care System, San Antonio, Texas USA
- UT Health San Antonio, San Antonio, Texas USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Alexis K. Huynh
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Melissa M. Farmer
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
- David Geffen School of Medicine at University of California, Los Angeles, California USA
| | - Tannaz Moin
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
- David Geffen School of Medicine at University of California, Los Angeles, California USA
| | - Sabine M. Oishi
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Jessica L. Moreau
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Karen E. Dyer
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Holly Jordan Lanham
- South Texas Veterans Health Care System, San Antonio, Texas USA
- UT Health San Antonio, San Antonio, Texas USA
| | - Luci Leykum
- South Texas Veterans Health Care System, San Antonio, Texas USA
- UT Health San Antonio, San Antonio, Texas USA
| | - Alison B. Hamilton
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
- David Geffen School of Medicine at University of California, Los Angeles, California USA
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Huynh AK, Hamilton AB, Farmer MM, Bean-Mayberry B, Stirman SW, Moin T, Finley EP. A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions. Front Public Health 2018; 6:134. [PMID: 29868542 PMCID: PMC5968102 DOI: 10.3389/fpubh.2018.00134] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/20/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women's engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation. METHODS We conducted a process of strategy mapping to apply Proctor and colleagues' rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation. RESULTS Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities. DISCUSSION We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research.
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Affiliation(s)
- Alexis K. Huynh
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
| | - Alison B. Hamilton
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Melissa M. Farmer
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Shannon Wiltsey Stirman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Tannaz Moin
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Erin P. Finley
- South Texas Veterans Healthcare System, San Antonio, TX, United States
- UT Health Science Center, San Antonio, TX, United States
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Narain K, Bean-Mayberry B, Washington DL, Canelo IA, Darling JE, Yano EM. Access to Care and Health Outcomes Among Women Veterans Using Veterans Administration Health Care: Association With Food Insufficiency. Womens Health Issues 2018; 28:267-272. [PMID: 29475630 DOI: 10.1016/j.whi.2018.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Food insecurity has been associated with worse health outcomes in the civilian population. Male veterans of the Gulf Wars have been shown to have a higher prevalence of food insecurity than similarly situated civilians. Women veterans have more risk factors for food insecurity, relative to male veterans, yet little is known about the prevalence of food insecurity in this cohort. METHODS We used the Women Veterans' Health Utilization and Experience Survey for this analysis. Our study population consisted of women veterans who had at least three primary care or women's health visits to 1 of 12 Veteran's Health Administration health care facilities from December 2013 to November 2014. Multiple logistic regression was used to examine the relationship between food insufficiency (an inadequate amount of food intake owing to a lack of money or resources), delayed/missed care, anxiety, depression, and self-reported fair to poor health, controlling for race/ethnicity, marital status, and employment status. RESULTS The prevalence of food insufficiency among women veterans was 27.6%. Being food insufficient was associated with 16.4, 15.4, 14.9, and 12.1 percentage point increases in the probability of delayed/missed care, screening positive for anxiety, screening positive for depression, and reporting fair to poor health, respectively (p < .05). CONCLUSIONS The prevalence of food insufficiency in this cohort was associated with delayed access to health care and worse health outcomes. Interventions addressing Veterans Administration access and health outcomes will need to examine the potential role of food insufficiency.
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Affiliation(s)
- Kimberly Narain
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Bevanne Bean-Mayberry
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Donna L Washington
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ismelda A Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jill E Darling
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Hamilton AB, Farmer MM, Moin T, Finley EP, Lang AJ, Oishi SM, Huynh AK, Zuchowski J, Haskell SG, Bean-Mayberry B. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research. Implement Sci 2017; 12:127. [PMID: 29116022 PMCID: PMC5678767 DOI: 10.1186/s13012-017-0658-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/20/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women's Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women's Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans' engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health. METHODS/DESIGN The three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women's health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans' mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design. DISCUSSION EMPOWER represents a coherent program of women's health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans' engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women's Health, to disseminate and spread the programs nationally. TRIAL REGISTRATION The two implementation research studies described in this protocol have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534 , registered 9 December 2016. Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961 , registered 21 October 2016.
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Affiliation(s)
- Alison B. Hamilton
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Melissa M. Farmer
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Tannaz Moin
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Erin P. Finley
- South Texas Veterans Health Care, San Antonio, TX USA
- University of Texas Health Science Center, San Antonio, TX USA
| | - Ariel J. Lang
- VA San Diego Healthcare System, San Diego, CA USA
- University of California San Diego, San Diego, CA USA
| | - Sabine M. Oishi
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Alexis K. Huynh
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Jessica Zuchowski
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, CT USA
- Yale School of Medicine, Yale University, New Haven, CT USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
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Carney D, Frayne S, Klap R, Bastian L, Bean-Mayberry B, Sadler A, Pomernacki A, Phibbs C, Saechao F, Balasubramanian V, Romodan Y, Yano E. Expanding the VA Women’s Health Practice-Based Research Network: Increasing Capacity for Equitable Representation of Women in VA Research. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Farmer MM, Stanislawski MA, Plomondon ME, Bean-Mayberry B, Joseph NT, Thompson LE, Zuchowski JL, Daugherty SL, Yano EM, Ho PM. Sex Differences in 1-Year Outcomes After Percutaneous Coronary Intervention in the Veterans Health Administration. J Womens Health (Larchmt) 2017; 26:1062-1068. [PMID: 28498792 DOI: 10.1089/jwh.2016.6057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Advancements in percutaneous coronary intervention (PCI) for treating obstructive coronary artery disease have reduced major adverse events, including mortality. Yet, evidence as to whether women and men experience similar outcomes is mixed. The objective was to examine sex differences in 1-year major adverse cardiac outcomes for the national population of patients undergoing PCI at Veterans Health Administration (VA) cardiac catheterization laboratories. METHODS All Veterans undergoing PCI at VA hospitals between October 1, 2007 and September 30, 2013 (N = 64,757; Women = 1,040) were included. Cox proportional hazards models compared 1-year postprocedural outcomes [rehospitalization for myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE)] by sex. RESULTS Women Veterans undergoing PCI were more likely to be younger, black, obese, and have chronic depression and less likely to have common cardiovascular risk factors and to have had prior cardiac events than Veteran men. One-year rates for women versus men were 2.1% and 2.5% for rehospitalization (p-value = 0.57); 3.5% and 4.9% for mortality (p-value = 0.14), and 5.4% and 6.9% for MACE (p-value = 0.18). There were no significant sex differences in any of the outcomes in Cox proportional hazards models. CONCLUSIONS Despite differences in clinical risk factors at the time of PCI, women and men Veterans treated at VA cardiac catheterization laboratories experienced comparable 1-year rehospitalization for MI, mortality, and MACE post-PCI. These results demonstrated similar 1-year post-PCI outcomes for men and women in a national population of patients who have more comorbidities and mental health issues than the general population.
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Affiliation(s)
- Melissa M Farmer
- 1 VA HSR&D Center for the Study of Healthcare Innovation , Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | | | | | - Bevanne Bean-Mayberry
- 1 VA HSR&D Center for the Study of Healthcare Innovation , Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.,3 Department of Medicine, UCLA David Geffen School of Medicine , Los Angeles, California
| | - Nataria T Joseph
- 4 Social Sciences Division, Pepperdine University , Malibu, California
| | - Lauren E Thompson
- 5 Division of Cardiology, School of Medicine, University of Colorado , Aurora, Colorado.,6 Colorado Cardiovascular Outcomes Research (CCOR) Consortium , Colorado
| | - Jessica L Zuchowski
- 1 VA HSR&D Center for the Study of Healthcare Innovation , Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Stacie L Daugherty
- 5 Division of Cardiology, School of Medicine, University of Colorado , Aurora, Colorado.,6 Colorado Cardiovascular Outcomes Research (CCOR) Consortium , Colorado
| | - Elizabeth M Yano
- 1 VA HSR&D Center for the Study of Healthcare Innovation , Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.,7 Department of Health Policy and Management, UCLA Fielding School of Public Health , Los Angeles, California
| | - P Michael Ho
- 2 VA Eastern Colorado Health Care System , Denver, Colorado.,5 Division of Cardiology, School of Medicine, University of Colorado , Aurora, Colorado.,6 Colorado Cardiovascular Outcomes Research (CCOR) Consortium , Colorado
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Carter A, Borrero S, Wessel C, Washington DL, Bean-Mayberry B, Corbelli J. Racial and Ethnic Health Care Disparities Among Women in the Veterans Affairs Healthcare System: A Systematic Review. Womens Health Issues 2016; 26:401-9. [PMID: 27138241 DOI: 10.1016/j.whi.2016.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/04/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Women are a rapidly growing segment of patients who seek care in the Veterans Affairs (VA) Healthcare System, yet many questions regarding their health care experiences and outcomes remain unanswered. Racial and ethnic disparities have been well-documented in the general population and among veterans; however, prior disparities research conducted in the VA focused primarily on male veterans. We sought to characterize the findings and gaps in the literature on racial and ethnic disparities among women using the VA. METHODS We systematically reviewed the literature on racial and ethnic health care disparities exclusively among women using the VA Healthcare System. We included studies that examined health care use, satisfaction, and/or quality, and stratified data by race or ethnicity. RESULTS Nine studies of the 2,591 searched met our inclusion criteria. The included studies examined contraception provision/access (n = 3), treatment of low bone mass (n = 1), hormone therapy (n = 1), use of mental health or substance abuse-related services (n = 2), trauma exposure and use of various services (n = 1), and satisfaction with primary care (n = 1). Five of nine studies showed evidence of a significant racial or ethnic difference. CONCLUSION In contrast with the wealth of literature examining disparities both among the male veterans and women in non-VA settings, only nine studies examine racial and ethnic disparities specifically among women in the VA Healthcare System. These results demonstrate that there is an unmet need to further assess health care disparities among female VA users.
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Affiliation(s)
- Andrea Carter
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity, Research, and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - Charles Wessel
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Donna L Washington
- Veterans Affairs Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Bevanne Bean-Mayberry
- Veterans Affairs Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jennifer Corbelli
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Lewis ET, Jamison AL, Ghaus S, Durazo EM, Frayne SM, Hoggatt KJ, Bean-Mayberry B, Timko C, Cucciare MA. Receptivity to alcohol-related care among U.S. women Veterans with alcohol misuse. J Addict Dis 2016; 35:226-237. [PMID: 27049338 DOI: 10.1080/10550887.2016.1171670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous research indicates women Veterans have a potentially large, unmet need for alcohol-related care but are under-represented in treatment settings. The purpose of this study was to identify factors associated with women Veterans' receptivity to a recommendation for alcohol-related care when they present to Veterans Affairs (VA) primary care with alcohol misuse. Semi-structured interviews were conducted from 2012-2013 with 30 women Veterans at two VA facilities who screened positive for alcohol misuse during a primary care visit and discussed their alcohol use with their primary-care provider. Qualitative analyses identified 9 themes women used to describe what affected their receptivity to a recommendation for alcohol-related care (i.e., VA specialty substance use disorder services). The most common themes positively associated with women's receptivity included self-appraisal of their drinking behavior as more severe, the provider's presentation of treatment options, availability of gender-specific services, and worse physical and mental health. The themes identified here may have important implications for the clinical strategies providers can use to present alcohol-related care options to women Veterans to facilitate their use of care. These strategies include educating women about the health effects of alcohol misuse and increasing providers' knowledge about available care options (within the care organization or the community), including the availability of gender-specific services.
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Affiliation(s)
- Eleanor T Lewis
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Andrea L Jamison
- b National Center for Post-Traumatic Stress Disorder (NC-PTSD), VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Sharfun Ghaus
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Eva M Durazo
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Susan M Frayne
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA.,c Women's Health Section, VA Palo Alto Health Care System , Palo Alto , California , USA.,d Stanford University School of Medicine, Division of General Medical Disciplines , Stanford , California , USA
| | - Katherine J Hoggatt
- e VA Greater Los Angeles Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy , Sepulveda , California , USA.,f Department of Epidemiology , UCLA Fielding School of Public Health , Los Angeles , California , USA
| | - Bevanne Bean-Mayberry
- g Department of Medicine , David Geffen School of Medicine, University of California Los Angeles , Los Angeles , California , USA
| | - Christine Timko
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA.,h Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Michael A Cucciare
- i Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,j VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.,k Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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Trentalange M, Bielawski M, Murphy TE, Lessard K, Brandt C, Bean-Mayberry B, Maisel NC, Wright SM, Allore H, Skanderson M, Reyes-Harvey E, Gaetano V, Haskell S, Bastian LA. Patient Perception of Enough Time Spent With Provider Is a Mechanism for Improving Women Veterans' Experiences With VA Outpatient Health Care. Eval Health Prof 2016; 39:460-474. [PMID: 26908572 DOI: 10.1177/0163278716629523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We postulated that associations between two specific provider characteristics, class (nurse practitioner relative to physician) and primary care providers who are proficient and interested in women's health (designated women's provider relative to nondesignated) and overall satisfaction with provider, were mediated through women veterans' perception of enough time spent with the provider. A national patient experience survey was administered to 7,620 women veterans. Multivariable models of overall patient satisfaction with provider were compared with and without the proposed mediator. A structural equation model (SEM) of the mediation of the two provider characteristics was also evaluated. Without the mediator, associations of provider class and designation with overall patient satisfaction were significant. With the proposed mediator, these associations became nonsignificant. An SEM showed that the majority (>80%) of the positive associations between provider class and designation and the outcome were exerted through patient perception of enough time spent with provider. Higher ratings of overall satisfaction with provider exhibited by nurse practitioners and designated women's health providers were exerted through patient perception of enough time spent with provider. Future research should examine what elements of provider training can be developed to improve provider-patient communication and patient satisfaction with their health care.
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Affiliation(s)
- Mark Trentalange
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Terrence E Murphy
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Bevanne Bean-Mayberry
- Veterans Health Administration Health Services Research & Development, Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Natalya C Maisel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Steven M Wright
- Office of Performance Measurement, VHA Office of Analytics & Business Intelligence, Department of Veterans Affairs, Providence, RI, USA
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Evelyn Reyes-Harvey
- Office of Performance Measurement, VHA Office of Analytics & Business Intelligence, Durham, NC, USA
| | - Vera Gaetano
- VA Connecticut HSR&D Pain, Research, Informatics, Multimorbidities, and Education (Prime) Center, West Haven, CT, USA
| | - Sally Haskell
- Women's Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, CT, USA
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Callegari LS, Gray KE, Zephyrin LC, Harrington LB, Gerber MR, Cochrane BB, Weitlauf JC, Bean-Mayberry B, Bastian LA, Mattocks KM, Haskell SG, Katon JG. Hysterectomy and Bilateral Salpingo-Oophorectomy: Variations by History of Military Service and Birth Cohort. Gerontologist 2016; 56 Suppl 1:S67-77. [PMID: 26768393 DOI: 10.1093/geront/gnv666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Little is known about hysterectomy and bilateral salpingo-oophorectomy (BSO), which are associated with both health risks and benefits, among women Veterans. PURPOSE OF THE STUDY To compare the prevalence of hysterectomy with or without BSO, and early hysterectomy, between postmenopausal Veterans and non-Veterans. DESIGN AND METHODS We used baseline data from the Women's Health Initiative Clinical Trial and Observational Study. Multinomial logistic regression models examined differences in the prevalence of hysterectomy (neither hysterectomy nor BSO, hysterectomy without BSO, and hysterectomy with BSO) between Veterans and non-Veterans. Generalized linear models were used to determine whether early hysterectomy (before age 40) differed between Veterans and non-Veterans. Analyses were stratified by birth cohort (<65, ≥65 years at enrollment). RESULTS The unadjusted prevalence of hysterectomy without BSO was similar among Veterans and non-Veterans in both birth cohorts (<65: 22% vs 21%; ≥65: 22% vs 21%). The unadjusted prevalence of hysterectomy with BSO was equivalent among Veterans and non-Veterans in the >65 cohort (21%), but higher among Veterans in the <65 cohort (22% vs 19%). In adjusted analyses, although no differences were observed in the >65 cohort, Veterans in the <65 cohort had higher odds of hysterectomy without BSO (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03, 1.36) and with BSO (OR 1.26, 95% CI 1.10, 1.45), as well as elevated risk of early hysterectomy (relative risk 1.32, 95% CI 1.19, 1.47), compared with non-Veterans. IMPLICATIONS Aging women Veterans may have higher prevalence of hysterectomy and BSO than non-Veterans. This information contributes to understanding the health needs and risks of women Veterans and can inform clinical practice and policy for this population.
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Affiliation(s)
- Lisa S Callegari
- Department of Obstetrics and Gynecology, University of Washington, Seattle. VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington.
| | - Kristen E Gray
- VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle
| | - Laurie C Zephyrin
- VA Office of Patient Care, Women's Health Services, Washington, DC. VA New York Harbor. Department of Obstetrics and Gynecology, New York University Langone School of Medicine. Department of Veterans Affairs, Veterans Health Administration, Washington, DC
| | - Laura B Harrington
- Department of Epidemiology, University of Washington School of Public Health, Seattle
| | - Megan R Gerber
- VA Boston Healthcare System, Massachusetts. Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Barbara B Cochrane
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
| | - Bevanne Bean-Mayberry
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, California. Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Lori A Bastian
- VA Connecticut, West Haven. Division of General Internal Medicine, University of Connecticut, Farmington
| | - Kristin M Mattocks
- VA Central Western Massachusetts, Leeds. University of Massachusetts Medical School, Worcester
| | - Sally G Haskell
- VA Office of Patient Care, Women's Health Services, Washington, DC. VA Connecticut Health Care System, New Haven
| | - Jodie G Katon
- VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle. VA Office of Patient Care, Women's Health Services, Washington, DC
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Fox AB, Hamilton AB, Frayne SM, Wiltsey-Stirman S, Bean-Mayberry B, Carney D, Di Leone BA, Gierisch JM, Goldstein KM, Romodan Y, Sadler AG, Yano EM, Yee EF, Vogt D. Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' "Caring for Women Veterans" Program. J Contin Educ Health Prof 2016; 36:96-103. [PMID: 27262152 PMCID: PMC8082471 DOI: 10.1097/ceh.0000000000000073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although providing culturally sensitive health care is vitally important, there is little consensus regarding the most effective strategy for implementing cultural competence trainings in the health care setting. Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations. Yet, to our knowledge, EBQI has not yet been applied to cultural competence training. To evaluate whether EBQI could enhance the impact of an evidence-based training intended to improve veterans affairs health care staff gender sensitivity and knowledge (Caring for Women Veterans; CWV), we compared the reach and effectiveness of EBQI delivery versus standard web-based implementation strategies of CWV and assessed barriers and facilitators to EBQI implementation. METHODS Workgroups at four diverse veterans affairs health care sites were randomized to either an EBQI or standard web-based implementation condition (SI). All EBQI sites selected a group-based implementation strategy. Employees (N = 84) completed pretraining and posttraining assessments of gender sensitivity and knowledge, and focus groups/interviews were conducted with leadership and staff before and after implementation. RESULTS Reach of CWV was greater in the EBQI condition versus the SI condition. Whereas both gender sensitivity and knowledge improved in the EBQI condition, only gender sensitivity improved in the SI condition. Qualitative analyses revealed that the EBQI approach was well received, although a number of barriers were identified. DISCUSSION Findings suggest that EBQI can enhance the uptake and effectiveness of employee trainings. However, the decision to pursue EBQI must be informed by a consideration of available resources.
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Affiliation(s)
- Annie B. Fox
- Women’s Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA
| | - Alison B. Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Susan M. Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA
- Women’s Health Section, VA Palo Alto Health Care System, Palo Alto, CA
- Division of General Medical Disciplines and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA
| | - Shannon Wiltsey-Stirman
- Women’s Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Bevanne Bean-Mayberry
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Diane Carney
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA
| | - Brooke A.L. Di Leone
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA
| | - Jennifer M. Gierisch
- Durham VA Medical Center, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Karen M. Goldstein
- Durham VA Medical Center, Durham, NC
- Department of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Yasmin Romodan
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA
| | - Anne G. Sadler
- Iowa City VA Healthcare System, Iowa City, IA
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Elizabeth M. Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Ellen F. Yee
- New Mexico VA Healthcare System, Albuquerque, NM
| | - Dawne Vogt
- Women’s Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
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34
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Cucciare MA, Lewis ET, Hoggatt KJ, Bean-Mayberry B, Timko C, Durazo EM, Jamison AL, Frayne SM. Factors Affecting Women's Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans. Womens Health Issues 2015; 26:232-9. [PMID: 26341569 DOI: 10.1016/j.whi.2015.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/26/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND One in five women veterans screens positive for alcohol misuse. Women may be less likely than men to disclose alcohol use to a primary care provider (PCP), resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may affect women veterans' willingness to disclose alcohol use to a PCP. METHODS Between October 2012 and May 2013, in-depth interviews were conducted with 30 women veterans at two Department of Veterans Affairs (VA) medical facilities. Qualitative data analyses identified common themes representing factors that influence women's decision to disclose alcohol use to a PCP. FINDINGS Nine themes were endorsed by women veterans as influencing their willingness to disclose alcohol use to their PCP. Themes included provider behaviors perceived as encouraging or discouraging disclosure of alcohol misuse, perceived positive relationship with provider, negative emotions such as concerns about being judged or labeled an "alcoholic," health concerns about drinking, non-health-related concerns about drinking, self-appraisal of drinking behavior, social support, and clinic factors. CONCLUSIONS Our findings demonstrate the importance of social relationships, comfort with one's provider, and education on the potential harms (especially health related) associated with alcohol in encouraging disclosure of alcohol use in women veterans. Our results also support VA national health care efforts, including the provision of brief alcohol counseling and the use of primary care clinics specializing in the care of women veterans.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas; VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Eleanor T Lewis
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California
| | - Katherine J Hoggatt
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Eva M Durazo
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California
| | - Andrea L Jamison
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California
| | - Susan M Frayne
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California; Women's Health Service, VA Palo Alto Health Care System, Palo Alto, California; Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
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Katon JG, Gray KE, Gerber MR, Harrington LB, Woods NF, Weitlauf JC, Bean-Mayberry B, Goldstein KM, Hunt JR, Katon WJ, Haskell SG, McCutcheon SJ, Gass ML, Gibson CJ, Zephyrin LC. Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women. GERONT 2015. [DOI: 10.1093/geront/gnv104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Bielawski MP, Goldstein KM, Mattocks KM, Bean-Mayberry B, Yano EM, Bastian LA. Improving care of chronic conditions for women veterans: identifying opportunities for comparative effectiveness research. J Comp Eff Res 2014; 3:155-66. [PMID: 24645689 DOI: 10.2217/cer.14.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This article aims to critically analyze research focused on the findings for five chronic conditions: chronic pain, diabetes, cardiovascular disease, HIV and cancer among women veterans to identify opportunities for comparative effectiveness research. We provide a descriptive analysis from the relevant articles in prior systematic reviews. In order to identify potential gaps in research for these specific conditions, we also conducted a literature search to highlight studies focusing on women veterans published since the last systematic review. While the scientific knowledge base has grown for these chronic conditions among women veterans, the vast majority of the published literature remains descriptive and/or observational, with only a few studies examining gender differences and even fewer clinical trials. There is a need to conduct comparative effectiveness research on chronic conditions among women veterans to improve health and healthcare.
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Affiliation(s)
- Mark P Bielawski
- Center of Excellence, VA Connecticut Healthcare System, Newington, CT, USA
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Bastian LA, Trentalange M, Murphy TE, Brandt C, Bean-Mayberry B, Maisel NC, Wright SM, Gaetano VS, Allore H, Skanderson M, Reyes-Harvey E, Yano EM, Rose D, Haskell S. Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics. Womens Health Issues 2014; 24:605-12. [PMID: 25442706 DOI: 10.1016/j.whi.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers. METHODS Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs. FINDINGS Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01-1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs. CONCLUSIONS The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics.
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Affiliation(s)
- Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut; University of Connecticut Health Center, Farmington, Connecticut.
| | | | | | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Bevanne Bean-Mayberry
- Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Natalya C Maisel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Steven M Wright
- Office of Performance Measurement, Department of Veterans Affairs, Providence, Rhode Island
| | - Vera S Gaetano
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Heather Allore
- University of Connecticut Health Center, Farmington, Connecticut
| | | | - Evelyn Reyes-Harvey
- Office of Performance Measurement, Office of Analytics & Business Intelligence, Durham, North Carolina
| | - Elizabeth M Yano
- Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Danielle Rose
- Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Sally Haskell
- Women's Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, Connecticut
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Washington DL, Bean-Mayberry B, Hamilton AB, Cordasco KM, Yano EM. Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans. J Gen Intern Med 2013; 28 Suppl 2:S571-6. [PMID: 23807067 PMCID: PMC3695266 DOI: 10.1007/s11606-012-2323-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis. OBJECTIVE To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness. DESIGN AND PARTICIPANTS Cross-sectional 2008-2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population. MAIN MEASURES Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era. KEY RESULTS Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women's health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras. CONCLUSIONS Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs' higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.
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Affiliation(s)
- Donna L Washington
- VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, CA USA.
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Katon J, Reiber G, Rose D, Bean-Mayberry B, Zephyrin L, Washington DL, Yano EM. VA location and structural factors associated with on-site availability of reproductive health services. J Gen Intern Med 2013; 28 Suppl 2:S591-7. [PMID: 23807070 PMCID: PMC3695272 DOI: 10.1007/s11606-012-2289-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION With the increasing number of women Veterans enrolling in the Veterans Health Administration (VA), there is growing demand for reproductive health services. Little is known regarding the on-site availability of reproductive health services at VA and how this varies by site location and type. OBJECTIVE To describe the on-site availability of hormonal contraception, intrauterine device (IUD) placement, infertility evaluation or treatment, and prenatal care by site location and type; the characteristics of sites providing these services; and to determine whether, within this context, site location and type is associated with on-site availability of these reproductive health services. METHODS We used data from the 2007 Veterans Health Administration Survey of Women Veterans Health Programs and Practices, a national census of VA sites serving 300 or more women Veterans assessing practice structure and provision of care for women. Hierarchical models were used to test whether site location and type (metropolitan hospital-based clinic, non-metropolitan hospital-based clinic, metropolitan community-based outpatient clinic [CBOC]) were associated with availability of IUD placement and infertility evaluation/treatment. Non-metropolitan CBOCs were excluded from this analysis (n = 2). RESULTS Of 193 sites, 182 (94 %) offered on-site hormonal contraception, 97 (50 %) offered on-site IUD placement, 57 (30 %) offered on-site infertility evaluation/treatment, and 11 (6 %) offered on-site prenatal care. After adjustment, compared with metropolitan hospital based-clinics, metropolitan CBOCs were less likely to offer on-site IUD placement (OR 0.33; 95 % CI 0.14, 0.74). CONCLUSION Compared with metropolitan hospital-based clinics, metropolitan CBOCs offer fewer specialized reproductive health services on-site. Additional research is needed regarding delivery of specialized reproductive health care services for women Veterans in CBOCs and clinics in non-metropolitan areas.
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Affiliation(s)
- Jodie Katon
- Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, University of Washington School of Public Health, 1660 S. Columbian Way S-152, Seattle, WA 98108, USA.
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Frayne SM, Carney DV, Bastian L, Bean-Mayberry B, Sadler A, Klap R, Phibbs CS, Kimerling R, Vogt D, Yee EF, Lin JY, Yano EM. The VA Women's Health Practice-Based Research Network: amplifying women veterans' voices in VA research. J Gen Intern Med 2013; 28 Suppl 2:S504-9. [PMID: 23807057 PMCID: PMC3695282 DOI: 10.1007/s11606-013-2476-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Susan M. Frayne
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
- />Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA USA
- />Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA USA
| | - Diane V. Carney
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Lori Bastian
- />VA HSR&D Center of Excellence, VA Medical Center, Durham, NC USA
- />Division of General Internal Medicine, University of Connecticut Health Center, Farmington, CT USA
| | - Bevanne Bean-Mayberry
- />VA HSR&D Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA
- />Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Anne Sadler
- />VA HSR&D Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Mental Health Service Line, Iowa City VA Health Care System, Iowa City, IA USA
- />Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Ruth Klap
- />VA HSR&D Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA
| | - Ciaran S. Phibbs
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
- />Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA USA
- />Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA USA
- />Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA
| | - Rachel Kimerling
- />VA HSR&D Center of Excellence, VA Palo Alto Health Care System, Palo Alto, CA USA
- />National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Dawne Vogt
- />National Center for PTSD, VA Boston Healthcare System, Boston, MA USA
- />Division of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Ellen F. Yee
- />New Mexico VA Health Care System, Albuquerque, NM USA
- />University of New Mexico, Albuquerque, NM USA
| | - Julia Y. Lin
- />VA Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Elizabeth M. Yano
- />VA HSR&D Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA USA
- />Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
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Washington DL, Bean-Mayberry B, Mitchell MN, Riopelle D, Yano EM. Tailoring VA primary care to women veterans: association with patient-rated quality and satisfaction. Womens Health Issues 2011; 21:S112-9. [PMID: 21724130 DOI: 10.1016/j.whi.2011.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 03/26/2011] [Accepted: 04/15/2011] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Donna L Washington
- VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda, California, USA.
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Yano EM, Bastian LA, Bean-Mayberry B, Eisen S, Frayne S, Hayes P, Klap R, Lipson L, Mattocks K, McGlynn G, Sadler A, Schnurr P, Washington DL. Using research to transform care for women veterans: advancing the research agenda and enhancing research-clinical partnerships. Womens Health Issues 2011; 21:S73-83. [PMID: 21724148 DOI: 10.1016/j.whi.2011.04.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/05/2011] [Accepted: 04/08/2011] [Indexed: 10/28/2022]
Abstract
The purpose of this paper is to report on the outcomes of the 2010 VA Women's Health Services Research Conference, which brought together investigators interested in pursuing research on women veterans and women in the military with leaders in women's health care delivery and policy within and outside the VA, to significantly advance the state and future direction of VA women's health research and its potential impacts on practice and policy. Building on priorities assembled in the previous VA research agenda (2004) and the research conducted in the intervening six years, we used an array of approaches to foster research-clinical partnerships that integrated the state-of-the-science with the informational and strategic needs of senior policy and practice leaders. With demonstrated leadership commitment and support, broad field-based participation, strong interagency collaboration and a push to accelerate the move from observational to interventional and implementation research, the Conference provided a vital venue for establishing the foundation for a new research agenda. In this paper, we provide the historical evolution of the emergence of women veterans' health services research and an overview of the research in the intervening years since the first VA women's health research agenda. We then present the resulting VA Women's Health Research Agenda priorities and supporting activities designed to transform care for women veterans in six broad areas of study, including access to care and rural health; primary care and prevention; mental health; post deployment health; complex chronic conditions, aging and long-term care; and reproductive health.
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Affiliation(s)
- Elizabeth M Yano
- VA Greater Los Angeles HSR&D Center of Excellence for Study of Healthcare Provider Behavior, Los Angeles, California 91343, USA.
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Bean-Mayberry B, Yano EM, Washington DL, Goldzweig C, Batuman F, Huang C, Miake-Lye I, Shekelle PG. Systematic Review of Women Veterans’ Health: Update on Successes and Gaps. Womens Health Issues 2011; 21:S84-97. [DOI: 10.1016/j.whi.2011.04.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 11/30/2022]
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Sambamoorthi U, Bean-Mayberry B, Findley PA, Yano EM, Banerjea R. Organization of care and diagnosed depression among women veterans. Am J Manag Care 2010; 16:657-665. [PMID: 20873953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To analyze the association between the organizational features of integration of physical and mental healthcare in womens health clinics and the diagnosis of depression among women veterans with or at risk for cardiovascular conditions (ie, diabetes mellitus, heart disease, or hypertension). STUDY DESIGN Retrospective and observational secondary data analyses. METHODS We studied 27,972 women veterans from 118 facilities with diagnosed cardiovascular conditions in fiscal year 2001 (FY2001) using merged Medicare claims and Veterans Health Administration (VHA) data merged with the 1999 VHA Survey of Primary Care Practices and the 2001 VHA Survey of Women Veterans Health Programs and Practices. The dependent variable was a binary indicator for diagnosed depression during FY2001 at the individual level. We used a multilevel logistic regression model to control for clustering of women veterans within facilities. Individual-level independent variables included demographics, socioeconomic characteristics, and chronic physical conditions. RESULTS Overall, 27% of women veterans using the VHA were diagnosed as having depression in FY2001. Across facilities, rates of diagnosed depression varied from 13% to 41%. After controlling for individual-level and facility-level independent variables, women veterans who were served in separate women's health clinics with integrated physical and mental healthcare were more likely to have diagnosed depression. The adjusted odds ratio was 1.12 (95% confidence interval, 1.01-1.25). CONCLUSIONS Existing women-specific VHA organizational features with integration of primary care and mental health seem effective in diagnosing depression. Emerging patient-centered medical home models may facilitate diagnosis and treatment of mental health issues among women with complex chronic conditions.
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Affiliation(s)
- Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
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Yano EM, Hayes P, Wright S, Schnurr PP, Lipson L, Bean-Mayberry B, Washington DL. Integration of women veterans into VA quality improvement research efforts: what researchers need to know. J Gen Intern Med 2010; 25 Suppl 1:56-61. [PMID: 20077153 PMCID: PMC2806960 DOI: 10.1007/s11606-009-1116-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Department of Veterans Affairs (VA) and other federal agencies require funded researchers to include women in their studies. Historically, many researchers have indicated they will include women in proportion to their VA representation or pointed to their numerical minority as justification for exclusion. However, women's participation in the military-currently 14% of active military-is rapidly changing veteran demographics, with women among the fastest growing segments of new VA users. These changes will require researchers to meet the challenge of finding ways to adequately represent women veterans for meaningful analysis. We describe women veterans' health and health-care use, note how VA care is organized to meet their needs, report gender differences in quality, highlight national plans for women veterans' quality improvement, and discuss VA women's health research. We then discuss challenges and potential solutions for increasing representation of women veterans in VA research, including steps for implementation research.
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Affiliation(s)
- Elizabeth M Yano
- VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street, Sepulveda, CA 91343, USA.
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Abstract
OBJECTIVES To compare the prevalence of influenza and pneumococcal immunization rates according to sex in a national sample of older veterans in the Department of Veterans Affairs (VA) healthcare system. DESIGN Retrospective, cross-sectional. SETTING VA healthcare system. PARTICIPANTS Current VA healthcare system users aged 65 and older eligible for immunization in fiscal years 2001 to 2003 (N=48,424 patient records). MEASUREMENTS Generalized estimating equations were performed to analyze combined chart review and administrative data to determine effect of sex on receipt of influenza and pneumococcal immunizations. RESULTS Unadjusted immunization rates were higher for men than women for influenza (73% vs 69%) and pneumococcal (87% vs 83%) vaccine. Adjusting for demographics, clinical comorbidities, use, and region, women had significantly lower odds of influenza (odds ratio (OR)=0.85, 95% confidence interval (CI=0.79-0.92) and pneumococcal (OR=0.77, 95% CI=0.71-0.84) immunization. CONCLUSION Older female veterans have lower rates of immunization than older male veterans in VA settings. Although VA remains above community levels for immunization, older female veterans will benefit from targeted efforts to increase immunization prevalence.
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Affiliation(s)
- Bevanne Bean-Mayberry
- Veterans Affairs Greater Los Angeles Health Services Research and Development Center of Excellence, Center for Study of Health Care Provider Behavior, Sepulveda, California, USA.
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Haskell SG, Bean-Mayberry B, Goulet JL, Skanderson M, Good CB, Justice AC. Determinants of hormone therapy discontinuation among female veterans nationally. Mil Med 2008; 173:91-6. [PMID: 18251338 DOI: 10.7205/milmed.173.1.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The growing presence of female veterans within the Department of Veterans Affairs (VA) health care system highlights the need to assess the quality of and access to gender-specific care for menopause. We assessed the use of hormone therapy (HT) among female veterans before and after the release of the Women's Health Initiative clinical trial results and evaluated whether the structure of women's health care services within the VA system affects the use of HT. METHODS We identified all female veterans using HT in 2001 by using the VA pharmacy benefits management database and administrative data. Subjects identified as using HT in 2001 were evaluated to determine estrogen use status in 2003 and 2004. We calculated the change in HT use over time and performed multivariate analyses to identify patient and utilization determinants of HT discontinuation. RESULTS In 2001, 36,222 female veterans used HT. By 2004, 23,924 (66%) had discontinued HT. Subjects who had used a VA women's clinic or were younger (40-54 years of age) were significantly less likely to discontinue HT. However, Hispanic ethnicity, African American race, and clinical diagnoses such as heart disease and mastectomy were significantly associated with discontinuation. CONCLUSION Discontinuation rates in the VA system parallel those in the private sector. However, patients with any use of VA women's clinics were less likely to discontinue HT, indicating a practice setting variation that may indicate either more specific care or differential implementation of the new HT guidelines. Further research is warranted to assess whether a disparity occurs according to practice setting (or provider factors) with rapid shifts in guidelines.
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Affiliation(s)
- Sally G Haskell
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT 06515, USA
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Bean-Mayberry B, Yano EM, Bayliss N, Navratil J, Weisman CS, Scholle SH. Federally funded comprehensive women's health centers: leading innovation in women's healthcare delivery. J Womens Health (Larchmt) 2008; 16:1281-90. [PMID: 18001184 DOI: 10.1089/jwh.2006.0284] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AIMS Women's healthcare has historically been fragmented, given the artificial separation of reproductive care from general medical care. Aiming to advance new care models for delivery of comprehensive, integrated clinical care for women, two federal agencies-the U.S. Department of Health and Human Services (DHHS) and Department of Veterans Affairs (VA)-launched specialized women's health centers (WHCs). Exemplars of comprehensive service delivery, these originally federally funded centers have served as foundations for innovations in delivering comprehensive care to women in diverse practice settings. Little is known, however, about details of their organization, staffing, practice arrangements, and service availability that might inform adoption of similar models in the community. METHODS Using comparable key informant surveys, we collected organizational data from the DHHS National Centers of Excellence (CoE) (n = 13) and the original VA comprehensive WHC's (n = 8). We abstracted supplemental data (e.g., academic affiliation) from the 2001 American Hospital Association (AHA) survey. RESULTS All DHHS and VA women's health programs served urban areas, and nearly all had academic partnerships. DHHS centers had three times the average caseload as did VA centers. Preventive cancer screening and general reproductive services were uniformly available at all centers, although DHHS centers offered extensive reproductive services on-site more frequently, and VA centers more often had on-site mental healthcare. CONCLUSIONS The DHHS and VA comprehensive WHCs share similar missions and comparable organization, education, and clinical services, demonstrating their commitment to reducing fragmented service delivery. Their common structural components present opportunities for further advancing women's quality of care across other systems of care.
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Affiliation(s)
- Bevanne Bean-Mayberry
- VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health- care System, Sepulveda, California 91343, USA.
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Abstract
OBJECTIVE To explore the effect of race on primary care quality and satisfaction among women in the Department of Veterans Affairs (VA). METHODS We used a mail survey to measure primary care quality and satisfaction. We focused on 4 primary care domains: patient preference for provider, interpersonal communication, accumulated knowledge, and coordination. We performed univariate analyses to compare variables by race and multiple logistic regression analysis to examine the effect of race on the probability of reporting a perfect score on each domain, while adjusting for patient characteristics and site. RESULTS Black women were younger, unmarried, educated, of higher income, and reported female providers and gynecological care in VA more often. In regression analysis, race was not significantly associated with any primary care domain or satisfaction. Gynecological care from VA provider was associated with perfect ratings on patient preference for provider (odds ratio [OR] 2.0, 95% confidence intervals [CI] 1.3, 3.1), and satisfaction (OR 1.6, 95% CI 1.2, 2.3), while female provider was associated with interpersonal communication (OR 1.9, 95% CI 1.4, 2.6). CONCLUSIONS While demographics and health experiences vary by race among veterans, race had no effect on primary care ratings. Future studies need to determine whether this racial equity persists in health outcomes among women veterans.
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Affiliation(s)
- Bevanne Bean-Mayberry
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
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Bean-Mayberry B, Gordon AJ, Fultz SL. The debt repayment paradox for VA clinical investigators. JAMA 2004; 291:2316; author reply 2316. [PMID: 15150202 DOI: 10.1001/jama.291.19.2316-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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