title: Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics.
abstract: BACKGROUND
  In response to concerns about the availability and quality of women's health services in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress approved landmark legislation earmarking funds to enhance women's health services. A portion of the appropriation was used to launch Comprehensive Women's Health Centers as exemplars for the development of VA women's health care throughout the system. We report on the diffusion and characteristics of VA women's health clinics (WHCs) 10 years later.
  
  
  METHODS
  In 2001, we surveyed the senior women's health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size). We evaluated the comparability of WHCs (n = 66) with characteristics of the original comprehensive women's health centers (CWHCs; n = 8).
  
  
  RESULTS
  Gender-specific service availability in WHCs was comparable to that of CWHCs with important exceptions in mental health, mammography and osteoporosis management. WHCs were less likely to have same-gender providers (p < .05), women's health training programs (p < .01), separate women's mental health clinics (p < .001), separate space (p < .05), or adequate privacy (p < .05); however, they were less likely to have experienced educational program closures (p < .001) and staffing losses (p < .05) compared to CWHCs.
  
  
  CONCLUSIONS
  Diffusion of comprehensive women's health care is as yet incomplete. More research is needed to examine the quality of care associated with these models and to establish the business case for managers faced with small female patient caseloads.
authors.affiliation: VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, 16111 Plummer Street (152), Sepulveda, CA 91343, USA. elizabeth.yano@va.gov
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Caroline
authors.initials: C
authors.lastname: Goldzweig
authors.forename: Ismelda
authors.initials: I
authors.lastname: Canelo
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
mesh_terms: D004059:Diffusion of Innovation; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*