title: Tailoring VA primary care to women veterans: association with patient-rated quality and satisfaction.
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.
  
  
  CONCLUSIONS
  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.
authors: VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda, California, USA. donna.washington@va.gov
authors: Donna L
authors: DL
authors: Washington
authors: Bevanne
authors: B
authors: Bean-Mayberry
authors: Michael N
authors: MN
authors: Mitchell
authors: Deborah
authors: D
authors: Riopelle
authors: Elizabeth M
authors: EM
authors: Yano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States; D016387:Women's Health; D055815:Young Adult