title: Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics.
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.
  
  
  RESULTS
  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.
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; University of Connecticut Health Center, Farmington, Connecticut. Electronic address: lori.bastian@va.gov.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Mark
authors.initials: M
authors.lastname: Trentalange
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.affiliation: 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.
authors.forename: Bevanne
authors.initials: B
authors.lastname: Bean-Mayberry
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
authors.forename: Natalya C
authors.initials: NC
authors.lastname: Maisel
authors.affiliation: Office of Performance Measurement, Department of Veterans Affairs, Providence, Rhode Island.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Wright
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Vera S
authors.initials: VS
authors.lastname: Gaetano
authors.affiliation: University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Heather
authors.initials: H
authors.lastname: Allore
authors.affiliation: Department of Veterans Affairs, Pittsburgh, Pennsylvania.
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: Office of Performance Measurement, Office of Analytics & Business Intelligence, Durham, North Carolina.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Reyes-Harvey
authors.affiliation: 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.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.affiliation: 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.
authors.forename: Danielle
authors.initials: D
authors.lastname: Rose
authors.affiliation: Women's Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, Connecticut.
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients / Q000523:psychology*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D016387:Women's Health; D055815:Young Adult