title: Associations between provider designation and female-specific cancer screening in women Veterans.
abstract: BACKGROUND
  In 2010, the Department of Veterans Affairs Healthcare System (VA) implemented policy to provide Comprehensive Primary Care (for acute, chronic, and female-specific care) from designated Women's Health providers (DWHPs) at all VA sites. However, since that time no comparisons of quality measures have been available to assess the level of care for women Veterans assigned to these providers.
  
  
  OBJECTIVE
  To evaluate the associations between cervical and breast cancer screening rates among age-appropriate women Veterans and designation of primary-care provider (DWHP vs. non-DWHP).
  
  
  METHODS
  Cross-sectional analyses using the fiscal year 2012 data on VA women's health providers, administrative files, and patient-specific quality measures.
  
  
  METHODS
  The sample included 37,128 women Veterans aged 21 through 69 years.
  
  
  METHODS
  Variables included patient demographic and clinical factors (ie, age, race, ethnicity, mental health diagnoses, obesity, and site), and provider factors (ie, DWHP status, sex, and panel size). Screening measures were defined by age-appropriate subgroups using VA national guidelines.
  
  
  RESULTS
  Female-specific cancer screening rates were higher among patients assigned to DWHPs (cervical cytology 94.4% vs. 91.9%, P<0.0001; mammography 86.3% vs. 83.3%, P<0.0001). In multivariable models with adjustment for patient and provider characteristics, patients assigned to DWHPs had higher odds of cervical cancer screening (odds ratio, 1.26; 95% confidence interval, 1.07-1.47; P<0.0001) and breast cancer screening (odds ratio, 1.24; 95% CI, 1.10-1.39; P<0.0001).
  
  
  CONCLUSIONS
  As the proportion of women Veterans increases, assignment to DWHPs may raise rate of female-specific cancer screening within VA. Separate evaluation of sex neutral measures is needed to determine whether other measures accrue benefits for patients with DWHPs.
authors.affiliation: *VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy †Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA ‡VA Connecticut Healthcare System, West Haven §Department of Internal Medicine, University of Connecticut Health Center, Farmington ∥Department of Internal Medicine, School of Medicine, New Haven, CT ¶VA Pittsburgh Health Care System, Pittsburgh, PA #VHA Office of Informatics and Analytics (10P2), Durham, NC **VA Palo Alto Health Care System, HSR&D Center for Innovation to Implementation (Ci2i), Palo Alto, CA ††VA Connecticut HSR&D Pain, Research, Informatics, Multimorbidities, and Education (Prime) Center, West Haven, CT ‡‡Office of Analytics & Business Intelligence (10P2B), Durham, NC ∥∥Women's Health Services, Patient Care Services, VA Central Office, Washington, DC ¶¶Yale University School of Medicine, Yale Center for Medical Informatics, West Haven, CT.
authors.forename: Bevanne
authors.initials: B
authors.lastname: Bean-Mayberry
authors.forename: Lori
authors.initials: L
authors.lastname: Bastian
authors.forename: Mark
authors.initials: M
authors.lastname: Trentalange
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: Heather
authors.initials: H
authors.lastname: Allore
authors.forename: Evelyn
authors.initials: E
authors.lastname: Reyes-Harvey
authors.forename: Natalya C
authors.initials: NC
authors.lastname: Maisel
authors.forename: Vera
authors.initials: V
authors.lastname: Gaetano
authors.forename: Steven
authors.initials: S
authors.lastname: Wright
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016134:Organizational Policy; D011320:Primary Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D058014:Veterans Health; D016387:Women's Health