title: Patient Perception of Enough Time Spent With Provider Is a Mechanism for Improving Women Veterans' Experiences With VA Outpatient Health Care.
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.
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA mark.trentalange@yale.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Trentalange
authors.affiliation: VA Connecticut Healthcare System, Newington, CT, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bielawski
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
authors.affiliation: VA Connecticut Healthcare System, Newington, CT, USA.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Lessard
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, USA.
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, CA, USA.
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, CA, USA.
authors.forename: Natalya C
authors.initials: NC
authors.lastname: Maisel
authors.affiliation: Office of Performance Measurement, VHA Office of Analytics & Business Intelligence, Department of Veterans Affairs, Providence, RI, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Wright
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.|Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Allore
authors.affiliation: Department of Veterans Affairs, Pittsburgh, PA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: Office of Performance Measurement, VHA Office of Analytics & Business Intelligence, Durham, NC, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Reyes-Harvey
authors.affiliation: VA Connecticut HSR&D Pain, Research, Informatics, Multimorbidities, and Education (Prime) Center, West Haven, CT, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: Gaetano
authors.affiliation: Women's Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, CT, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
authors.affiliation: VA Connecticut Healthcare System, Newington, CT, USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010465:Perception; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D016387:Women's Health
keywords: experiences with health care; nurse practitioners; primary care; structural equation model; veterans; women