Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VA Facilities (PEC 16-352)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 21
- 试验地点
- 50
- 主要终点
- Gender-sensitive Care Environment
研究概览
简要总结
Gaps in delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women seen in VA. VA policy action providing guidance on delivery of comprehensive healthcare services for women Veterans was disseminated nationally in 2010, followed by annual assessments and site visits evaluating local VA efforts. While substantial inroads have been made, policy implementation, even when leveraged by field-based women's health leaders, has not been uniformly successful in achieving delivery of comprehensive care by designated providers in gender-sensitive care environments that ensure women's privacy, dignity and safety, all tenets of the original guidance and the updated directive (2017).
Building on prior effectiveness of an evidence-based quality improvement (EBQI) approach to tailoring VA's medical home model -- Patient Aligned Care Teams (PACT) -- to the needs of women Veterans, VA leaders in women's health adopted EBQI to help low-performing VAs systematically improve services.
The objectives of the resulting Partnered Evaluation Initiative (PEI) funded by VA's Quality Enhancement Research Initiative and VA Office of Women's Health were:
- To evaluate barriers and facilitators to achieving delivery of comprehensive women's health care in the identified low-performing VAs;
- To evaluate effectiveness of EBQI in supporting low-performing VA facilities achieve improved organizational features, provider/staff attitudes, quality of care, and patient experiences among women Veteran patients; and,
- To evaluate contextual factors, local implementation processes, and organizational changes in the participating facilities over time.
详细描述
Gaps in delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women seen in VA. VA policy action providing guidance on delivery of comprehensive healthcare services for women Veterans was disseminated nationally in 2010, followed by annual assessments and site visits evaluating local VA efforts. While substantial inroads have been made, policy implementation, even when leveraged by field-based women's health leaders, has not been uniformly successful in achieving delivery of comprehensive care by designated providers in gender-sensitive care environments that ensure women's privacy, dignity and safety, all tenets of the original guidance and the updated VA directive (2017).
In collaboration with VA Women's Health Services (WHS), VA researchers developed a series of studies to better understand and help improve comprehensive care implementation through the Women Veterans' Healthcare CREATE Initiative. Among these, one focused on testing an evidence-based quality improvement (EBQI) approach to tailoring VA's medical home model -- Patient Aligned Care Teams (PACT) -- to the needs of women Veterans, which has yielded significant local improvements in women Veterans' care. EBQI emphasizes a multilevel partnered approach to building capacity for innovation, implementation and spread of evidence-based practice. With its demonstrated success in the CREATE PACT study and several other EBQI trials, WHS adopted EBQI as a strategy to help low-performing VA facilities systematically improve services.
The objectives of the WHS/QUERI Partnered Evaluation Initiative that this project represents are:
-
To evaluate the barriers and facilitators to achieving delivery of comprehensive women's health care in the identified low-performing VA facilities;
-
To evaluate the effectiveness of EBQI in supporting low-performing VA facilities achieve improved:
-
Organizational features (e.g., level of comprehensive services available; care coordination arrangements; PACT features implemented; environment of care improvements);
-
Provider/staff attitudes (e.g., improved gender awareness; women's health knowledge and practice);
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Unit of randomization: VA healthcare facilities (VA medical center or community-based outpatient clinic)
- •Subset of VA healthcare facilities identified as low-performing on the basis of composites of access/wait times, gender disparities in quality, e.g.:
- •depression screening
- •diabetic blood sugar control
- •Presence/absence of VA-required structural facets of care, e.g.:
- •designated women's health providers
- •mammography coordinator
- •gynecology access
- •Women Veteran Program Manager (WVPM)
- •3:1 staffing ratio for PACT teamlets
- •Key Stakeholder Inclusion Criteria (qualitative interviews):
- •Veteran Integrated Service Network (VISN) level leader (Director or Chief Medical Officer)
- •VISN level WVPM Lead, VISN level primary care director, VISN level QI/system redesign lead)
- •VA facility leader (Director or other member of senior leadership)
- •Chief of Staff
- •primary care director
- •women's health medical director
- •local EBQI champion
- •other key personnel
- •Provider/Staff Survey Inclusion Criteria:
- •Primary care providers (medical doctor [MD], doctor of osteopathy [DO], nurse practitioner [NP], physician assistant [PA]) delivering primary care in general primary care and/or women's health clinics
- •PACT teamlet members (registered nurse [RN] care managers, licensed vocational nurse/licensed practical nurse [LVN/LPN]/health technicians, and clerks)
- •larger PACT team members, e.g.:
- •social workers
- •dieticians
- •health coaches
- •integrated mental health
排除标准
- •Facility-level exclusion: Facilities not identified in the initial sample of VA facilities (sample not renewed over time).
结局指标
主要结局
Gender-sensitive Care Environment
时间窗: 24-month change in gender-sensitive care environment
Multi-item scale score reflecting survey items (from The Women's Assessment Tool for Comprehensive Health (WATCH)) on availability of same-gender providers, availability of same-gender staff, privacy of physical layout, availability of privacy curtains, level of implementation of local culture campaign that values and treats Women Veterans with respect. The score ranges from 0 to 7, with a higher score reflecting greater gender-sensitive care environment.
Gender Awareness
时间窗: 24-month change in gender awareness among VA primary care and women's health providers and staff
A 12-item score reflecting primary care and women's health providers' and staff's awareness and knowledge of women Veterans' military roles and healthcare needs . The score ranges from 1 to 5 with higher scores reflecting greater gender awareness.
Quality Improvement Experience
时间窗: 24-month change
The count of quality improvement activities reported by provider and staff in primary care and women's health settings; including 1) training in quality improvement methods \[e.g., LEAN\], 2) collaboration with other VA facilities to identify best practices, 3) working with Women Veteran Program Manager to identify and/or solve local problems in caring for women Veterans, 4) using of VA performance data, 5) using of VA survey data by gender, 6) working on a quality improvement project focused on women Veterans, 7) involving in small tests of change for quality improvement.
次要结局
- Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass(24-month change)
- Gender-specific Preventive Care Delivery(24-month change in gender-specific preventive care delivery)
- Accessibility of Care(24-month change in accessibility)
- Provider Rating(24-month change)
- Coordination of Care(24-month change)
- Gender-neutral Guideline-concordant Preventive Care Receipt(24-month change)