Cordasco Kristina M, Huynh Alexis K, Zephyrin Laurie, Hamilton Alison B, Lau-Herzberg Amy E, Kessler Chad S, Yano Elizabeth M
*VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System; North Hills †VA Greater Los Angeles Healthcare System ‡Department of Medicine, UCLA, Los Angeles, CA §VA Women's Health Services, Office of Patient Care Services, Veterans Health Administration, Washington, DC ∥VA New York Harbor Healthcare System ¶Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY #Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA **Durham VA Medical Center ††Departments of Emergency Medicine and Internal Medicine, Duke University School of Medicine, Durham, NC ‡‡Department of Health Policy & Management, UCLA School of Public Health, Los Angeles, CA.
Med Care. 2015 Apr;53(4 Suppl 1):S81-7. doi: 10.1097/MLR.0000000000000320.
Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care.
To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care.
Semistructured interviews with VA emergency and women's health key informants.
ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities.
Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies.
Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.
越来越多的女性前往退伍军人事务部（VA）的急诊科就诊。2011年对VA女性紧急服务的全国清查显示，许多急诊科在妇科急诊护理的资源和流程方面存在差距。
为指导VA解决这些差距，我们试图了解促进和/或阻碍提高VA急诊科提供紧急妇科护理的能力和质量的因素。
对VA急诊科和女性健康关键信息提供者进行半结构化访谈。
13个VA医疗机构的急诊科主任/提供者（n = 14）、急诊科护士长（n = 13）和女性退伍军人项目经理（n = 13）。
领导力、员工、空间、需求、资金、政策和社区被认为是影响VA急诊科建立能力和改善退伍军人女性紧急妇科护理的重要因素。这些因素相互交织，跨越多个组织层面，因此每个急诊科的能力不仅反映了其自身因素，还反映了其当地医疗中心、非VA社区背景以及VA区域和国家趋势及政策的因素。
旨在为退伍军人女性建立VA紧急妇科服务的政策和质量改进举措需要是多因素的，并针对多个组织层面。政策需要灵活，以考虑各急诊科及其医疗中心和社区背景的广泛差异。建立并鼓励地方领导参与的方法，如基于证据的质量改进方法，可能是最有效的。
