VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Womens Health Issues. 2024 Sep-Oct;34(5):540-548. doi: 10.1016/j.whi.2024.07.002. Epub 2024 Aug 28.
A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8-10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.
We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016-2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans' optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers.
Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal.
Ensuring a welcoming environment may improve women veterans' primary care experiences.
欢迎的环境可能会影响患者的护理体验，对于退伍军人卫生管理局 (VA) 设施中的代表性不足的群体，如女性退伍军人，这可能尤为重要，因为她们只占患者的 8-10%。为女性退伍军人确保欢迎环境可能面临的挑战包括男性退伍军人和工作人员或志愿者的不当言论，以及在 VA 设施内外感到不安全。我们评估了与性别相关的护理环境问题报告和患者报告的结果之间的关联。
我们使用消费者评估医疗保健计划和系统以患者为中心的医疗之家 (CAHPS-PCMH) 调查综合措施，合并了来自女性退伍军人（n=4961）的全国性患者报告结果，并将退伍军人事务部设施中女性退伍军人计划经理报告的性别相关护理环境问题（n=127，2016-2017）与退伍军人事务部设施合并。我们进行了多水平二元逻辑回归分析，以评估女性退伍军人计划经理报告的大/极端问题与女性退伍军人对初级保健体验的最佳评价（获得、协调、全面性、提供者沟通和初级保健提供者的总体评价）的可能性之间的关联。我们调整了患者、地点和地区层面的特征，以及退伍军人事务部设施内患者的聚类，并应用设计权重来解决患者数据中的无回应偏差。女性退伍军人的回应率为 40%，女性退伍军人计划经理的回应率为 90%。
很少（<15%）女性退伍军人计划经理报告了大/极端的护理环境问题。在这些地点接受护理的女性退伍军人不太可能将提供者沟通和全面性（评估心理社会健康）评为最佳。
确保欢迎的环境可能会改善女性退伍军人的初级保健体验。
