Trial Outcomes & Findings for Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VAs (NCT NCT03238417)
NCT ID: NCT03238417
Last Updated: 2023-07-27
Results Overview
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.
Recruitment status
COMPLETED
Study phase
NA
Target enrollment
21 participants
Primary outcome timeframe
12-month change in gender-sensitive care environment
Results posted on
2023-07-27
Participant Flow
Cross-sectional surveys were sent to primary care providers and staff at 21 VA Medical Centers at baseline, 12 months, and 24 months.
Twenty one VA facilities were randomized to receive evidence-based quality improvement (EBQI) in a dynamic waitlist control design in which seven facilities received EBQI per year while the remaining 14 facilities were assigned as control.
Unit of analysis: VA Medical Centers
Participant milestones
| Measure |
Evidence-Based Quality Improvement (EBQI)
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level quality improvement (QI) team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
Waitlist controls will continue naturalistic routine care implementation of VA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Overall
STARTED
|
1330 7
|
2632 14
|
|
Overall
COMPLETED
|
327 7
|
644 14
|
|
Overall
NOT COMPLETED
|
1003 0
|
1988 0
|
|
Baseline
STARTED
|
513 7
|
934 14
|
|
Baseline
COMPLETED
|
124 7
|
217 14
|
|
Baseline
NOT COMPLETED
|
389 0
|
717 0
|
|
12-month
STARTED
|
400 7
|
911 14
|
|
12-month
COMPLETED
|
81 7
|
205 14
|
|
12-month
NOT COMPLETED
|
319 0
|
706 0
|
|
24-month
STARTED
|
417 7
|
847 14
|
|
24-month
COMPLETED
|
122 7
|
222 14
|
|
24-month
NOT COMPLETED
|
295 0
|
625 0
|
Reasons for withdrawal
| Measure |
Evidence-Based Quality Improvement (EBQI)
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level quality improvement (QI) team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
Waitlist controls will continue naturalistic routine care implementation of VA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Overall
non-response
|
955
|
1920
|
|
Overall
partial completion
|
48
|
68
|
|
Baseline
Partial completion
|
17
|
48
|
|
Baseline
non-response
|
372
|
669
|
|
12-month
non-response
|
296
|
669
|
|
12-month
partial completion
|
23
|
37
|
|
24-month
non-response
|
287
|
594
|
|
24-month
partial completion
|
8
|
31
|
Baseline Characteristics
Race and Ethnicity were not collected from any participant.
Baseline characteristics by cohort
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
Total
n=21 VA Medical Centers
Total of all reporting groups
|
|---|---|---|---|
|
Age, Customized
age · 20-29
|
1 Participants
n=124 Participants
|
8 Participants
n=217 Participants
|
9 Participants
n=341 Participants
|
|
Age, Customized
age · 30-39
|
16 Participants
n=124 Participants
|
39 Participants
n=217 Participants
|
55 Participants
n=341 Participants
|
|
Age, Customized
age · 40-49
|
23 Participants
n=124 Participants
|
53 Participants
n=217 Participants
|
76 Participants
n=341 Participants
|
|
Age, Customized
age · 50-59
|
51 Participants
n=124 Participants
|
64 Participants
n=217 Participants
|
115 Participants
n=341 Participants
|
|
Age, Customized
age · 60+
|
16 Participants
n=124 Participants
|
26 Participants
n=217 Participants
|
42 Participants
n=341 Participants
|
|
Age, Customized
age · missing
|
17 Participants
n=124 Participants
|
27 Participants
n=217 Participants
|
44 Participants
n=341 Participants
|
|
Sex/Gender, Customized
Gender · Female
|
91 Participants
n=124 Participants
|
163 Participants
n=217 Participants
|
254 Participants
n=341 Participants
|
|
Sex/Gender, Customized
Gender · Male
|
17 Participants
n=124 Participants
|
30 Participants
n=217 Participants
|
47 Participants
n=341 Participants
|
|
Sex/Gender, Customized
Gender · missing
|
16 Participants
n=124 Participants
|
24 Participants
n=217 Participants
|
40 Participants
n=341 Participants
|
|
Race and Ethnicity Not Collected
|
—
|
—
|
0 Participants
Race and Ethnicity were not collected from any participant.
|
|
Primary care provider and staff
Primary care providers
|
23 Participants
n=124 Participants
|
50 Participants
n=217 Participants
|
73 Participants
n=341 Participants
|
|
Primary care provider and staff
staff
|
101 Participants
n=124 Participants
|
167 Participants
n=217 Participants
|
268 Participants
n=341 Participants
|
|
Years worked in VA
|
9.85 years
STANDARD_DEVIATION 8.40 • n=124 Participants
|
6.96 years
STANDARD_DEVIATION 7.24 • n=217 Participants
|
8.01 years
STANDARD_DEVIATION 7.79 • n=341 Participants
|
PRIMARY outcome
Timeframe: 12-month change in gender-sensitive care environmentPopulation: One Women Veteran Program Manger per VA Medical Center responded to the survey about the site's Women's Health Program on WATCH.
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.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers.
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers.
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender-sensitive Care Environment
Baseline
|
4.2 score on a scale
Standard Deviation 2.3
|
3.3 score on a scale
Standard Deviation 1.9
|
|
Gender-sensitive Care Environment
12 month
|
1.6 score on a scale
Standard Deviation 1.9
|
1.4 score on a scale
Standard Deviation 1.7
|
PRIMARY outcome
Timeframe: 24-month change in gender-sensitive care environmentPopulation: One Women Veteran Program Manger per VA Medical Center responded to the survey about the site's Women's Health Program on WATCH.
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.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Center
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Center
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender-sensitive Care Environment
Baseline
|
4.2 score on a scale
Standard Deviation 2.3
|
3.3 score on a scale
Standard Deviation 1.9
|
|
Gender-sensitive Care Environment
24 month
|
3.2 score on a scale
Standard Deviation 0.8
|
2.8 score on a scale
Standard Deviation 1.6
|
PRIMARY outcome
Timeframe: 12-month change in gender awareness among VA primary care and women's health providers and staff.Population: Primary care and women's health providers and staff. The analysis was based on cases with non-missing outcome data. There are 19 missing cases in the EBQI arm and 39 missing in the control arm.
A 12-item score reflecting primary care and women's health providers' and staff's awareness and knowledge of women Veterans' military background and healthcare needs. The score ranges from 1 to 5 with higher scores reflecting greater gender awareness.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender Awareness
baseline
|
3.66 score on a scale
Standard Deviation 0.53
|
3.63 score on a scale
Standard Deviation 0.49
|
|
Gender Awareness
12- month
|
3.67 score on a scale
Standard Deviation 0.61
|
3.62 score on a scale
Standard Deviation 0.52
|
PRIMARY outcome
Timeframe: 24-month change in gender awareness among VA primary care and women's health providers and staffPopulation: Primary care and women's health providers and staff. The analysis was based on cases with non-missing outcome data. There are 22 missing cases in the EBQI arm and 32 in the control arm.
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.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender Awareness
Baseline
|
3.66 score on a scale
Standard Deviation 0.53
|
3.63 score on a scale
Standard Deviation 0.49
|
|
Gender Awareness
24-month
|
3.64 score on a scale
Standard Deviation 0.51
|
3.74 score on a scale
Standard Deviation 0.54
|
PRIMARY outcome
Timeframe: 12-month changePopulation: Primary care and women's health providers and staff at 21 VA Medical Centers. The analysis was based on cases with non-missing outcome data. There were 31 missing in the EBQI arm and 43 missing in the control arm.
The count of quality improvement activities reported by providers and staff in primary care and women's health settings; including 1) training in quality improvement methods, 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.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=205 Participants
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=422 Participants
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Quality Improvement Experience
Baseline · 0 activity
|
29 Participants
|
70 Participants
|
|
Quality Improvement Experience
Baseline · 1 activity
|
17 Participants
|
46 Participants
|
|
Quality Improvement Experience
Baseline · 2 activities
|
17 Participants
|
29 Participants
|
|
Quality Improvement Experience
Baseline · 3 activities
|
11 Participants
|
19 Participants
|
|
Quality Improvement Experience
Baseline · 4 activities
|
14 Participants
|
13 Participants
|
|
Quality Improvement Experience
Baseline · 5 activities
|
3 Participants
|
4 Participants
|
|
Quality Improvement Experience
Baseline · 6 activities
|
8 Participants
|
7 Participants
|
|
Quality Improvement Experience
Baseline · 7 activities
|
2 Participants
|
4 Participants
|
|
Quality Improvement Experience
Baseline · missing
|
23 Participants
|
25 Participants
|
|
Quality Improvement Experience
12-month · 0 activity
|
26 Participants
|
54 Participants
|
|
Quality Improvement Experience
12-month · 1 activity
|
16 Participants
|
41 Participants
|
|
Quality Improvement Experience
12-month · 2 activities
|
13 Participants
|
38 Participants
|
|
Quality Improvement Experience
12-month · 3 activities
|
5 Participants
|
22 Participants
|
|
Quality Improvement Experience
12-month · 4 activities
|
6 Participants
|
11 Participants
|
|
Quality Improvement Experience
12-month · 5 activities
|
2 Participants
|
12 Participants
|
|
Quality Improvement Experience
12-month · 6 activities
|
2 Participants
|
5 Participants
|
|
Quality Improvement Experience
12-month · 7 activities
|
3 Participants
|
4 Participants
|
|
Quality Improvement Experience
12-month · missing
|
8 Participants
|
18 Participants
|
PRIMARY outcome
Timeframe: 24-month changePopulation: Primary care and women's health providers and staff at 21 VA Medical Centers. The analysis was based on cases with non-missing outcome data. There were 27 missing in the EBQI arm and 32 missing in the control arm.
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.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=246 Participants
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=439 Participants
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Quality Improvement Experience
Baseline · 4 activities
|
14 Participants
|
13 Participants
|
|
Quality Improvement Experience
Baseline · 5 activities
|
3 Participants
|
4 Participants
|
|
Quality Improvement Experience
Baseline · 7 activities
|
2 Participants
|
4 Participants
|
|
Quality Improvement Experience
24-month · 7 activities
|
3 Participants
|
3 Participants
|
|
Quality Improvement Experience
Baseline · 0 activity
|
29 Participants
|
70 Participants
|
|
Quality Improvement Experience
Baseline · 1 activity
|
17 Participants
|
46 Participants
|
|
Quality Improvement Experience
Baseline · 2 activities
|
17 Participants
|
29 Participants
|
|
Quality Improvement Experience
Baseline · 3 activities
|
11 Participants
|
19 Participants
|
|
Quality Improvement Experience
Baseline · 6 activities
|
8 Participants
|
7 Participants
|
|
Quality Improvement Experience
Baseline · missing
|
23 Participants
|
25 Participants
|
|
Quality Improvement Experience
24-month · 0 activity
|
44 Participants
|
66 Participants
|
|
Quality Improvement Experience
24-month · 1 activity
|
19 Participants
|
43 Participants
|
|
Quality Improvement Experience
24-month · 2 activities
|
22 Participants
|
39 Participants
|
|
Quality Improvement Experience
24-month · 3 activities
|
18 Participants
|
27 Participants
|
|
Quality Improvement Experience
24-month · 4 activities
|
7 Participants
|
16 Participants
|
|
Quality Improvement Experience
24-month · 5 activities
|
2 Participants
|
9 Participants
|
|
Quality Improvement Experience
24-month · 6 activities
|
3 Participants
|
12 Participants
|
|
Quality Improvement Experience
24-month · missing
|
4 Participants
|
7 Participants
|
SECONDARY outcome
Timeframe: 12-month changePopulation: The analysis population size was extracted from EPRP reported denominators. EPRP randomly selected women patients aged 21-64and reviewed their charts for cervical cancer screening with a Pap test in the past three years.
Rate of cervical cancer screening using the VA External Peer Review Program (EPRP) chart-based quality metrics.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender-specific Preventive Care Delivery
Baseline
|
87.5 percentage of women patients
Standard Deviation 4.1
|
87.2 percentage of women patients
Standard Deviation 4.3
|
|
Gender-specific Preventive Care Delivery
12 month
|
87.5 percentage of women patients
Standard Deviation 3.9
|
88.1 percentage of women patients
Standard Deviation 6.11
|
SECONDARY outcome
Timeframe: 24-month change in gender-specific preventive care deliveryPopulation: The analysis population size is extracted from EPRP reported denominators. EPRP randomly selected women patients aged 21-64and reviewed their charts for cervical cancer screening with a Pap test in the past three years.
Rate of cervical cancer screening using the VA External Peer Review Program (EPRP) chart-based quality metrics.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender-specific Preventive Care Delivery
Baseline
|
87.5 percentage of women patients
Standard Deviation 4.12
|
87.2 percentage of women patients
Standard Deviation 4.30
|
|
Gender-specific Preventive Care Delivery
24 month
|
84.6 percentage of women patients
Standard Deviation 3.98
|
85.8 percentage of women patients
Standard Deviation 4.83
|
SECONDARY outcome
Timeframe: 12-month change in accessibilityPopulation: The analysis population size is extracted from SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
Women Veterans' ratings of accessibility based on the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded "always" to validated survey items measuring accessibility, the higher percentage representing better access.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Accessibility of Care
baseline
|
48.6 percent always
Standard Deviation 12.2
|
44.4 percent always
Standard Deviation 18.5
|
|
Accessibility of Care
12month
|
41.1 percent always
Standard Deviation 24.5
|
37.1 percent always
Standard Deviation 8.0
|
SECONDARY outcome
Timeframe: 24-month change in accessibilityPopulation: The analysis population size is extracted from SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
Women Veterans' ratings of accessibility from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded "always" to validated survey items measuring accessibility, the higher percentage representing better access.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Accessibility of Care
Baseline
|
46.7 Percent always
Standard Deviation 9.3
|
43.0 Percent always
Standard Deviation 17.8
|
|
Accessibility of Care
24month
|
42.7 Percent always
Standard Deviation 13.7
|
42.3 Percent always
Standard Deviation 14.7
|
SECONDARY outcome
Timeframe: 12-month changePopulation: The analysis population size is unknown and reported at the level of the VA Medical Centers. SHEP randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
Women Veterans' ratings of care coordination from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded "always" to validated survey items measuring care coordination, the higher percentage representing better coordination.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Coordination of Care
baseline
|
54.60 percent always
Standard Deviation 12.43
|
55.78 percent always
Standard Deviation 14.05
|
|
Coordination of Care
12 month
|
52.95 percent always
Standard Deviation 19.30
|
58.65 percent always
Standard Deviation 9.67
|
SECONDARY outcome
Timeframe: 24-month changePopulation: The analysis population size is extracted SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
Women Veterans' ratings of care coordination from the Survey of Healthcare Experience of Patients (SHEP) program. The mean score is the percent of female patients who responded "always" to validated survey items measuring care coordination, the higher percentage representing better coordination.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Coordination of Care
baseline
|
53.0 percent always
Standard Deviation 9.3
|
54.7 percent always
Standard Deviation 13.4
|
|
Coordination of Care
24 month
|
51.4 percent always
Standard Deviation 13.7
|
51.2 percent always
Standard Deviation 15.2
|
SECONDARY outcome
Timeframe: 12-month changePopulation: The analysis population is extracted from EPRP, which randomly selected VA women patients aged 18-75 whose charts were reviewed for preventive care measures.
Percentage of women Veterans' obtaining recommended preventive care based on eligibility for service (e.g., meet eligibility guidelines for timely eye exams for diabetes, flu vaccination, colorectal cancer screening) using VA External Peer Review Program (EPRP) chart-based quality metrics.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender-neutral Guideline-concordant Preventive Care Receipt
12 month
|
75.9 percentage of female patients
Standard Deviation 4.7
|
75.1 percentage of female patients
Standard Deviation 3.1
|
|
Gender-neutral Guideline-concordant Preventive Care Receipt
Baseline
|
78.8 percentage of female patients
Standard Deviation 2.2
|
78.6 percentage of female patients
Standard Deviation 2.9
|
SECONDARY outcome
Timeframe: 24-month changePopulation: The analysis population is extracted from EPRP, which randomly selected women patients aged 18-75 whose charts were reviewed for preventive care metrics.
Percentage of women Veterans' obtaining recommended preventive care based on eligibility for service (e.g., meet eligibility guidelines for timely eye exams for diabetes, flu vaccination, colorectal cancer screening) using VA External Peer Review Program (EPRP) chart-based quality metrics
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Gender-neutral Guideline-concordant Preventive Care Receipt
Baseline
|
78.8 percentage of female patients
Standard Deviation 2.23
|
78.6 percentage of female patients
Standard Deviation 2.75
|
|
Gender-neutral Guideline-concordant Preventive Care Receipt
24 month
|
75.9 percentage of female patients
Standard Deviation 4.7
|
75.0 percentage of female patients
Standard Deviation 3.0
|
SECONDARY outcome
Timeframe: 12-month changePopulation: The analysis population was extracted from the Patient Aligned Care Teams (PACT) Compass, developed to meet the needs for VA PACT implementation.
Percentage of women Veterans assigned to a designated women's health provider in a general primary care and/or women's health primary care setting.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass
12 month
|
74.0 percentage of female patients
Standard Deviation 6.3
|
73.8 percentage of female patients
Standard Deviation 13.7
|
|
Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass
Baseline
|
65.8 percentage of female patients
Standard Deviation 17.2
|
65.8 percentage of female patients
Standard Deviation 17.2
|
SECONDARY outcome
Timeframe: 24-month changePopulation: The analysis population was extracted from the Patient Aligned Care Teams (PACT) Compass, developed to meet the needs for VA PACT implementation.
Percentage of women Veterans assigned to a designated women's health provider in a general primary care and/or women's health primary care setting
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass
Baseline
|
65.8 percentage of female patients
Standard Deviation 17.2
|
68.7 percentage of female patients
Standard Deviation 11.3
|
|
Assignment to a Designated Women's Health Provider or a Women's Health Primary Care Teams, Using Patient Aligned Care Teams Compass
24 month
|
78.6 percentage of female patients
Standard Deviation 11.3
|
73.1 percentage of female patients
Standard Deviation 13.8
|
SECONDARY outcome
Timeframe: 12 month changePopulation: Analysis population size was extracted SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
Percent of women patients who rated 9 or 10 on a scale of 0 to 10 for the provider rating question on the Survey of Healthcare Experiences of Patients (SHEP). Higher scores are better.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Provider Rating
Baseline
|
65.9 percentage of women patients
Standard Deviation 13.5
|
63.6 percentage of women patients
Standard Deviation 16.7
|
|
Provider Rating
12 Month
|
59.9 percentage of women patients
Standard Deviation 32.5
|
71.3 percentage of women patients
Standard Deviation 13.4
|
SECONDARY outcome
Timeframe: 24-month changePopulation: The analysis population size is extracted SHEP, which randomly selected eligible patients who were invited to respond to the SHEP surveys by mail or online.
Percent of women patients who rated 9 or 10 on a scale of 0 to 10 for the provider rating question from the Survey of Healthcare Experiences of Patients (SHEP). Higher scores are better.
Outcome measures
| Measure |
Evidence-Based Quality Improvement (EBQI)
n=7 VA Medical Centers
EBQI represents a multilevel stakeholder engaged top-down/bottom-up research-clinical partnership approach to systematically improving the design and implementation of local innovations adapted to local contexts. The EBQI contractor will (1) convene facility-level stakeholder meetings, (2) facilitate local facility-level QI team design meetings, (3) provide external practice facilitation through within and across facility QI collaboration calls, (4) provide formative QI data feedback and (5) provide QI training/education to local teams.
Launched at participating VA facilities through advance key stakeholder interviews, in-person site visits, data review (e.g., structure and environment of care, gender disparities in quality and patient experience), QI training, technical support (e.g., QI project and measures development), additional formative feedback from the evaluation (e.g., provider/survey measure summaries), external and internal practice facilitation, and across-EBQI site collaboration calls. Local leadership, EBQI champions and QI teams develop and implement innovation projects aimed at improving prioritized quality targets related to women Veterans' health and healthcare needs as well as facility-level structural changes needed to improve compliance with VA guidelines.
|
Waitlist Controls
n=14 VA Medical Centers
Waitlist controls will continue naturalistic routine care implementation of VHA directives and other guidance related to comprehensive women's health care.
|
|---|---|---|
|
Provider Rating
Baseline
|
65.9 percentage of women patients
Standard Deviation 13.5
|
63.6 percentage of women patients
Standard Deviation 16.7
|
|
Provider Rating
24 months
|
59.7 percentage of women patients
Standard Deviation 14.2
|
57.5 percentage of women patients
Standard Deviation 14.2
|
Adverse Events
Evidence-Based Quality Improvement (EBQI)
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Waitlist Controls
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Elizabeth M. Yano, PhD, MSPH
VA Greater Los Angeles Healthcare System
Phone: 818-891-7711
Email: [email protected]
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place