Evaluating Evidence-Based Quality Improvement of Comprehensive Women's Health Care Implementation in Low-Performing VA Facilities

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 sites 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 VHA
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 or 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:

1. To evaluate the barriers and facilitators to achieving delivery of comprehensive women's
health care in the identified low-performing VA facilities;

2. To evaluate the effectiveness of EBQI in supporting low-performing VA facilities achieve
improved:

1. Organizational features (e.g., level of comprehensive services available; care
coordination arrangements; PACT features implemented; environment of care
improvements);

2. Provider/staff attitudes (e.g., improved gender awareness; women's health knowledge
and practice);

d) Quality of care and patient experiences among women Veteran patients using secondary
data; and,

3. To evaluate contextual factors, local implementation processes, and organizational
changes in the participating facilities over time.

Results of the evaluation will be used to provide feedback to stakeholders, including women
Veterans, at the local, network and national levels, while also being used to continuously
refine EBQI implementation processes. The evaluation will also help inform optimal strategies
for ongoing improvements in women Veterans' care in the 24 participating VA facilities, other
VA facilities and for other improvement initiatives in this and other program offices.