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Military sexual trauma and patient perceptions of Veteran Health Administration health care quality.
Womens Health Issues. 2011 Jul-Aug; 21(4 Suppl):S145-51.WH

Abstract

BACKGROUND

Although sexual trauma is associated with poorer patient perceptions of health care quality, few studies have investigated this relationship in settings with comprehensive policies surrounding detection and treatment of sexual trauma, such as the Veterans Health Administration (VHA). We examined the association of military sexual trauma (MST) with patient satisfaction with VHA outpatient care among men and women.

METHODS

This is a cross-sectional study of a national representative sample of 164,632 VHA outpatients (5,758 women and 158,884 men) from fiscal year 2007. Measures included MST status, patients' ratings of overall satisfaction with VHA care in the last 2 months, and nine other dimensions of patient satisfaction. We assessed bivariate and multivariate associations between MST and overall satisfaction and each dimension of patient satisfaction. Multivariate models were adjusted for demographic characteristics, health status, and medical utilization. All analyses were stratified by gender.

FINDINGS

The proportion of patients reporting very good or excellent overall satisfaction was 78.5% for men and 72.3% for women. Findings showed that, once confounding was controlled, men and women veterans' MST status was not associated with satisfaction ratings of VHA health care overall. However, women veterans with a history of MST rated the dimensions of overall coordination and education and information less favorably than women veterans without an MST history. Post hoc analysis of individual items in these domains suggested that areas of improvement might include greater attention to provider-patient communication, including communication across multiple providers. There was no association between men's MST status and subdomains of health care satisfaction.

CONCLUSION

Patient ratings of overall satisfaction of VHA care are high. Opportunities exist, however, to educate providers on the special coordination needs of female veterans with histories of MST. These female veterans might benefit from care coordination. When investigating satisfaction in patients with histories of sexual trauma, our findings suggest the importance of adjusting analyses for important patient characteristics.

Authors+Show Affiliations

National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, Menlo Park, California 94025, USA. rachel.kimerling@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21724134

Citation

Kimerling, Rachel, et al. "Military Sexual Trauma and Patient Perceptions of Veteran Health Administration Health Care Quality." Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health, vol. 21, no. 4 Suppl, 2011, pp. S145-51.
Kimerling R, Pavao J, Valdez C, et al. Military sexual trauma and patient perceptions of Veteran Health Administration health care quality. Womens Health Issues. 2011;21(4 Suppl):S145-51.
Kimerling, R., Pavao, J., Valdez, C., Mark, H., Hyun, J. K., & Saweikis, M. (2011). Military sexual trauma and patient perceptions of Veteran Health Administration health care quality. Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health, 21(4 Suppl), S145-51. https://doi.org/10.1016/j.whi.2011.04.007
Kimerling R, et al. Military Sexual Trauma and Patient Perceptions of Veteran Health Administration Health Care Quality. Womens Health Issues. 2011 Jul-Aug;21(4 Suppl):S145-51. PubMed PMID: 21724134.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Military sexual trauma and patient perceptions of Veteran Health Administration health care quality. AU - Kimerling,Rachel, AU - Pavao,Joanne, AU - Valdez,Courtney, AU - Mark,Hanna, AU - Hyun,Jenny K, AU - Saweikis,Meghan, PY - 2010/11/30/received PY - 2011/04/15/revised PY - 2011/04/18/accepted PY - 2011/7/5/entrez PY - 2011/7/8/pubmed PY - 2011/11/4/medline SP - S145 EP - 51 JF - Women's health issues : official publication of the Jacobs Institute of Women's Health JO - Womens Health Issues VL - 21 IS - 4 Suppl N2 - BACKGROUND: Although sexual trauma is associated with poorer patient perceptions of health care quality, few studies have investigated this relationship in settings with comprehensive policies surrounding detection and treatment of sexual trauma, such as the Veterans Health Administration (VHA). We examined the association of military sexual trauma (MST) with patient satisfaction with VHA outpatient care among men and women. METHODS: This is a cross-sectional study of a national representative sample of 164,632 VHA outpatients (5,758 women and 158,884 men) from fiscal year 2007. Measures included MST status, patients' ratings of overall satisfaction with VHA care in the last 2 months, and nine other dimensions of patient satisfaction. We assessed bivariate and multivariate associations between MST and overall satisfaction and each dimension of patient satisfaction. Multivariate models were adjusted for demographic characteristics, health status, and medical utilization. All analyses were stratified by gender. FINDINGS: The proportion of patients reporting very good or excellent overall satisfaction was 78.5% for men and 72.3% for women. Findings showed that, once confounding was controlled, men and women veterans' MST status was not associated with satisfaction ratings of VHA health care overall. However, women veterans with a history of MST rated the dimensions of overall coordination and education and information less favorably than women veterans without an MST history. Post hoc analysis of individual items in these domains suggested that areas of improvement might include greater attention to provider-patient communication, including communication across multiple providers. There was no association between men's MST status and subdomains of health care satisfaction. CONCLUSION: Patient ratings of overall satisfaction of VHA care are high. Opportunities exist, however, to educate providers on the special coordination needs of female veterans with histories of MST. These female veterans might benefit from care coordination. When investigating satisfaction in patients with histories of sexual trauma, our findings suggest the importance of adjusting analyses for important patient characteristics. SN - 1878-4321 UR - https://www.unboundmedicine.com/medline/citation/21724134/Military_sexual_trauma_and_patient_perceptions_of_Veteran_Health_Administration_health_care_quality_ DB - PRIME DP - Unbound Medicine ER -