Military sexual trauma history and patient perceptions of healthcare quality in the Veteran's Health Administration

Background/Purpose: Approximately 22% of female Veterans and 1% of male Veterans who utilize VHA report a history of military sexual trauma (MST), defined as sexual assault or severe harassment experienced during military service. Early data on women Veterans suggested that those who reported a history of military sexual assault may be less satisfied with VHA care. Since the time of that study, VHA has implemented a number of improvements related to the identification and treatment of MST. Additionally although male Veterans also experience MST, no studies to date have assessed their satisfaction with VHA care. In response to this need, this study will investigate the association between a history of MST in female and male users of VHA and patient perceptions of quality with VHA outpatient care.

Methods: This is a cross-sectional study of a representative sample of 164,632 VHA outpatients (5,758 women and 158,884 men) from fiscal year 2007. The study sample includes all Veterans who completed the Survey of Healthcare Experiences of Patients (SHEP) Ambulatory Care (VHA, Office of Quality and Performance) and also had been previously screened for MST. The SHEP utilizes a stratified sample to ensure representation of new primary care patients, established primary care patients and specialty care patients from each VHA medical facility or clinic, based on VHA utilization files. Questions on the SHEP ask patients to rate the overall quality of their VHA health care in the last two months over various domains. We assessed bivariate associations between MST and quality domains, and multivariate models adjusted for demographic characteristics, disability, and medical utilization. All analyses were completed separately by gender.

Results: After adjusting for patient characteristics, there was no significant relationship between adjusted quality ratings and MST status for either women or men. Overall quality ratings were high for both women and men (72.3% and 78.6%, respectively). Bivariate differences in all quality ratings were accounted for by demographic characteristics and disability.

Conclusions: Patient ratings of the overall quality of VHA care are high. A history of MST does not appear to negatively impact patient perceptions of quality. High quality ratings may be associated with increased provider training, outreach, and awareness of MST-related health care issues throughout VHA, accompanied by regular monitoring of both MST-related care and patient perceptions of quality.