Potential issues with large databases such as the CDW and the Non-VA Care Cube included inaccurate coding of procedures and diagnoses as well as missing data. This possible limitation was addressed by randomly selecting 400 patients in the database to verify the database information against the patient’s EMR, which matched 100% of the time. In addition, the authors calculated the hysterectomy rates using a denominator based on all women veterans accessing VA health care, which included women who had previously had a hysterectomy. Therefore, the true hysterectomy rate may have been underestimated.
Conclusion
The VA operates the largest health care system in the U.S. with more than 500,000 women veterans currently utilizing VA health care.11 The VA provides services to women veterans living in urban, suburban, and rural areas. The breadth of geographic locations, the declining number of VA facilities offering gynecologic surgical services, and the growing population of female veterans present unique challenges to providing accessible and comparable health care to these female patients.
VA district 4 (Continental) has the lowest population density as well as the lowest VA hysterectomy rate in FY 2014, which may be attributable to the aforementioned challenges. As a result of these challenges, an increasing number of gynecologic surgical referrals to non-VA facilities was observed during the study period. The VA has made considerable progress in supporting and promoting health care for women by strategically enhancing services and access for women veterans. Although the number of hysterectomies has increased across VA facilities offering gynecologic surgical services, about 1 in 3 women veterans are referred to non-VA facilities for their gynecologic surgical needs. The VA has a challenging opportunity to expand gynecologic surgical services and improve access for the growing population of women veterans. To accommodate this growth, the VA may consider strategically increasing the number of facilities providing gynecologic surgical services or expanding established gynecologic surgical departments.
