BACKGROUND: Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory
care is less well understood.
OBJECTIVE: To study gender differences in quality of care for patients receiving primary care in the Veterans Affairs (VA) Health Care
System.
DESIGN: Cross-sectional samples of VA enrollees during fiscal years 1999 to 2000.
PARTICIPANTS: Samples of 6,442 to 86,405 men and women treated at VA facilities for whom at least 1 of 9 quality measures was available.
MEASUREMENTS: Appropriate general preventive services (pneumococcal vaccination, influenza vaccination, colorectal cancer screening), and
specific services for diabetes (annual hemoglobin A1c [HbA1c] testing, good glycemic control, annual diabetic eye exam), hypertension
(good blood pressure control), or prior myocardial infarction (use of β-blockers or aspirin).
RESULTS: In adjusted analyses, there were no substantial gender differences in rates of appropriate care. For women compared with
men, the adjusted relative risk for appropriate care ranged from 0.96 for blood pressure control (95% confidence interval:
0.93 to 0.99; P=.02) to 1.05 for HbA1c≤8.0% (95% confidence interval: 1.03 to 1.07; P<.01). Analyses stratified by age demonstrated equivalent care between men and women in 9 of the 14 subgroups evaluated.
CONCLUSIONS: In this large national health care system that predominantly serves men, the quality of ambulatory care is equivalent for
women and men on numerous measures.
Key words gender - quality - veterans - prevention - diabetes mellitus
The authors have no conflicts of interest to declare.
The results were presented at the 2004 Society of General Internal Medicine annual conference and the annual meeting of VA
Health Services Research and Development.
The data were provided by the Office of Quality and Performance, VA Central Office. Dr. Jha was funded in part by the Office
of Quality and Performance, Veterans Health Administration, and by an Institutional National Research Service Award (#5T32HS00020-16)
from the Agency for Healthcare Research and Quality.