Table 2 Formative and summative evaluation data sources, samples, and measures

 Random samples of complete enumerated list of women Veterans age 18 or older enrolled as VA patients with at least 3 primary care or women’s health clinic visits in the 12 months prior to the start of the baseline survey (target final enrollment of 40 women Veterans at each site for total of 480 at all 12 participating sites by 24-month follow-up)

• Healthcare utilization (VA, non-VA, dual use, VA-paid community care)

• Overall VA, VA primary care, women’s health, mental health use and quality ratings, satisfaction

• Trauma-sensitive primary care (exams, provider communication around trauma histories)

• Preferences for care (e.g., same-gender provider, women’s clinic)

• Access to care (e.g., appointments, waiting rooms, phone access, including barriers, delays, missed care)

• Continuity of care

• Mental health needs (anxiety, depression, posttraumatic stress disorder screens)

• Care coordination (e.g., with specialists, non-VA)

• Comprehensiveness of care (e.g., available services)

• Provider-patient communication

• Gender sensitivity

• Psychosocial safety

• Trust in providers

• Health status, functional status, comorbidities

• Military exposures (e.g., combat, harassment)

• Lifetime trauma exposure

• Sociodemographics

 Census of all VA providers and staff who hold positions as non-resident providers (MDs, NPs, PAs), nurses (RNs, LVNs, LPNs), administrative staff (clerks, medical support assistants), or PACT greater team professionals (e.g., social workers, pharmacists, dieticians, health educators, health coaches, and co-located mental health providers) who practice or work at one of the 12 participating sites and who are members of their local general PC/PACT or WH-PACT teams

• EBQI exposure/participation (e.g., # hours spent, QI training time, awareness/knowledge, barriers/facilitators)

• QI orientation/culture (e.g., participative decision-making, readiness to change)

• Gender awareness (e.g., gender sensitivity, knowledge, women’s health knowledge/attitudes, self-assessment of proficiency)

• PACT achievement (e.g., team-based care, teamlet communication, knowledge and skills, psychological safety, openness to new ideas, ease/difficulty of integrating women Veterans’ preferences and needs)

• Practice context (e.g., leadership norms, organizational readiness to change, job satisfaction)

• Provider/staff characteristics (e.g., age, gender, race, ethnicity, clinician type, designated women’s health provider, panel characteristics, half-days in clinic)

 Primary care and women’s health clinic leaders (all 12 participating sites)

• Leadership support (e.g., degree of buy-in, leadership involvement in EBQI)

• Local resources (e.g., sufficiency of resources to implement PACT, meet comprehensive care needs)

• Practice structure (e.g., type of clinic model, separate vs. integrated clinic space, onsite vs. offsite services)

• Ability to engage in EBQI (e.g., QI orientation in PC, in WH, barriers to local QI, practice stress)

• Gender-sensitive care environment (e.g., availability of same-gender providers, privacy, sufficiency of equipment for pelvic exams)

• Access to gender-specific care (e.g., availability of designated women’s health providers, gynecologists; reliance on VA vs. community care)

• PACT implementation (e.g., teamlet staffing ratios, teamlet function, secure messaging)

• Practice characteristics (e.g., practice size, urban or rural location, academic affiliation, years in operation)

 Purposive sample of 48 or more VA primary care directors, women’s health medical directors, Women Veteran Program Managers, and VA medical center leadership (all 12 participating sites)

• EBQI activities (e.g., site initiation of EBQI activities, leadership and stakeholder/staff involvement)

• PACT implementation (e.g., general PACT and women’s health PACT activities and implementation issues)

• Facilitators/barriers to implementation of PACT in general and for women Veterans specifically (e.g., sufficiency of resources/time, training needed)

 Stratified random sample of 36 or more PACT teamlet members stratified by role (8 EBQI sites only):

 • Non-resident providers (MD, NP, PA)

 • Nurses (RN, LVN, LPN)

 • Administrative staff (clerk, medical support assistant)

 • Co-located mental health professionals who practice or work in the general PC/PACT and/or WH-PACT teams

• Teamlet composition and roles (e.g., members, formation, task allocation)

• Teamlet structured communication (e.g., meetings, use of huddles, training, coordinating care with specialists)

• PACT teamlet and practice changes (e.g., role expansions, performance feedback)

• Access/continuity of care (e.g., improvements, non-face-to-face care, reducing/preventing walk-ins, group visits)

• Impact of PACT changes (e.g., planning and implementing changes, small tests of change, resources needed, leadership support, teamlet reactions)

• Communicating strategies for improvement (e.g., how teamlets improve together, how best practices are shared)

 Area-, organizational (VA medical center and clinic-level)-, provider- and patient-level data (all 12 participating sites)

• Quality of care measures from VA performance measures (chart-based and patient-survey-based measures by gender), including prevention and chronic disease metrics (e.g., immunizations, cancer screening, diabetes process measures) and patient ratings of access, continuity and coordination

• Utilization and cost measures (e.g., total annual costs per patient and utilization by type of care, panel sizes)

• Organizational measures (e.g., facility complexity)

• Provider characteristics (e.g., primary care and women’s health provider types, volume, ratios)

• Patient-level measures (e.g., primary care, women’s health, mental health, specialty care visits, hospitalizations, emergency room visits; diagnoses)