Childbearing in U.S. Military Hospitals: Dimensions of Care Affecting Women's Perceptions of Quality and Satisfaction

Authors

  • Erica M. Harriott MHSA, MPH,

    1. Erica Harriott, Thomas Williams, and Michael R. Peterson are at the Center for Health Care Management Studies, Office of the Assistant Secretary of Defense, Health Affairs (OASD(HA), TRICARE Management Activity, Falls Church, Virginia, United States.
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  • Thomas V. Williams PhD,

    Corresponding author
    1. Erica Harriott, Thomas Williams, and Michael R. Peterson are at the Center for Health Care Management Studies, Office of the Assistant Secretary of Defense, Health Affairs (OASD(HA), TRICARE Management Activity, Falls Church, Virginia, United States.
      * Thomas V. Williams Ph.D., Director, Center for Health Care Management Studies; TRICARE Management Activity (TMA), Falls Church, VA 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-3206, USA.
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  • And Michael R. Peterson DVM, DrPH

    1. Erica Harriott, Thomas Williams, and Michael R. Peterson are at the Center for Health Care Management Studies, Office of the Assistant Secretary of Defense, Health Affairs (OASD(HA), TRICARE Management Activity, Falls Church, Virginia, United States.
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  • The opinions or statements herein are those of the authors and do not necessarily reflect the views of the U.S. Department of Defense.

* Thomas V. Williams Ph.D., Director, Center for Health Care Management Studies; TRICARE Management Activity (TMA), Falls Church, VA 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-3206, USA.

Abstract

Abstract: Background: The U.S. Department of Defense provides medical services for approximately 9.1 million beneficiaries, one-half of whom are women. Information is lacking about how well the military health system has adopted patient-centered approaches for promoting individual choice and preference in a bureaucratically structured military hospital. The purpose of this study was to examine women's evaluations of maternity care with respect to decision-making, confidence, trust in health care providers, and treatment within the military hospital. Methods: The Department of Defense Inpatient Childbirth Survey was mailed to a simple stratified random sample of beneficiaries who received maternity care at a military hospital between July 1 and September 30, 2001. Data for 11 dimensions of women's care and experiences were examined from self-reported assessments of 2,124 respondents who gave birth at one of 44 military hospitals. A multiple logistic regression model was estimated to determine which dimensions of care predicted beneficiaries’ likelihood to recommend the military hospital to family and friends. Result: Less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women's willingness to recommend their specific military hospital to others were courtesy and availability of staff, confidence and trust in provider, treatment with respect and dignity, information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making. Conclusions: In a military population, obstetric patients who are treated with respect, courtesy, and dignity, are involved in decisions about their care, and have established trusting relationships with their practitioners are significantly more likely to recommend the military hospital to others. It is important for military health care leaders to establish a proactive program of patient-centered maternity care. Continuous care, education, support services, and a multidisciplinary approach should be integrated to retain and recapture obstetric patients who are served in military hospitals in the United States.

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