Inroads and Roadmaps: Using Research to Transform VA Care for Women Veterans

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Inroads and Roadmaps Using Research to
Transform VA Care for Women Veterans

• Elizabeth M. Yano, PhD, MSPH
• VA Greater Los Angeles HSRD Center of Excellence
• UCLA School of Public Health
• VA Womens Health Services Research Conference
• Arlington, VA ? July 14, 2010

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Inroads and Roadmaps

• VA Womens Health Research Agenda (2004)
• Progress (2005-2010)
• Accelerating impacts through research-clinical
  partnerships
• Review of conference agenda

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VA Womens Health Research Agenda

• Literature mostly descriptive and observational
• Almost no trials or interventions
• Gaps on disease prevalence, transitions between
  military and VA care, quality
• Need for data and better understanding of women
  veterans health care needs and preferences

Sources Yano EM, et al. Toward a VA womens
health research agenda Setting evidence-based
priorities to improve the health and health care
of women veterans. JGIM. 200621S93-101.
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VA Womens Health Research AgendaHealth
Services Research Priorities

• Target conditions/populations
• Mental health (e.g., PTSD, MST), substance use
• Chronic diseases (e.g., diabetes, chronic pain)
• Reproductive health (e.g., fertility, prenatal
  care)
• Target special populations
• Pregnancy and fertility issues, military
  exposures, returning military and reservists,
  long term care, homelessness, recent amputees
• Models of care, organizational factors
• Womens clinics, provider competencies/comfort,
  training, sensitivity, VA vs. community care

Sources Yano EM, et al. Toward a VA womens
health research agenda Setting evidence-based
priorities to improve the health and health care
of women veterans. JGIM. 200621S93-101.
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VAs Womens Health Research AgendaFostering
Womens Research

• Build capacity, connections, communication
• Improved networking, collaborations, mentoring
• www1.va.gov/resdev/programs/womens_health/
• Address methodologic limitations other barriers
• Womens Health scientific review enhanced
• VA womens health deployment health
  solicitations
• Develop infrastructure and consultative support
• Increase visibility/awareness of VA WH research
• JGIM Special Issue on VA Womens Health Care
• Listserv, collaboration, interest group

Sources Yano EM, et al. Toward a VA womens
health research agenda Setting evidence-based
priorities to improve the health and health care
of women veterans. JGIM. 200621S93-101.
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More Studies Conducted to Evaluate Health Care
Needs, Access, Barriers

• Chronic physical and mental illness care
• Ambulatory care use, unmet health care needs
• Organization of VA womens health care
• Women Veterans Cohort Study (OEF/OIF)
• Physical and mental health conditions, use, costs
  and satisfaction after military discharge
• National Survey of Women Veterans
• Over 3,600 across US (VA users and non-users)
• Health care needs, use, VA experiences,
  preferences

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More Studies Conducted on VA Womens Mental
Health Care Needs

• RCT of PTSD treatment for women
• Barriers/facilitators to seeking PTSD treatment
• Evaluation of VA MST screening and treatment
• Including the MST assessment process
• Detection/treatment of intimate partner violence
• Implementation of VA womens mental health care
  programs
• Sexual violence and gynecologic health

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More Studies Conducted Among OEF/OIF Women
Deployed Veterans

• Post-deployment mental health, substance abuse
  service needs
• Physical and/or sexual assault in deployed women
• Risks, outcomes, service needs
• Combat, sexual assault, PTSD in OEF/OEF military
  women (VA/DoD)
• Gender diffs in stigma, barriers to care
• Community and family reintegration
• Including service needs for WV mothers

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Research among women in military and women
veterans
Special Issue on Women Veterans Health Health
Care
Partial year
Year of Publication
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Substantial Growth in of VA Womens Health
Researchers
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Substantial Growth in of VA Womens Health
Researchers
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Substantial Growth in of VA Womens Health
Researchers
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Accelerating Research Impacts through
Research-Clinical Partnerships

• Laboratory for evidence-based practice
• Large number of clinician researchers
• Active engagement in wide array of research
• VA leaders and managers active partners
• Unusual degree of communication upward
• Women Veterans Health Strategic Healthcare Group,
  Center for Women Veterans, Advisory Committee for
  Women Veterans, Veterans Service Organizations,
  VA Central Office leadership briefings, testimony

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Accelerating Research Impacts for Women Veterans
(Examples)

• Trial of PTSD treatment for women veterans
• Benefits of prolonged exposure (PE) therapy
• Briefings to VA leadership (VACO, OMHS)
• Multi-year rollout (PE) plus national training
  program
• Womens clinics? ? paps/mamms, ? care ratings
• Briefings ? new VHA Handbook on Womens Health
• Improving gender sensitivity
• Interviews with women veterans about VA
  experiences
• Designed and tested gender aware curriculum
• Now being tested in 4 sites before going national

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• If you dont like change, you are going to like
  irrelevance even less.
• --Secretary Shinseki

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Conference Agenda

• Special panel on enhancing research-clinical
  partnerships
• National research summaries
• Womens Health Evaluation Initiative
• Systematic Review Update
• National Survey of Women Veterans
• State of VA Womens Mental Health Research
• VA Leadership Panel
• Traditional research presentations

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Conference Agenda

• Workshops
• How to accelerate the move to interventions
• Military health services research VA/DoD
• Patient-centered medical homes for women
• Advancing the agenda and impacts
• Breakout sessions on priority topics
• Implementation/policy panel discussion

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Conference Attendees

• Department of Veterans Affairs
• Department of Defense
• Department of Health Human Services
• NIH, NIMH, AHRQ
• Department of Labor
• Congressional Staff

• Institute of Medicine
• National Committee for Quality Assurance
• Society for Womens Health Research
• Jacobs Institute for Womens Health
• RAND

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Special Thanks

• VA Womens Health Services Research Planning Group

• Lori Bastian, MD,
• Bevanne Bean-Mayberry, MD
• Susan Frayne, MD
• Patricia Hayes, PhD
• Linda Lipson, MA

• Kristin Mattocks, PhD
• Geraldine McGlynn, MA
• Anne Sadler, PhD, RN
• Donna Washington, MD
• Elizabeth Yano, PhD

• VA GLA Womens Health Services Research Program

• Ruth Klap, PhD
• Ismelda Canelo, MPA
• Susan Stockdale, PhD

• Britney Chow, BA
• Jennifer Peralta
• Amy Lau, MPH

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John G. Demakis, MD, MPH

• 1st VA womens HSR studies
• 1st VA HSRD WH-related career development
  awardees
• Oversaw 1st VA womens HSR agenda
• 1st special women veterans JGIM issue

Director, VA HSRD Service (1998-2004)