Inroads and Roadmaps: Using Research to Transform VA Care for Women Veterans Elizabeth M. Yano, PhD, MSPH VA Greater Los Angeles HSR&D Center of Excellence UCLA School of Public Health VA Women’s Health Services Research Conference Arlington, VA  July 14, 2010

Inroads and Roadmaps VA Women’s Health Research Agenda (2004) Progress ( ) Accelerating impacts through research- clinical partnerships Review of conference agenda

VA Women’s 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 women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans. JGIM. 2006;21:S

VA Women’s Health Research Agenda: Health 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 –Women’s clinics, provider competencies/comfort, training, sensitivity, VA vs. community care Sources: Yano EM, et al. Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans. JGIM. 2006;21:S

VA’s Women’s Health Research Agenda: Fostering Women’s Research Build capacity, connections, communication –Improved networking, collaborations, mentoring –www1.va.gov/resdev/programs/womens_health/ Address methodologic limitations & other barriers –Women’s Health scientific review enhanced –VA women’s health & deployment health solicitations –Develop infrastructure and consultative support Increase visibility/awareness of VA WH research –JGIM Special Issue on VA Women’s Health Care –Listserv, collaboration, interest group Sources: Yano EM, et al. Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans. JGIM. 2006;21:S

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 women’s 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

More Studies Conducted on VA Women’s 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 women’s mental health care programs Sexual violence and gynecologic health

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

Research among women in military and women veterans Year of Publication Partial year Special Issue on Women Veterans Health & Health Care

VA Women’s Health Researchers Substantial Growth in # of VA Women’s Health Researchers

VA Women’s Health Researchers Substantial Growth in # of VA Women’s Health Researchers

VA Women’s Health Researchers Substantial Growth in # of VA Women’s Health Researchers

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

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 Women’s clinics   paps/mamms,  care ratings –Briefings  new VHA Handbook on Women’s 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

“If you don’t like change, you are going to like irrelevance even less.” --Secretary Shinseki

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

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

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 Women’s Health Research Jacobs Institute for Women’s Health RAND

Special Thanks Lori Bastian, MD, Bevanne Bean-Mayberry, MD Susan Frayne, MD Patricia Hayes, PhD Linda Lipson, MA VA Women’s Health Services Research Planning Group Kristin Mattocks, PhD Geraldine McGlynn, MA Anne Sadler, PhD, RN Donna Washington, MD Elizabeth Yano, PhD Ruth Klap, PhD Ismelda Canelo, MPA Susan Stockdale, PhD VA GLA Women’s Health Services Research Program Britney Chow, BA Jennifer Peralta Amy Lau, MPH

Director, VA HSR&D Service ( ) John G. Demakis, MD, MPH 1 st VA women’s HSR studies 1 st VA HSR&D WH-related career development awardees Oversaw 1 st VA women’s HSR agenda 1 st special women veterans’ JGIM issue