Inroads and Roadmaps: Inroads and Roadmaps: Using Research to Transform VA Using Research to Transform VA Care for Women Veterans Care for Women Veterans Elizabeth M. Yano, PhD, MSPH Elizabeth M. Yano, PhD, MSPH VA Greater Los Angeles HSR&D Center of VA Greater Los Angeles HSR&D Center of Excellence Excellence UCLA School of Public Health UCLA School of Public Health VA Women’s Health Services Research VA Women’s Health Services Research Conference Conference Arlington, VA Arlington, VA July 14, 2010 July 14, 2010
Transcript
Inroads and Roadmaps: Inroads and Roadmaps: Using Research to Transform VA Care Using Research to Transform VA Care
for Women Veteransfor Women Veterans
Elizabeth M. Yano, PhD, MSPHElizabeth M. Yano, PhD, MSPHVA Greater Los Angeles HSR&D Center of ExcellenceVA Greater Los Angeles HSR&D Center of Excellence
UCLA School of Public HealthUCLA School of Public Health
VA Women’s Health Services Research ConferenceVA Women’s Health Services Research ConferenceArlington, VA Arlington, VA July 14, 2010 July 14, 2010
Inroads and RoadmapsInroads and Roadmaps
VA Women’s Health VA Women’s Health Research Agenda Research Agenda (2004)(2004)
Progress Progress (2005-2010)(2005-2010)
Accelerating impacts Accelerating impacts through research-through research-clinical partnershipsclinical partnerships
Review of conference Review of conference agendaagenda
VA Women’s Health Research AgendaVA Women’s Health Research Agenda
Literature mostly descriptive and observationalLiterature mostly descriptive and observational– Almost no trials or interventionsAlmost no trials or interventions
Gaps on disease prevalence, transitions between Gaps on disease prevalence, transitions between military and VA care, quality military and VA care, quality
Need for data and better understanding of women Need for data and better understanding of women veterans’ health care needs and preferencesveterans’ 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:S93-101.
VA Women’s Health Research Agenda:VA Women’s Health Research Agenda:Health Services Research PrioritiesHealth Services Research Priorities
Target special populations:Target special populations:– Pregnancy and fertility issues, military exposures, Pregnancy and fertility issues, military exposures,
returning military and reservists, long term care, returning military and reservists, long term care, homelessness, recent amputeeshomelessness, recent amputees
Models of care, organizational factorsModels of care, organizational factors– Women’s clinics, provider competencies/comfort, Women’s clinics, provider competencies/comfort,
training, sensitivity, VA vs. community caretraining, sensitivity, VA vs. community careSources: 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:S93-101.
VA’s Women’s Health Research Agenda:VA’s Women’s Health Research Agenda:Fostering Women’s ResearchFostering Women’s Research
Address methodologic limitations & other barriersAddress methodologic limitations & other barriers– Women’s Health scientific review enhancedWomen’s Health scientific review enhanced– VA women’s health & deployment health solicitationsVA women’s health & deployment health solicitations– Develop infrastructure and consultative supportDevelop infrastructure and consultative support
Increase visibility/awareness of VA WH researchIncrease visibility/awareness of VA WH research– JGIM Special Issue on VA Women’s Health CareJGIM Special Issue on VA Women’s Health Care– Listserv, collaboration, interest groupListserv, 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:S93-101.
More Studies Conducted to Evaluate More Studies Conducted to Evaluate Health Care Needs, Access, BarriersHealth Care Needs, Access, Barriers
Chronic physical and mental illness careChronic physical and mental illness care
Ambulatory care use, unmet health care needsAmbulatory care use, unmet health care needs
Organization of VA women’s health care Organization of VA women’s health care
Women Veterans Cohort Study (OEF/OIF)Women Veterans Cohort Study (OEF/OIF)– Physical and mental health conditions, use, costs and Physical and mental health conditions, use, costs and
satisfaction after military discharge satisfaction after military discharge
National Survey of Women Veterans National Survey of Women Veterans – Over 3,600 across US (VA users and non-users) Over 3,600 across US (VA users and non-users) – Health care needs, use, VA experiences, preferencesHealth care needs, use, VA experiences, preferences
More Studies Conducted on VA More Studies Conducted on VA Women’sWomen’s Mental Health Care NeedsMental Health Care Needs
RCT of PTSD treatment for womenRCT of PTSD treatment for women
Barriers/facilitators to seeking PTSD treatmentBarriers/facilitators to seeking PTSD treatment
Evaluation of VA MST screening and treatmentEvaluation of VA MST screening and treatment– Including the MST assessment processIncluding the MST assessment process
Detection/treatment of intimate partner violenceDetection/treatment of intimate partner violence
Implementation of VA women’s mental health Implementation of VA women’s mental health care programscare programs
Sexual violence and gynecologic healthSexual violence and gynecologic health
More Studies Conducted Among More Studies Conducted Among OEF/OIF Women Deployed & VeteransOEF/OIF Women Deployed & Veterans
Post-deployment mental health, Post-deployment mental health, substance abuse service needssubstance abuse service needs
Physical and/or sexual assault in Physical and/or sexual assault in deployed womendeployed women– Risks, outcomes, service needsRisks, outcomes, service needs
Combat, sexual assault, PTSD in Combat, sexual assault, PTSD in OEF/OEF military women (VA/DoD)OEF/OEF military women (VA/DoD)
Gender diffs in stigma, barriers to careGender diffs in stigma, barriers to care
Community and family reintegration Community and family reintegration – Including service needs for WV mothersIncluding service needs for WV mothers
Research among women in military and women veterans
Year of Publication
Partial year
Special Issue on WomenVeterans Health & Health Care
VA Women’s Health ResearchersSubstantial Growth in # of VA Women’s Health Researchers
VA Women’s Health ResearchersSubstantial Growth in # of VA Women’s Health Researchers
VA Women’s Health ResearchersSubstantial Growth in # of VA Women’s Health Researchers
Accelerating Research Impacts through Accelerating Research Impacts through Research-Clinical Partnerships Research-Clinical Partnerships
““Laboratory” for evidence-based practiceLaboratory” for evidence-based practice– Large number of clinician researchersLarge number of clinician researchers– Active engagement in wide array of research Active engagement in wide array of research – VA leaders and managers active partnersVA leaders and managers active partners
Unusual degree of communication “upward”Unusual degree of communication “upward”– Women Veterans Health Strategic Healthcare Group, Women Veterans Health Strategic Healthcare Group,
Center for Women Veterans, Advisory Committee for Center for Women Veterans, Advisory Committee for Women Veterans, Veterans Service Organizations, VA Women Veterans, Veterans Service Organizations, VA Central Office leadership briefings, testimonyCentral Office leadership briefings, testimony
Accelerating Research Impacts for Accelerating Research Impacts for Women Veterans (Examples)Women Veterans (Examples)
Trial of PTSD treatment for women veteransTrial of PTSD treatment for women veterans– Benefits of prolonged exposure (PE) therapy Benefits of prolonged exposure (PE) therapy – Briefings to VA leadership (VACO, OMHS)Briefings to VA leadership (VACO, OMHS)– Multi-year rollout (PE) plus national training programMulti-year rollout (PE) plus national training program
Women’s clinicsWomen’s clinics paps/mamms, paps/mamms, care ratings care ratings– Briefings Briefings new VHA Handbook on Women’s Health new VHA Handbook on Women’s Health
Improving gender sensitivityImproving gender sensitivity– Interviews with women veterans about VA experiencesInterviews with women veterans about VA experiences– Designed and tested “gender aware” curriculumDesigned and tested “gender aware” curriculum
Now being tested in 4 sites before going national Now being tested in 4 sites before going national
““If you don’t like change, you are going to If you don’t like change, you are going to like irrelevance even less.”like irrelevance even less.”
--Secretary Shinseki--Secretary Shinseki
Conference AgendaConference Agenda
Special panel on enhancing research-Special panel on enhancing research-clinical partnershipsclinical partnerships– National research summariesNational research summaries
Women’s Health Evaluation InitiativeWomen’s Health Evaluation Initiative
Systematic Review UpdateSystematic Review Update
National Survey of Women VeteransNational Survey of Women Veterans
State of VA Women’s Mental Health ResearchState of VA Women’s Mental Health Research
– VA Leadership Panel VA Leadership Panel
Traditional research presentations Traditional research presentations
Conference AgendaConference Agenda
WorkshopsWorkshops– How to accelerate the move to interventionsHow to accelerate the move to interventions– Military health services research: VA/DoDMilitary health services research: VA/DoD– Patient-centered medical homes for womenPatient-centered medical homes for women
Advancing the agenda and impactsAdvancing the agenda and impacts– Breakout sessions on priority topicsBreakout sessions on priority topics– Implementation/policy panel discussionImplementation/policy panel discussion
Conference AttendeesConference Attendees
Department of Department of Veterans AffairsVeterans Affairs
Department of Department of DefenseDefense
Department of Health Department of Health & Human Services& Human Services– NIH, NIMH, AHRQNIH, NIMH, AHRQ
Department of LaborDepartment of Labor
Congressional StaffCongressional Staff
Institute of MedicineInstitute of Medicine
National Committee National Committee for Quality Assurancefor Quality Assurance
Society for Women’s Society for Women’s Health ResearchHealth Research
Jacobs Institute for Jacobs Institute for Women’s HealthWomen’s Health
