LEADING THE NATION IN WOMEN’S HEALTH: LEADING THE NATION IN WOMEN’S HEALTH:

THE IMPORTANT ROLE OF RESEARCHTHE IMPORTANT ROLE OF RESEARCH Patty Hayes, Ph.D.

Chief Consultant

Women Veterans Health Strategic Health Care Group

Department of Veterans Affairs

VA Women’s Health Services Research ConferenceVA Women’s Health Services Research Conference

Arlington, VA Arlington, VA July 2010 July 2010

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Overarching Goal

Enhance the language, practice, and culture

of VA to be more inclusive of women Veterans

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Strategic Vision Understanding and treating the effects of military

service on women’s lives• All effects- of course awareness of negative effects and

vulnerabilities, but also of strengths and resilience, etc.

Provide an active communication between Researchers and Program/policy Offices to inform the provision of care,and to provide the most useful research

Time is short and the stakes are high: We must be able to be informed about what to do, and measure how well we do it.

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Population of Women Veterans

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128,397 separated female OEF/OIF Veterans since 2002

Source data supplied 7/9/10 by the Office of the Actuary, Office of Policy and Planning, Department of Veterans Affairs

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There are enough women Veterans to study

Women have often been excluded from VA research designs because there were “not enough women veterans to form a statistical group”

Many VA studies are still reported only for men, even when women have been sampled

Challenge is to• Provide accessible population data to allow for appropriate

study design• Support collaboration across sites

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Women Veterans and the VA

Real growth has been from 4% to 6% of users, with a one year relative increase of 15% in 2008-2009 alone

Number of Female Veterans enrolled in VA plans

Number that used VA healthcare facilities

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The population of women Veterans is rapidly expanding Prior to 2005, only 11% of eligible women Veterans

used VHA health services (compared to 22% of male Veterans)

Today, 16% women Veterans use VHA- but still relatively fewer than male Veterans who are at 23% market penetration

However, 48% of OEF/OIF women have enrolled in VHA services

There are many women Veterans “in the pipeline” and women are accessing VA at an expanding rate

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Branch of ServiceWomen as a % of

Total Personnel

Number of

WomenOfficers Enlisted

Army 13.7% 71,100 12,983 58,117

Navy 14.7% 48,755 7,611 41,144

Marine Corps 6.3% 11,706 1,138 10,568

Air Force 19.6% 64,430 11,835 52,595

Coast Guard 12.2% 4,950 1,160 3,790

Reserve & Guard 17.9% 145,769 22,131 123, 638

History: Vietnam Era, 3%; Gulf War I,11% female8

Women Active Duty Personnel by Branch (2008)

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Utility of Research on women Veterans-the convergence Understanding the population and the sub-populations

of Women Veterans Informing program planning, development and

implementation efforts, including• Models of provision of health care• Clinical quality, behavior change implementation• Rural vs. urban, ethnicity and race factors, aging women,

young women Designing educational tools for staff, providers and

Veterans—and measuring effectiveness

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Key priorities for women Veterans’ Key priorities for women Veterans’ care:care:

Improve access to VA careImprove access to VA care Improve care culture surrounding women VetsImprove care culture surrounding women Vets Improve woman Veteran centered careImprove woman Veteran centered care Improve coordination across providersImprove coordination across providers

• Across women’s clinics, primary and specialty careAcross women’s clinics, primary and specialty care• Reproductive health servicesReproductive health services• Within VA and with community providersWithin VA and with community providers

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A key example: Redesigning Primary Care Delivery

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Note: Women’s clinics offering only gender-specific care (Pap clinic or gynecology care alone)

do not meet the new definition for comprehensive primary care

Comprehensive Primary Care for Women Veterans: Complete primary care from one designated Women’s Health Primary Care Provider at one site (CBOCs included)

• Care for acute and chronic illness• Gender-specific primary care• Preventive services• Mental Health services• Coordination of care

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“Hayes” Assessment of WH Field Status “Aging Infrastructure” of women’s research, with

considerable geographic dispersion Senior researchers and research-clinicians are over-

committed for own research survival and mentoring• Little or No protected time for mentoring (succession plan)

The Women’s Health Fellows and other junior researchers may not have critical alignment with mentoring researchers who have direct women’s health expertise

Data sources are complex and “protected”, as well as frequently “Dirty”— or not designed with gender factors

Opportunities for start up support may be limited

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Infusion of resources Research: Practice Based Research Network

underway Research: Collaborative Research and Initiatives Research: Opportunities for mentoring Program/Data Partnerships for example: Women’s

Health Evaluation Initiative ( WHEI)• Has allowed for data identification and reconciliation across

other data sets such as VSSC, ARC,etc , and data definitions Direct Program support for communications, cross

pollination of ideas and projects Research: Agenda setting conference-HSRD &

Women’s Health—the way forward

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