LEADING THE NATION IN WOMEN’S HEALTH: THE IMPORTANT ROLE OF RESEARCH

1. LEADING THE NATION IN WOMEN’S HEALTH: THE 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 Conference Arlington, VA  July 2010

2. Overarching Goal Enhance the language, practice, and culture of VA to be more inclusive of women Veterans

3. 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.

4. Population of Women Veterans Source data supplied 7/9/10 by the Office of the Actuary, Office of Policy and Planning, Department of Veterans Affairs 128,397 separated female OEF/OIF Veterans since 2002 4

5. 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

6. Women Veterans and the VA Number of Female Veterans enrolled in VA plans Number that used VA healthcare facilities Real growth has been from 4% to 6% of users, with a one year relative increase of 15% in 2008-2009 alone 6 6

7. 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

8. Women Active Duty Personnel by Branch (2008) History: Vietnam Era, 3%; Gulf War I,11% female 8 8

9. 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

10. Key priorities for women Veterans’ care: • Improve access to VA care • Improve care culture surrounding women Vets • Improve woman Veteran centered care • Improve coordination across providers • Across women’s clinics, primary and specialty care • Reproductive health services • Within VA and with community providers

11. A key example: Redesigning Primary Care Delivery 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 • 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 11

12. “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

13. 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