What Progress Have We Made on the VA 

Women’s Health Services Research Agenda?

Elizabeth Yano, PhD, MSPH

VA Greater Los Angeles Healthcare System

UCLA School of Public Health

Spotlight on Women’s Health Cyberseminar

April 3, 2013

Center for the Study of

Healthcare Provider Behavior
Overview of Today’s Talk 

• Brief review of the development of VA’s 

women’s health research agenda

• Review progress on VA women’s health 

services research agenda (HSR&D)

– Including gaps and opportunities

• Update on progress of VA Women’s Health 

Research Network (WHRN)

– Including VA Women’s Health CREATE

2 
3 

Poll Question #1

• What is your primary role in VA? 

– Student, trainee, or fellow 

– Clinician

– Researcher

– Manager or policy-maker

– Other
4 

Poll Question #2

• Are you directly involved in women

Veterans’ care?

– Women’s health medical director

– Women Veterans Program Manager (VISN or 

facility level)

– Women’s health provider other than director

– Women’s health staff (e.g., NPs, RNs, social 

workers, etc.)

– Women’s health manager or policymaker
VA’S WOMEN’S HEALTH 

RESEARCH AGENDA

Development, Current Portfolio, Gaps and Opportunities

5 
2010

Development of VA Women’s Health Research:

Agenda Setting Conference of Experts

2006

2006
7 

1st VA WH Research Agenda Recommendations

Biomedical/Lab 

R&D

Clinical 

Sciences R&D

Rehabilitation 

R&D

Health Services 

R&D

Infrastructure Group

Build ORD capacity

(networking, collaboration,

mentoring, RFPs) 

Address methodological

limitations & barriers

(scientific review, technical 

consultation, interventions

multi-site research/PBRN)

↑ visibility/awareness 

(publication, dissemination,

communication, impact)

↑ # PIs

↑ # grants

↑ # papers
8 

HSR&D Funded Rest of Infrastructure 

2010

Women’s Health 

Research 

Consortium 

Women Veterans’ 

Practice Based 

Research Network

• Cyberseminars/workshops

• Technical consultation

• Collaboration (workgroups)

• Mentorship (mentors, CDAs)

• Networking (conference, listserv)

• VA journal supplements

• Coordinating Center w/4 “founder” sites

• Multi-site technical support (incl CSP) 

• Internal projects to test infrastructure

• Patient interviews/card sort

• Provider interviews

• Implementation trial

 
9 

2nd VA Women’s Health Research Agenda

HSR&D

ORD

Sec 

VA

VA Women’s Health 

Research Agenda (2011)

AgendaSetting 

Conference 

(2010)

SDR

Strategic 

planning

WHI 

WV 

Issue

Updated 

Systematic

Review 

• Access/rural health

• Primary care/prevention

• Mental health

• Post-deployment health

• Complex chronic/LTC/aging

• Reproductive health

IoM, 

DHHS, 

DoD, etc.

Many moving

pieces being

managed...
Current VA Women’s Health Research 

Portfolio: Access/Rural Health

• Lost to VA Care: Attrition of Women Veterans 

New to VA Care (Frayne & Hamilton) (CREATE)

• Evaluation of Quality & Coordination of Women 

Veterans’ Outsourced Care Perceptions (Bastian 

& Mattocks) (CREATE) (VA/non-VA use) 

• Evaluation of VA Call Center (Taylor) (WHS) 

• Rural Health Resource Center pilots (ORH) 

• New National Women Veterans Survey (barriers 

to care) (WHS) 

10
11

Current VA Women’s Health Research 

Portfolio: Primary Care/Prevention

• Implementation of Women’s Health Patient 

Aligned Care Teams (Yano & Rubenstein) (CREATE)

• Controlled Trial of Tele-Support and Education for 

Women’s Health Care in CBOCs (Washington & 

Cordasco) (CREATE)

• Impacts of VA Delivery of Comprehensive 

Women’s Health Care (Yano, Chou, Rose) (CREATE)

• Evaluation of Quality & Coordination of Women 

Veterans’ Outsourced Care Perceptions (Bastian & 

Mattocks) (CREATE) (mammography quality) 
• Beyond service connection: what helps PTSDdisabled Veterans get better? (Murdoch)

• Evaluating VA’s assessment of MST in Veterans 

(Sadler)

• A randomized controlled trial of Women’s 

substance abuse treatment (Najavits) (CSR&D)

• VA Women’s Overall Mental Health Assessment 

of Needs (Kimerling) (n=6,288 WVs) (MHS) 

• Evaluation of Women’s Mental Health Care 

Arrangements (Oishi) (MHS) 

Current VA Women’s Health Research 

Portfolio: Mental Health

12
13

Current VA Women’s Health Research 

Portfolio: Post-Deployment Health

• Women Veterans Cohort Study (Brandt)

• Gender differences in post-deployment addictive 

behaviors among returning veterans (Desai)

• Understanding pain of gastrointestinal origin in 

women that serve in OEF/OIF (Greenwood)

• Interventions online to facilitate post-war access 

of Reserve and National Guard servicewomen 

(Sadler)

• Urogenital symptoms, depression and PTSD in 

OEF/OIF women Veterans (Bradley)
Current VA Women’s Health Research 

Portfolio: Post-Deployment Health

• Combat, sexual assault and post-traumatic 

stress in OEF/OIF military women (Sadler)

• Soldier to civilian: RCT of an intervention to 

promote post-deployment reintegration (Sayer) 

• Complicated family reintegration in OEF/OIF 

Veterans (Sayers)

• Stigma, gender and other barriers to VHA use 

for OEF/OIF Veterans (Vogt)

14
15

Current VA Women’s Health Research 

Portfolio: Complex Chronic Disease/LTC

• Long term health outcomes of women’s service 

during the Vietnam era (Magruder) (CSP)

• Women Veterans with insomnia: Characteristics 

and treatment preferences (Martin)

• Screening and referring women Veterans for 

homeless vulnerability (Washington) (WHS) 

• VA Emergency Services for Women (Cordasco) 

(WHS) 
Example: Long Term Health Outcomes 

of Women Vietnam Veterans (VA CSP 579)

• Most comprehensive examination of a group of 

women Vietnam Era Veterans to date

– Long-term mental and physical health effects of 

military service during Vietnam Era (7/4/65-3/28/73)

– ∼ 10,000 women selected to participate in this 

groundbreaking study (surveys + interviews complete)

– Remarkably high response rates

– Chart abstraction underway for random sample ∼900

– Data should be available next year

Source: Kathryn Magruder, PhD (PI) & Amy Kilbourne, PhD (Co-PI)

For more information, contact Perry Point CSP Coordinating Center
17

• Contraceptive services (Borrero) 

• State of VA reproductive health care (Zephyrin, 

Katon, Hoggatt, et al) (WHS) 

• Maternity care coordination pilots (WHS) 

Current VA Women’s Health Research 

Portfolio: Reproductive Health

17
Current VA Women’s Health Research 

Portfolio: Agenda Support

• Women Veterans health research database 

(Shekelle)

• Women’s Health Research Network (Yano & 

Frayne)

18
19

State of VA WHSR Agenda (2013)

Access/rural 

health

Primary care/ 

prevention

Mental health

Post-deployment 

health

Complex chronic 

conds/LTC/aging

Reproductive 

health

WH CREATE attrition and use studies

Rest is WHS or ORH-funded 

WH CREATE WH PACT study

WH CREATE Telesupported CBOC study

Rest is WHS or PC-funded 

Was biggest area (PTSD, MST mostly) 

Expanding to SUD, medical-MH, OEF/OIF 

Much partner-funded work (MHS, WHS)

Now the biggest area by far (mostly MH)

Mostly HSR&D-funded 

Moving to interventions now

CSP longitudinal Vietnam WVs study 

Insomnia work (emerging)

Mostly WHS-funded (ED, WHEI, homeless)

HSR&D contraceptive use study 

WHS-funded reproductive health report, 

maternity care coordination pilots 
Poll Question #3

• In what areas of research are you 

interested?

– Access/rural health

– Primary care/prevention

– Mental health

– Post-deployment health

– Complex chronic conditions/long term care

– Reproductive health

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VA WOMEN’S HEALTH 

RESEARCH NETWORK 

What has been accomplished so far?

21
Deliverable Achievements to Date

10 proposals 

submitted 

(4 using PBRN)

• > 20 research grants funded (7 are multi-site PBRN)

•Additional projects submitted/under review/in preparation

30 cyberseminars 

in 3 years

• 30 delivered in 2 years

• 100-600 participants in each with substantial download activity

•Also presentations/workshops at scientific meetings

• National WH Research Media Roundtables (CRADO & USH)

Identify 10 

mentors

•Identified 15+ mentors in 1st year

• 3 VA HSR&D Career Development Awardees (CDAs) funded

• 15 VA CDAs participating in ongoing CDA seminar series

So what have we done so far?

Dichter Iverson Hoggatt
Deliverable Achievement to Date

Enhanced 

researchclinical 

partnerships

• 15+ projects for VA operations/policy leaders (e.g., evaluation of 

VA telegynecology, Sourcebook Volume 1 disseminated, expert 

panel on comprehensive care for women Veterans, evaluation of VA 

emergency care resources/processes for women, support of MHS’ 

deliverables for VA/DoD Integrated Mental Health Strategic Plan, 

more Sourcebooks underway)

• Secretary’s Women Veterans Task Force–provided consultation 

on agenda (e.g., VA/DoD coordination, outreach/education)—direct 

task force participation (e.g., drafted national operating plan for 

evaluation/data collection workgroup)

So what have we done so far?
Deliverable Achievement to Date

60 technical 

consults per 

year

• VA Women’s Health Services Research Conference: 

Using Research to Build the Evidence Base for Improving the 

Quality of Care for Women Veterans (July 2010)

• VA researchers, providers and policymakers

• Included leaders from virtually every VHA Office

• Included senior representatives from DVA, DoD, DHHS, 

DoL, and Institute of Medicine

• Established VA HSR&D women’s health services research 

agenda and increased research-clinical-policy partnerships

• Conference request for FY13 submitted by VA HSR&D

•Technical consults: Accomplished/exceeded (>10/month)

•Workgroups (9) developing research on focused content areas 

(PTSD, military sexual trauma, chronic pain, intimate partner 

violence, reproductive health, substance use disorders, 

disparities, qualitative research, LGBT issues)

So what have we done so far?
So what have we done so far?

Deliverable Achievement to Date

20 research • Women’s Health Issues special VA supplement 

articles • 18 research articles, 3 commentaries, 1 editorial (from 47 

accepted submitted papers)

• 4 papers among top 5 cited in journal

• Journal of General Internal Medicine special VA issue: 

• 19 papers accepted (from 79 submitted papers)

• Special editorials (HSR&D, WHS, AHRQ/WH, PBRN)

• “More papers published in the past 5 years than the previous 25 

years combined...” (acceleration appears to be continuing)

Jul/Aug 2011

June 2013 (est) 
VA Women’s Health Researchers Number of VA Women’s Health Researchers 
VA Women’s Health Researchers Number of VA Women’s Health Researchers (2004)
VA Women’s Health Researchers Number of VA Women’s Health Researcher
99

VA Women’s Health Researchers Number of VA Women’s Health Researcher

Over 200 VA investigators in Consortium no

99
Achievement to Date

Projects: 

•WV mental health needs in primary care (Kimerling)

•Prevalence of mental health conditions in primary care

•Women Veterans’ preferences for how mental health 

care is delivered (e.g., same gender providers, care 

setting, telephone care) (∼550 women Veterans)

• Caring for Women Veterans implementation (Vogt-Yee)

• Cluster RCT of evidence-based e-learning course and 

other locally tailored gender awareness activities 

• Using evidence based quality improvement to test local 

implementation approaches

• 4 VA facilities, 32 work groups, 100s VA providers/staff

•Will inform effective regional and national rollout

•VA provider interviews (Klap)

• Completed interviews with VA primary care, women’s 

health and mental health providers about frontline 

quality improvement needs for women Veterans

PBRN Founder Site Leads: Lori Bastian, MD, MPH; Anne Sadler, PhD, RN, 

Susan Frayne, MD, MPH, Bevanne Bean-Mayberry, MD, MHS.

So what have we done so far?

Deliverable

Functional VA

Practice Based 

Research Network

(PBRN) with three 

projects testing 

infrastructure
Deliverable Achievement to Date

PBRN 

growth to 6 

sites

37 sites, geographically dispersed; represents one in every 3 women 

Veteran VHA patients nationally (100,000 women Veterans)

So what have we done so far?

• Diverse patient

 populations included

 (young/old, urban/rural)

• Diverse site lead

 expertise (content areas,

 researchers/clinicians) 

• Includes 37 of 140 VAs

• Includes 17 of 21 VISNs

• 62% from sites with 

 VA HSR&D Centers

Susan Frayne, MD, PBRN Director; Diane Carney, PBRN Program Manager
VA HSR&D WOMEN’S HEALTH 

CREATE

Using Research to Accelerate Implementation of Comprehensive 

Women’s Health Care in VHA

32
VA HSR&D CREATE Initiative

• What is a “CREATE”?

– Stands for Collaborative Research to Enhance and 

Advance Transformation & Excellence 

– VA HSR&D initiative to promote partner-oriented 

research to increase impacts on Veterans’ care

– Group of 3-5 coordinated projects in a focused area

– Capitalize on national expertise (multi-center)

– Meaningful engagement with VHA program leaders 

with demonstrated commitment to implement findings

• Highly competitive national process and review

33
VA Women’s Health CREATE

• Goal: To use research to accelerate implementation 

of comprehensive care for women Veterans

– Comprehensive care codified in VHA Handbook 1330.01

– “each VA must ensure that eligible women Veterans 

have access to comprehensive medical care, including 

care for gender-specific conditions and mental health 

conditions...comparable to care provided for [men]”

– “all enrolled women Veterans need to receive 

comprehensive primary care from a designated women’s 

health provider who is interested and proficient in the 

delivery of comprehensive primary care to women, 

irrespective of where they are seen...” 

34
VA Women’s Health CREATE

• Project #1: Lost to VA Care: Attrition of Women Veterans New to 

VA Care (Frayne & Hamilton)

• Project #2: Impacts of VA Delivery of Comprehensive Women’s 

Health Care (Yano, Chou, Rose)

• Project #3: Implementation of VA Women’s Health Patient 

Aligned Care Teams (Yano & Rubenstein)

• Project #4: Controlled Trial of Tele-Support and Education for 

Women’s Health Care in CBOCs (Washington & Cordasco)

• Project #5: Evaluation of Quality & Coordination of Women 

Veterans’ Outsourced Care (Bastian & Mattocks)

35
VA Women’s Health CREATE

• VHA CREATE Partners

– Women’s Health Services (Hayes)

– Office of Mental Health Services (McCutcheon)

• VHA Project-specific Partners

– Office of Primary Care (PCS & 10N)

– Office of Specialty Care Services

– VHA Purchased Care

– National Radiology Office

– VISN 22

• Establishing a Women Veterans CREATE Council

• Projects launched in March 2013

36
Research-to-Practice “Pi

pe

Basic 

Translation to human studies

Efficacy to Biomedical

Research

Clinical

Science &

Knowledge

Health 

Services Implementa

Efficacy to

effectiveness Adoption, implemen

spread, sustainabilit

Research Research

• Interventions, practice guidelines• Document and diagnose gaps• Design/test implementation strate

Design/test implementation strate

• Organizational, provider, individual th

Adapted from: VA Quality Enhancement Research Initiative (QUERI) pNS, et al., Central challenges facing the national clinical research enter
WH Research-to-Practice “Pipel

Int ti I l t ti I 

ervention, 

Imp

lementation, 

Imp

PBRN

Clinical Efficacy to ff ti Ad i i l i

Science &

Knowledge

Health 

Services

Research

Implementation

Research

effectiveness Adoption, implementation,

spread, sustainability

Research Research

Ch 

Consortium

Chro• p

Research-clinical

partnerships

• p• o

partnerships

(finding new pathways)

(like WH CREATE) 
Thank you!

39

• For more information about VA women veterans’ health 

services research, visit the VA Office of Research & 

Development website on Women’s Health:

 http://www.research.va.gov/programs/womens_health/default.cfm 

• Funded by VA HSR&D Service, VA Quality Enhancement 

Research Initiative (QUERI), Women’s Health Services and 

Mental Health Services

• Views expressed in this presentation are those of the 

authors and do not necessarily represent the views of the 

Department of Veterans Affairs or the US Government

Women’s Health Workgroups

Workgroup Name Workgroup Chair

Post Traumatic Traumatic Stress Disorder Disorder Keren Lehavot LehavotChronic Pain Erin Krebs

Substance Use Disorders Michael Cucciare

Intimate Partner Violence Kate Iverson & Melissa Dichter

Qualitative Research Alison Hamilton

Access/Disparities Sonya Borrero

Military Sexual Trauma Rachel Kimerling

Reproductive Health Kristin MattocksLesbian, Gay, Bisexual, Transgender Kristin Mattocks

To join a workgroup workgroup please contact contact Ruth Klap at Ruth.Klap@v

Ruth.Klap@v