Funded by the VA HSR&D (Project# SDR 10-012)

Spotlight on Women Cyberseminar Series
VA Women’s Health Evaluation In

Susan Frayne MD, MPH

Center for Health Care Evaluation, VA Palo Alto Health Care 

Division of General Medical Disciplines, Stanford Univer

Program Evaluation Funding: VA Women Veterans Health Strategic Health C
W H lhC Womens Health Center

Mental Health Mental Health Wome

WV Program Mgr

Wome

Re

g g

MST Support Team

MiniresidencyF ll hi Fellowship
History of

Clinical Operations ‐ Research Research Partn

Partn

VA 

Women Veterans Health Strategic Health Care Group

Women’s Health Evaluation Initi

WHEI
Key Objective

Develop Develop a Sourcebook Sourcebook with key descriptiv

descriptiv

information about women veterans, e.g

• Distribution across facilities

• Growth over time• Demographic characteristics• Diagnoses• Utili ti Utilization

• Cost of care
Outline

•Introduction•Methods•Longitudinal increase in women Veteran po•Age, S i erv ce‐C td onnected st t a us

•Utilization

•New women entering VHA

•Medical Conditions
Poll

Do you provide provide clinical clinical care to women

Veterans?

*Yes*No
Poll

Do you conduct conduct research research which focuses focuses o

women Veterans?

*Yes*No
Poll

Do you conduct conduct research research which includes includes 

Veterans?

*Yes*No
Outline

•Introduction•Methods•Longitudinal increase in women Veteran po•Age, S i erv ce‐C td onnected st t a us

•Utilization

•New women entering VHA

•Medical Conditions
Methods

Cohort for today’s presentation:

Women veterans who use VHA

Excludes non‐veterans

~50% of VHA women patients patients are non‐veterans veterans

Employees (predominant group)

CHAMPVA, Tricare, other

Data sources:

NPCDDSSADUSH Enrollment file
Identifying women: 3‐step algorit

(and % of ADUSH Veteran Veteran VHA Patients Patients missing missing sex at 

Step 1: Assign Enrollment file value (SEX

wh il bl ) hen available)9% missing in 2000 (N=325,007)0 0% i i i 2009 (N 1 421) 0.0% missing in 2009 (N=1,421)

Step 2: Assign most recent non-missing 

6% i i i 2000 (N 203 39) 6% missing in 2000 (N=203,739)0.0% missing in 2009 (N=1,414)

St 3 S l t ith t t Step 3: Supplement with most recent no

missing value from utilization data (SF 

0 3% missing in 2000 (N=10 668) 0.3% missing in 2000 (N=10,668)0.0% missing in 2009 (N=589)
Measuring Utilization

 Nearly all women Veteran VHA patients in ADEnrollment file have some utilization in VHA outpi ti t tili ti fil inpatient utilization files.

1.8% (N=5,204) do not appear in utilization 

 Clinic stop codes identify primary care, womeand mental health (after deleting duplicate recordand mental health (after deleting duplicate record
Outline

•Introduction•Methods•Longitudinal increase in women Veteranpopulation•Age, Service‐Connected status•Utili i zat on

•New women entering VHA

•Medical Conditions
# of Women Veteran Outpatients in 

by Facility

Overall, 6% of Veteran VHA patients in FY0

7 0005 0006,0007,000

-Small population 

with unique needs

3 0004,0005,000

of WVs

with unique needs.

2,0003,000

No.

0

1,000

159

13

17

21

25

29

33

37

41

45

49

53

57

61

65

69

73

77

81

85

89

93

97

101

105

109

113

117

Facilities
# of Women Veterans Using VA:

Doubled over Past Decade
Outline

•Introduction•Methods•Longitudinal increase in women Veteran po•Age, S i erv ce‐C td onnected st t a us

•Utilization

•New women entering VHA

•Medical Conditions
New Trimodal Age Distribution

Women Veteran VHA patients

I di t tt ti t d 

-Immediate attention to needs 

and very elderly-Prepare for impending large elderly
Service‐Connected Status, FY00 vs F

Women Veteran VHA patients
Service‐Connected Status, by Age G

Women Veteran VHA Patients, FY09
Service‐Connected Status: Women vs

Veteran VHA patients
Outline

•Introduction•Methods•Longitudinal increase in women Veteran po•Age, S i erv ce‐C td onnected st t a us

•Utilization

•New women entering VHA

•Medical Conditions
Increasing VHA utilization by women V

E Berg 
# of Primary Care Visits,

By Age Group, Women vs. Men ( ) FY09

)
# of Mental Health Visits,

by Age Group, Women vs. Men ( ) FY09

)
Outline

•Introduction•Methods•Longitudinal increase in women Veteran po•Age, S i erv ce‐C td onnected st t a us

•Utilization

•New women entering VHA•Medical Conditions
New VHA Women Veteran Patient

Tend to be Younger Younger

FY09

100 -Services for child

age

80

ars old-Workforce educat

-Positive first impr-Potential life-long 

64%

4060

er 45 yeag

early intervention opportunities

39%

% und 20e

0

New VA Patients Returning VA Patien

Friedman SA 
Many new patients return to V

for primary care

91.1 100

for primary care

FY09

68.4 72.2 80

ran VHA 

52

4060

men Veter

patients

2040

% of wom

p

0

Year 1 OR 2 Year 1 AND 2

%

Years retained in VHA for primary care 

Friedman SA 
Outline

•Introduction•Methods•Longitudinal increase in women Veteran po•Age, S i erv ce‐C td onnected st t a us

•Utilization

•New women entering VHA

•Medical Conditions
Top 8 Conditions in Women Veteran

% ith diti Overall <40 years 40‐64 ye

Based on 1+ instance of an ICD‐9 code in FY08

% with condition Overall (n = 249,242) 40 years (n = 76,712) 40 64 ye

(n = 134,5

Hypertension 32.7 7.9 37.2 

Hyperlipidemia 30.8 9.1 36.5 

Depressive disorders 27.1 31.4 14.0 

Lumbosacral spine disorders 22.1 21.8 24.4 

Skin disorders 18.3 16.3 19.4 

Tendonitis Tendonitis, other soft tissue 18 3. 13 9. 22 0. Overweight/obesity 17.6 14.1 21.4 

Joint disorders, lower extremity 17.4 17.0 19.0 

-Common medical conditions amenable to intervention inclucardiovascular risk factors and painful conditions

Health services delivery systems must take varying needs 

-Health services delivery systems must take varying needs 

different age groups into account
31% of Women vs. 20% of Men ha

Di d agnosed Mental Heal ht Condi 

t 

Women Men

152025

-Robust mental health seneeded for a range of con

5

10

15 needed for a range of con

0

Mental health condition based on presence of ≥ 2 ICD‐9 codes in VA outpatient administrati

FY08; includes veteran patients only.
Putting It All Together

Descriptive data

Sociodemographics, utilization

Longitudinal FY2000‐FY2009Key subgroupsGender comparisons

Later:

Fee basis (Mattocks, Zephyrin)

Diagnoses

Future directions

Annual updatesIntegrated, longitudinal database

Implementation tool
http://www.thedctraveler.com/files/2007/09/vietnam-womens-memorial.jpg
Sourcebook Volume 1

Women Veterans HealthStrategic Health Care GroupPatricia Hayes PhD

Laura Herrera, MD, MPH

WHEI Team, P l a o AltoSusan Frayne MD, MPH

Ciaran Phibbs, PhD

Sarah Friedman, MSPH

Eric Berg, MS

Lakshmi Ananth, MSSamina Iqbal, MD (not shown)