Women Veterans Health Care – Strategic Goa

and Priorities

Patricia M. Hayes, Ph.DWomen Veterans Health Strategic Health Care GroupOffice of Patient Patient Care Services Services, Veterans Veterans Health Administratio

Administratio

Department of Veterans Affairs

May 9, 2012
Women Veteran Population Increasing, Women Veteran Population Increasing, 

Total Vet Population Declining VETERANS HEALTH ADMINISTRATION 

Source: VetPOP, VA Office of Policy and Planning 

5/9/12
Women VA Users Doubled Since 2000 

ts VHA Patien #Female V 

Sources: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Stra

VETERANS HEALTH ADMINISTRATION 

Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Stra

Care Group; Sourcebook: Women Veterans in the Veterans Health Administration V1: SociodCharacteristics and Use of VHA Care, 2011. VHA’s Office of Finance Allocation Resource Ce

5/9/12
Women Represent 

• 14.5% of Active Duty military

• 18% of National National Guard/Reserves Guard/Reserves

• 11.6% of Operation Enduring

Freedom/Operation Iraqi Freedom/Ope

New Dawn (OEF/OIF/OND) Veterans

• 6% of VA health care usersVETERANS HEALTH ADMINISTRATION 

5/9/12 
The Changing Face of VA 

– Young women– Frequent visits– Service

‐connected 

– Maternity care

– W ki or ng women

– Mental health need

VETERANS HEALTH ADMINISTRATION 

5/9/12
The Changing Face of VA 

– Older women– Largest Largest sub

‐populat

populat

– Menopausal needs

– Geriatric care

– Inpatient/ex

ten

d

e

d

– Pain management

VETERANS HEALTH ADMINISTRATION 

5/9/12
Mission 

• Ensure all women Veterans receive equitable

high‐quality, and comprehensive health care sensitive and safe environment at all VA facil

• Be a national leader in the provision of healt

for women Veterans, thereby raising the stan

f ll

VETERANS HEALTH ADMINISTRATION 

care for all women

5/9/12 
Strategic Goals 

• Transform health care delivery for women Veterans• Develop, implement and influence VA health policy a

relates to women Veterans

• Develop, implement and influence VA education init• Drive the focus and set the agenda to increase unde

of the effects of military service on women Veterans

• E dn G l oa : N d ee s of women V t e erans always consid

across program offices and in policy and key decisio

VETERANS HEALTH ADMINISTRATION 

5/9/12 
GOAL 1: T f h lth d l

Transform health care del

for women Veterans 

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Implementing Comprehensive Care 

Complete primary care from one designated Women’s 

Primary Care Provider at one site (including CBOCs)

• Care

for acute and

c

hr

• Gender

‐specific prima

• Preventive services

• Mental Health services

• Coordination of care• Model for Patient Align

Teams (PACT)

• Measured with women

primary care evaluatio

VETERANS HEALTH ADMINISTRATION 

(WATCH Tool)

5/9/12 
–

Clinical Research needs 

• Highest morbidity :

– Cardiac disease, HTN, Diabetes, Obesity– Lung Cancer, smoking smoking behaviors behaviors and smoking smoking ces

ces

– Colon cancer and patterns of test compliance

• Veteran experience and

– Cervical and breast cancer rates in Veterans– Pregnancy

• Unplanned, preconception behaviors

• Pregnancy outcomes

All l t d t M t l H lth C b t E 

VETERANS HEALTH ADMINISTRATION • All related to Mental Health, Combat Exposu

11
Installing Full-time Women Veterans Progr

time Women Veterans Progr

Managers (WVPMs) System-Wide • Serves as advocate for women Veterans

• Leads facility women’s health program

• Coordinates care across PACTs

• Implements improved services

• Increases outreach• Helps develop best practices• Serves as a linchpin for improved

women's health services

Can be involved in Research activities

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Women s Health Transformation Initi

’s Health Transformation Initi

Sub-initiative of New Models of Care • Homelessness

– Vulnerability Screening Tool– Planned Planned completion: completion: 9/2012

• Women Veterans Call Center

– Launched: 6/2011

• Privacy and Environment of Care

– Correction of bathroom and privacy deficiencies– Target for FY12: Correct 90% of bathroom and 65% of priva

deficiencies identified in the Privacy/EOC

5/9/12 
Women s Health Transformation Initi

’s Health Transformation Initi

Sub-initiative of New Models of Care Improved Care Coordination

• Emergency Room Care

– Assessment Assessment Tool development development– Ongoing provider/staff education– Planned completion: 9/2013

• Breast Cancer

– Tracking of abnormal test results– Breast Cancer Clinical Case Reg y istr– Planned Completion: 9/2013

• Teratogenic Identification of Drugs*

Pl d l ti 9/2013

VETERANS HEALTH ADMINISTRATION *Subject to funding

– Planned completion: 9/2013

5/9/12 
–

Culture Change • Women Veterans Health Care is leading deve

of a VA‐wide communication plan to enhance 

language, practice and culture of VA to be m

inclusive of women Veterans

• N ti a onal Women V t e erans Communications

Workgroup:

Broad representation representation across VA

– Tasked with developing strategies to reach wome

Veterans and VA employees

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Culture Change Through Communications 

VETERANS HEALTH ADMINISTRATION 

5/9/12 
GOAL D l

 i 

2: Develop, impl t d ement and 

influence VA health policy as it relato women Veterans 

VETERANS HEALTH ADMINISTRATION 

5/9/12 
2008 USH Report 

• Defined comprehensive

primary care for women

• Made recommendations recommendations on

how facilities can improve care

delivery

• Handbook 1330.01:

Recommendations becamepolicy

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Revised VHA Handbook 1330.01: 

“VHA Services for Women Veterans” • Outlines specific services at facilities and CBO

• Defines Comprehensive Primary Care for Wo

Veterans

• Requires women be seen by Women’s Health

Primary Care Providers

• Offers three clinic models

– General Primary Care Clinics, Separate but Shared 

Women’s Health Center

• Details safety and security requirements• Establishes systematic data collection procesVETERANS HEALTH ADMINISTRATION • Establishes systematic data collection proces

5/9/12 
Improving Reproductive Health Services 

• New and upcoming policies

– Maternity Care Coordination– Infertility Policy

– Emergency Contraception Rights of Conscience (R

• Maternity care

– 2010 Caregiver Law– Newborn care– Childcare pilots

VETERANS HEALTH ADMINISTRATION 

5/9/12 
GOAL D l

 i 

3: Develop, impl t d ement and 

influence VA education initiatives 

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Women’s Health Education 

• Recruiting and retraining providers interested and profici

women’s health

• National National Women’s Health Mini

‐Residency Residency Program Program (live a

– More than 1,200 Primary Care providers educated in Basic and Ad

Women’s Health Care

– Flagship Flagship education education model for VA

• SimLEARN partnership: large mini

‐residency, ED

‐WH curr

task trainer dissemination

• Advance

d f ll e owships in women V t e

terans’ h lth ea

• Monthly provider audio

‐conferences

• Co

‐

s

ponsored

2nd VA Women’s Health Research Conferen

VETERANS HEALTH ADMINISTRATION 

p

5/9/12 
Women’s Health Education FY12 

• Nursing Education

– Mini‐Residencies– Audio Conferences

• Women’s Health Training for

Emergency Medicine Providers

• Grants for innovative innovative education education

projects, Telehealth pilots

VETERANS HEALTH ADMINISTRATION 

5/9/12 
GOAL 4: D i th f d t th Drive the focus and set the 

agenda to increase understanding o

the effects of military service on wothe effects of military service on woVeterans’ lives 

VETERANS HEALTH ADMINISTRATION 

5/9/12 
service on women’s lives 

• Women’s Health Evaluation Initiative

• Practice Based Research Networks (PBRNs)

• Studies about post

‐deployment health, combat and 

exposure, gender

‐specific, reproductive and mental 

conditions

• More VA research on women Veterans published ove

period (2004

‐2008) than the preceding 25 years

Major Goal: Understand the effects of mil

Understand the effects of mil

Systematic review of VA Women’s Health Research:http://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=214Literature Search:VETERANS HEALTH ADMINISTRATION http://www.hsrd.research.va.gov/for_researchers/womens_health/searc

5/9/12 
Sourcebook 

• Volume 1: Sociodemographics

and Use of VHA Care

• Future volumes volumes focus on:

• Analysis of fee basis data• Diagnoses• Race and Ethnicity

• Challenges: data quality issues

re: employee employee vs. Veteran Veteran data,

changes over time

Sourcebook Volume 1:

VETERANS HEALTH ADMINISTRATION 

http://www.womenshealth.va.gov/publications.asp#research

5/9/12 
’

High Usage 

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

VETERANS HEALTH ADMINISTRATION 

Source: Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characte

of VHA Care, 2011.

5/9/12 
’

Women Use PC more than Men 

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

VETERANS HEALTH ADMINISTRATION 

Source: Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characte

of VHA Care, 2011.

5/9/12 
’

Mental Health Use 

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

VETERANS HEALTH ADMINISTRATION 

Source: Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characte

of VHA Care, 2011.

5/9/12 
’

Women Use MH more than Men 

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

VETERANS HEALTH ADMINISTRATION 

Source: Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characte

of VHA Care, 2011.

5/9/12 
’

Increase in Women with Service Increase in Women with Service -Connected Connected Disabilities 

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

VETERANS HEALTH ADMINISTRATION 

Source: Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characte

of VHA Care, 2011.

5/9/12 
’

More Service Connected Status among Womthan Men 

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

VETERANS HEALTH ADMINISTRATION 

Source: Women s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Healt

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characte

of VHA Care, 2011.

5/9/12 
Understanding Women Veterans 

• National Survey of Women Veterans 2010

– 3,500+ participants through telephone interviews– Fi

ndings: access, qualit

y perception,

b i arr ers

– Next scientific survey of women Veterans: 2012

• More to come

– Women Vietnam Veterans Study– Operation Enduring Freedom

/

Operation Iraqi Free

dom

(OEF/OIF) Cohort Study

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Key Research Questions 

• Outcomes• Im

plementation

• What do we need more research on?VETERANS HEALTH ADMINISTRATION 

5/9/12 
Implications 

• Develop, evaluate, and disseminate intervent

address:

– Women Veterans’ access

– Comprehensive care needs

– Care d li e very preferences

– Health care quality

– Awareness Awareness of VA care and

services for women

VETERANS HEALTH ADMINISTRATION 

5/9/12 
Questions?

www.womenshealth.va.gov

VETERANS HEALTH ADMINISTRATION 

5/9/12