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

Spotlight on Women Cyberseminar Series
Center for the Study of

Healthcare Provider Behavior

Center for H

Care Evalu

VA Women’s Health Resea

Consortium

Elizabeth M. Yano, PhD, MSPH

VA Greater Los Angeles HSR&D Center of Exce

UCLA S h l f P bli H l h UCLA School of Public Health

March 28, 2011
Background

Many more women serving in militaHigh numbers returning from Iraq aHigh numbers returning from Iraq a

Afghanistan

VA li i i i f t i th # VA clinicians caring for twice the #s 

decade ago

Increased demand for research to evidence-based practice and policy based practice and policy
Abbreviated History of VA Women’

Research

↑ WH resea

2010 Major contributions by VA HSR&D Service WH resea

VA WHSR c

PBRN, Vietna

2004

VA HSR&D Service

WH research agenda, 1st s

SMRB, JGIM issue, intere

2000

1st HSR&D WH solicitation

Æ funds 3 SDRs

2nd HSR&D WH research solicitation 

Æ fund

1993

1996

3rd solicitation, 1st WH-focused CDAs 

1992 Early VA WH agenda-setting process begun using NIH c

1st early WH studies begun (needs, care, gender diffe

1st HSR&D WH solicitation

Æ funds

3 SDRs 1993

VA mandates that all VA research studies include women veterans (response to PL 98-160)

1983

http://www.hsrd.research.va.gov/for_researchers/womens_health/search.cfm
VA’s Women’s Health Research Agen

Goals for Fosterin

g Researc

Add id tifi d h i iti Address identifi

e

d researc

h priorities

Build ORD capacity

– Improved networking, collaborations, mento

– www1.va.gov/resdev/programs/womens_he

Address methodologic limitations & othe

– Women’s Health scientific review enhanced– VA women’s health & deployment health so

Increase visibility/awareness of VA WH 

– JGIM Special Issue on VA Women’s Health 

– Listserv, collaboration, mentorship, interest 

Source: Yano EM, et al. Toward a VA women’s health research agenda: Setting evidence-ba

priorities to improve the health and health care of women veterans. JGIM. 2006;21:S93-101.
60

Women's Health Research Publicat

50

Research among women in military and women veterans

40

ationsSpecial Issue on Women Veterans Health & Health Care

30

f Publica

20

umber of “...more papers published in the last 5 years,

than the previous 25 years combined.”

10

Nu

0

Year of Publication

Source: Bean-Mayberry, et al. Systematic review of women veterans’ health research, 2004-2008. October 2
VA Women’s Health Researchers Number of VA Women’s Health Researchers 
VA Women’s Health Researchers Growth in # of VA Women’s Health Research
VA Women’s Health Researchers Substantial Growth in # of VA Women’s Health Resear
So we have the numbers of 

poten

But most VA investigators exclude But most VA investigators exclude 

from their studies

– Too few, too hard to recruit– Can’t recruit enou

g yg h to look at b

y

gen

– Not really interested in gender differe– Don t’ understand their health care ne

understand their health care ne

– Don’t understand how they use VA ca– Can’t get VA women’s research publi

Sources: Yano EM, Hayes P, Wright S, Schnurr PP, Lipson L, Bean-Mayberry B, Washington DL

Integration of women veterans into VA quality improvement research efforts: What researchers need to know. J Gen Intern Med. 2010;1:56-61.
Researchers are from Mars, 

Managers are from Venus...

“Why don’t researchers ever researchers ever

study the problems I 

need help with? need help with?

”

“Wh d ’t h lth “Why 

don’t

health

care managers ever 

pay att ti t ttention 

to my 

research?”

Source: David Atkins, MD, MPH, VA QUERI Program.
Researchers are from Mars

Managers are from Venus...

“Why don’t researchers ever researchers ever

study the problems I 

need help with? need help with?

”

“Wh d ’t h lth “Why 

don’t

health

care managers ever 

pay att ti t ttention 

to my 

research?”

We’re never goin

the “quality chas

Source: David Atkins, MD, MPH, VA QUERI Program.
Research-Clinical Partners

Passive handoff research eviden

– Doesn’t work– “Delivering a de

Different perspepriorities and pre

– Researchers’ tim

expectations diff

– Managers don t’ 

of wait-and-see

Source: S Asch, QUERI HIV, 2008.
Need to Accelerate Impa

Need to Accelerate Impa

Researchers may not have enough traininor HSR trials let alone implementation

− Need training on how to get to interventions (d

N t h i f ti t d t i t tN

o

t enoug

h in

formation 

to a

dap

t in

tervent

circumstances of women veterans

− Different experiences patterns of use Different experiences, patterns of use, comorb

comorb

care needs, expectations, trust

− Ex: TIDES (depression collaborative care) 

− Touches women who attend PC practices but not used 

clinics OR adapted to address comorbid PTSD and/or 

Inclusion of women alread

yq , re

quired, so n

market to, educate broader research com
VA Women’s Health Researc

Consortium Developed to Meet N

Use research to help transform VA Arm VA investigators with knowledArm VA investigators with knowled

skills and collaborations necessary 

generate new scientific knowledge generate new scientific knowledge

– Evidence-based care models, interve

strategies for transforming VA care fo

Hel

p VA HSR&D meet its WH rese

performance measures
VA Women’s Health Researc

Consortium Approaches

Provide methodological and conteneducation/trainin

g

( g, e.

g., c

yberseminars

)

Build capabilities and collaboration

– T h i l lt ti t Tec

h

nical consult

ation suppor

t

– Mentorship, communities of practice

Accelerate dissemination and implementation of research into praimplementation of research into pra
Consortium Part of Larger 

VA Women’s Health Research Ne

Women’s Health Women Veterans’ 

Research 

Consortium

Practice Based 

Research Network

For anothe
VA Women’s Health Research N

Practice 

Research N

Women’s Health 

Research Consortium

Palo Economics

Dtb AltoD

ata

bases

Coordin

Cent

(Palo A

Los 

Angeles

Consortium

Hub

Postdeployment 

health

Health 

systems/ 

delivery (Palo A

(Los Angeles)

• Statistics• Qualitative methods

Durha

Clinical trials 

expertise

• Qualitative methods• Survey/IRB• Implementation 

CIPRS
Target Audiences Target Audiences

• Intervention

VACO, VISNs, VAMCs

VA WH 

researchers • Consultatio

• Mentorship

VACO, VISNs, VAMCs

Other VA 

established 

researchers

• Educat• Conne• Market 

Market 

VA WH and 

other 

clinicians

• QI training• Connect• Collaborati
VA Women’s Health Research Conso

Research Experience Consortium Activitie

>150 VA Women’s

High

Research Experience Consortium Activitie

• Intervention design an• Multisite/clinical trial de• QI/implementation res

Health ResearchInterest Group & Listserv Members

Medium • Direct technical consu

• Identification of collabo• Scientific review/feedb

M t hi / t i Low • Mentorshi

p

/partnering 

• Skill building/training/e• Career development g

General HSR&D Investigators Capable of Adding Women Vets OR Generating New Women’s

• Education on women v• Direct technical consu• Link to collaborators/c

OR Generating New Women s

-

Focused Research Proposals •Gender-specific adapta

• Market PBRN capabili

VA Clinicians (e.g., Women’s Health,Primary Care, Subspecialty Care, 

• Education on women v• Highlight quality gaps • Create collaborative n

Acute Care, Long Term Care)(BOTTOM-UP PBRN QI RESEARCH)

• Evaluate frontline clini• Direct and indirect tec• Basic training on PBR
VA Women’s Health Research Con

Prioritize Training

Steering 

Committee 

Input

Investigator and 

Clinician Needs

Prioritize Training

& Consultation 

Activities

Input

Clinician Needs M k t t ti

Assessments

Mar

k

e

t segmen

t

ation

& Strategic planning
VA Women’s Health Research Con

Cyberseminars, Consu

Prioritize Training

Steering 

Committee 

Input

Skill Building & 

Career 

Guidance

Cyberseminars, Consu

Investigator and 

Clinician Needs

Prioritize Training

& Consultation 

Activities

Input Guidance 

Education on 

Women 

Clinician Needs M k t t ti 

Assessments

Veterans 

Mentorship & 

Mar

k

e

t segmen

t

ation

& Strategic planning

Collaboration 

Intervention

Development

Multi

-Site 

Intervention 

Trials

Implementation 

& QI Research
VA Women’s Health Research Con

Cyberseminars, Consul

Prioritize Training

Steering 

Committee 

Input

Skill Building & 

Career 

Guidance

Cyberseminars, Consul

Investigator and 

Clinician Needs

Prioritize Training

& Consultation 

Activities

Input Guidance 

Education on 

Women 

Clinician Needs M k t t ti 

Assessments

Veterans 

Mentorship & 

Mar

k

e

t segmen

t

ation

& Strategic planning

Impacts Collaboration 

Intervention

QI Research/

Impacts

Intervention

Development

Multi

-Site 

QI Research/

Implementation

Multi Site

Intervention 

Trials

Collaborative

networks

Implementation 

& QI Research

Market PBRN

Capabilities

Scientific

review
Research-to-Practice “Pipel

Basic 

Biomedical Clinical

Translation to human studies

Efficacy to Biomedical ff ti Ad i i l 

Research

Clinical

Science &

Knowledge

Health 

Services

Research

Implementatio

Research

effectiveness Adoption, implementa

spread, sustainability

Research Research

“T1” “T2”

• Interventions, practice guidelines• Document and diagnose gaps• Desi

gn/test im

plementation strate

g

gp g

• Organizational, provider, individual theo

Adapted from: VA Quality Enhancement Research Initiative (QUERI) pipeline model and SunNS, et al., Central challenges facing the national clinical research enterprise, JAMA 2003.
Research-Implementation Pipel

IMPLEMENTATION 

RESEARCH

Effectiveness (2):• Guidelines• Systematic reviews

Observational (3):• Quality gaps

Interventional

implementation 

studies (4/5/6)

Improved 

Proces

Outcom

• Quality gaps• Implement processes 

Phase 1 Pilot Projects

Phase 2 Small-Scale Efficacy Trials

Phase 3Large-Scale Effectiveness Trials

PhaAda

Efficacy Trials Effectiveness Trials Mon

Mon

Most VA women’s health research is at QUERI steps (pilot interventions) w/notable exceptions (PTSD, ge

Adapted from CIPRS (Mittman), VA QUERI Program

pilot interventions) w/notable exceptions (PTSD, ge
VA Women’s Health Researc

Education/Training

Spotlight on Women Spotlight on Women s’ Health cybersem

cybersem

– Mapping to different target audiences

• M th d l i M

eth

o

d

ology seminars

• Advanced methodology seminars

• Research highlight seminars Research highlight seminars• Clinical quality improvement research se

– Mapping to needs assessment result

Mapping to needs assessment result

Other venues for in-person training

– Workshops/precourses at HSR&D, S

AcademyHealth, QUERI, others
VA Women’s Health Researc

VA P ti t C t d M di l H d P 

Cyberseminars To Date

VA

P

atien

t

Cen

tere

d

M

edical Homes an

d

P

Centered Care for Women Veterans

• Melissa McNeil, MD, MPH (Pittsburgh VA, Univ Pitt• S S arah 

Scholle, DrPH ( ’ Nat l Comm fQ 

or 

Quality Assu

Improving Care for Women Veterans: MovinImproving Care for Women Veterans: Movin

Interventions and Implementation 

• Lori Bastian, MD, MPH (Durham VA, Duke University)• Susan Fra

y, , ( , ne, MD, MPH (VA Palo Alto, Stanford Univ)

• Linda Lipson, MA (VA HSR&D Service)• Ciaran Phibbs, PhD (VA Palo Alto, HERC, Stanford Uni• Elizabeth Yano, PhD (VA Greater Los Angeles, UCLA)Systematic Literature Review: Women Vete• Bevanne Bean-Mayberry, MD, MHS (VA Greater Los An• Isomi Miake Isomi Miake-Lye, BA (VA Greater Los Angeles) Lye, BA (VA Greater Los Angeles)
VA Women’s Health Resea

Cyberseminars To Date

Fi di f th N ti l S f W Findings from the National Survey of Wom• Donna L. Washington, MD, MPH (VA Greater Los A• Laura Herrera, MD (WVHSHG Discussant) 

Institute of Medicine’s Report on Women’s HInstitute of Medicine s Report on Women s H

Review

• Robert Wallace, PhD (IoM Board on Select Populations

University of Iowa City) 

• Elizabeth Yano, PhD (WHRN Discussant)Women’s Health Evaluation Initiative: A ResOperations Partnership Operations Partnership• Susan Frayne, MD, MPH (VA Palo Alto, Stanford Univ)• Patricia Hayes, PhD, (WVHSHG Discussant) 

Source: Institute of Medicine. Women’s Health Research: Progress, Pitfalls, and Promise. National Academ
VA Women’s Health Resea

Needs Assessment Resul

Top methodological training needs

– Implementation research – Statistical methods for evaluating gen

differences

– Influence of organizational factors on 

or impact of health system redesign o

impact of health system redesign o

– Intervention design– Using administrative data– Sampg g lin strategies

*Over 50% of respondents rating extremely helpful
VA Women’s Health Resea

Needs Assessment Resul

Top areas researchers want to learn mo

– Qualit

y of care for women veterans

– Access to care for women veterans– Women veterans Women veterans’ mental health mental health– Primary care for women veterans– Post deployment health

– Intimate partner violence for women v

– Military sexual trauma

*Over 50% of respondents rating topics extremely helpful
VA Women’s Health Resea

Needs Assessment Resul

B i t d ti VA ’ Barriers 

to con

ducting VA women’s 

research*

– Difficulty obtaining funding– Insufficient 

protected time for researc

– Difficulty accessing female research – Insufficient access to statistical progr

Insufficient access to statistical progr

– Difficulty identifying potential collabor– Lack of familiarity with national VA wo

Lack of familiarity with national VA wo

health policy issues

*Over 50% of respondents rating issues as interfering somewhat to

a lot with their ability to do VA women’s health research.
VA Women’s Health Resea

Mentorship Program

Outreach & recruitment of mentorsIdentification of Identification of

“mentees mentees

”

Identifying sources of support for “m

– VA Women’s Health Fellowship Program

– VA HSR&D Career Development Awards

– VA/NIMH Implementation Research Fellow

– NIH BRCH and Other K-Type Awards

– RWJ Clinical Scholars & Generalist Faculty 
VA Women’s Health Resea

Technical Consultation

• B ild iti f ti B

uild communities o

f practice 

– Key topical areas (e.g., access, OEF– Will be launching regular conference – Invitations based on interests 

(g 

re

gistr

• Continual email consults/troublesh• Group and one Group and one

-on

-one consultatio

one consultatio

– Focused on research development– Scientific review preparatory to propo

submission
VA Women’s Health Resea

Sample Technical Consultation A

Study design, sampling strategies 

how to achieve adequate #s of women 

Survey design/development, IRB isLarge database and cost analyses Large database and cost analysesQualitative methods ( gp focus groupsstructured interviews) and analysisStatistical analysis (and power calcStatistical analysis (and power calcImplementation science and resea
VA Women’s Health Resea

Needs Assessment Resul

Top resources or services requeste

– Brief newsletter 

( , g p

conferences, fundin

g op

VA policy initiatives, research events)

– Consultation/technical assistance in d

Consultation/technical assistance in d

VA WH research grant proposals

– Support for multi Support for multi

-site research site research (IRB lo

(IRB, lo

– Help in developing relationships with 

clinicians/leaders for multi clinicians/leaders for multi

-site resear

site resear

– Help identifying collaborators

*Over 50% of respondents indicated very likely to use
VA Women’s Health Resea

Dissemination

VA Women’s Health Services ReseField-based Meetin

g( y ) Jul

y 2010

)

– Virtually every VACO Office and majo– R f eps 

from D Do

D, DHHS (NIH NIMH AH

(NIH, NIMH, AH

IOM, NCQA, SWHR, Rand, SVAC/HV

– >75 oral and poster presentations*

*Opening reception and plenary talks available at www.research.va.gov. 
HSR&D Field-Based Research Me

Perceived Value 

Networking w/potential collaborators (96Valued mix of VA and non-VA 

( ) 99%

)

Helped with professional development (Broadened VA women Broadened VA women s’ HSR knowledg

HSR knowledg

Importance of research-clinical partnersUnderstand strategic/info needs of VACResearch methods plan to use in future Data sources plan to use in future (80%

*Agree to strongly agree

n=86
HSR&D Field-Based Research Me

Perceived Value 

Developed ideas for new WH research Positive im

p (p g ) ( 

act on L(pursuin

g WHSR

)

(

Helped me identify possible mentors (9Info will help me move to will help me move to int’ns/implem Conference compared favorably with otAppreciated efforts to reward/recognize Overall conference was worthwhile (99%Want regular updates on WHSR progre

*Agree to strongly agree

n=86
HSR&D Field-Based Research Me

Future Interests

Majority felt balance of topics just rif an

y g thin

g wanted even more on:

– Learning about VA leadership needs, – Learning about implementing researc

Learning about implementing researc

practice and policy

– Ti t t ki f t i Time spen

t on ne

tworking, 

fos

tering 

collaboration

– Overall conference duration
HSR&D Field-Based Research M

Perceived Value of Future Mee

100

Importance of Future 

Meeting

40

About how often 

one be conve

6080

100

3040

44% 44%

96%

4060

1020

10%

0

20

0

10

4% 

Very importantSomewhat importantNot ver

y im

portant

Every yea

r Ev

Every 3 years Ev

y p Not needed
VA Women’s Health Researc

Dissemination (cont’d)

C ll f P i C

all

for 

Papers in W ’ H lth 

Women’s 

Health 

– Manuscripts were due Nov 15th, 2010 – Final set of manuscripts under revisio

Technical reports on methods procTechnical reports on methods, procContent for ORD Women’s Health VA Intranet Sharepoint website

– Consider social networking site Consider social networking site (e g. ., 

Call for Papers in JGIM Supplemen
For more information For more information

...

Elizabeth (Becky) Yano, PhD, MSP

– Consortium PI elizabeth.

y @g ano

@va.

g

Ruth Klap, PhD

– C ti P M Consortium 

Program 

Manager ruth k

th.k