Women Veterans Health Care – Strategic Goals 

and Priorities for Research

Patricia M. Hayes, Ph.D

Women ‘s Health Sevices 

Office of Patient Care Services, Veterans Health Administration

Department of Veterans Affairs

February, 2014
VETERANS HEALTH ADMINISTRATION

Women Represent

• >15% of Active Duty military

• 18% of National Guard/Reserves

• 11.6% of Operation Enduring 

Freedom/Operation Iraqi Freedom/Operation 

New Dawn (OEF/OIF/OND) Veterans

• 6.5 % of VA health care users

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VETERANS HEALTH ADMINISTRATION

The Changing Face of VA

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– Young women

– Frequent visits

– Service-connected disabilities

– Maternity care

– Working women

– Complex co morbidities 

including mental health needs
VETERANS HEALTH ADMINISTRATION

– Aging women largest subpopulation

– Group with greatest gap in 

market penetration

– Menopausal needs

– Geriatric care

– Inpatient/extended stays

– Pain management

– Grief and loss and isolation

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The Changing Face of VA
VETERANS HEALTH ADMINISTRATION

Mission

• Ensure all women Veterans receive equitable, 

high-quality, and comprehensive health care in a 

sensitive and safe environment at all VA facilities

• Be a national leader in the provision of health care 

for women Veterans, thereby raising the standard of 

care for all women

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VETERANS HEALTH ADMINISTRATION

Strategic Goals

• Transform health care delivery for women Veterans

• Develop, implement and influence VA health policy as it 

relates to women Veterans 

• Develop, implement and influence VA education initiatives

• Drive the focus and set the agenda to increase understanding 

of the effects of military service on women Veterans’ lives 

– Focus on Research Integration: support highest utility research for 

evolution of program, greater understanding and improved outcomes

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VETERANS HEALTH ADMINISTRATION

GOAL 1: Transform health care delivery 

for women Veterans 

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VETERANS HEALTH ADMINISTRATION

Implementing Comprehensive Care

Complete primary care from one designated Women’s Health

Primary Care Provider at one site (including CBOCs)

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• Care for acute and chronic illness

• Gender-specific primary care

• Preventive services

• Mental Health services

• Coordination of care

• Model for Patient Aligned Care 

Teams (PACT) 

• Measured with women’s health 

primary care evaluation tools 

(WATCH Tool)
VETERANS HEALTH ADMINISTRATION

Status of Comprehensive Health Implementation

Data sources

• Site Visits Assessment Tool—now in 4th year, includes 

data and capabilities assessment, randomly selected 

sites-24 per year

• Annual WATCH: Women’s Assessment Tool for 

Comprehensive Health- “self administered” by VAMC

• All access on VSSC

– Includes data and capabilities

– Includes model of comprehensive care at each site and 

CBOC

– Data on numbers of Designated Women’s Health providers

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VETERANS HEALTH ADMINISTRATION

WATCH 2011 (WATCH 2013 submitted 11/2013)

• Models of care by site-Model 1,2 or 3

• “Number of Women’s Clinics” example:

According to the FY 2011 Women’s Assessment Tool for 

Comprehensive Health (WATCH) survey, VHA reported 

(and has by site number) : 

– Total Model 1 = 833 clinics

– Total Model 2 = 101 clinics

– Total Model 3 = 75 clinics “comprehensive women’s 

clinics”

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VETERANS HEALTH ADMINISTRATION

Data sources (continued)

• PACT *WH* clinic assignment in PCMM- regardless of 

how many women are in provider panel

• Several VSSC workbooks including

– Enrollees and Users— without employees health visits

– Top/all diagnostic categories

– Stop codes data

• WHEI Sourcebooks Vols 1, 2 and soon, 3

– WHEI has developed many variables and definitions 

including race/ethnicity, “conditions”, rural urban—DUA 

process

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VETERANS HEALTH ADMINISTRATION

More new data sources and definitions

• Designated WH PCPs in FY12(DAWC list):

– 99.3% of 140 HCSs had at least one designated WH PCP 

– 95.3% of 150 Medical Centers had at least one designated 

WH PCP

– 75.0% of 795 CBOCs had at least one designated WH PCP

• We have complied a list of every Designated 

Women’s Health Provider (DWHP) as of FY 2012

– Running data on Patient satisfaction

– Some clinical performance outcomes data underway

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VETERANS HEALTH ADMINISTRATION

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Women’s Comprehensive Health Expanded 

Focus 

*Subject to funding

• Cardiac care in women

– Following narrowing of gender

disparities, issues of women

at risk for cardiac disease persist

 -Workgroup examining status of care

• Breast Cancer 

– Tracking of abnormal test results

– Breast Cancer Clinical Case Registry-date soon

– Breast CA workgroup conducting surveys 

• Non-VA care evaluation

• Utilization and productivity of GYN care
VETERANS HEALTH ADMINISTRATION

Comprehensive health issues-High Morbidity and 

mortality risk 

• Lung CA and smoking in women—no current project

– NEW Lung CT pilot in VA—evaluation by gender?

• Colorectal CA screening in VA?

• Interpersonal Violence- VA has new policy, standing 

up new screening, new practice with POC’s at 

medical center

– Key research underway but lots of room for more

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VETERANS HEALTH ADMINISTRATION

Comprehensive Health:

Expansion in Reproductive Health

• Focus on preconception issues

• Healthy pregnancy, getting maternity outcome data

• Reproductive Mental Health issues

• Maternity care coordination- required designee at 

each medical center

• Implementation and diffusion of best practices-much 

work to be done

• Links with DoD Partners 

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VETERANS HEALTH ADMINISTRATION

Not just babies.... Reproductive health through the 

lifespan

• VA Emergency medicine and women-including 

abnormal bleeding in pregnancy, cardiac care, mental 

health care

– Interdisciplinary team training– Outcomes?

• Aging issues, menopause

• Urinary and incontinence issues, provision of toolkits 

and best practices for clinic approaches

• Use of telehealth for women’s health precepting, 

Gynecology, colposcopy

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VETERANS HEALTH ADMINISTRATION

GOAL 2: Develop, implement and 

influence VA health policy as it relates 

to women Veterans 

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VETERANS HEALTH ADMINISTRATION

Culture Change

• Women Veterans Health Care is leading development 

of a VA-wide communication plan to enhance the 

language, practice and culture of VA to be more 

inclusive of women Veterans

• How do we measure effect?

– What is impact on women Veterans perception of care

– Effect on outreach and enrollment/ by age cohorts

– In reach- effect on VA workforce

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VETERANS HEALTH ADMINISTRATION

2008 USH Report

• Defined comprehensive 

primary care for women

• Made recommendations on 

how facilities can improve care 

delivery 

• Handbook 1330.01: 

Recommendations became 

policy 

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VETERANS HEALTH ADMINISTRATION

Revised VHA Handbook 1330.01: 

“VHA Services for Women Veterans”

• Published 2010,Outlines specific services at facilities 

and CBOCs and defines Comprehensive Primary Care 

for Women Veterans

• Requires women be seen by designated Women’s 

Health Primary Care Providers

• Offers three clinic models

– General Primary Care Clinics, Separate but Shared Space, 

Women’s Health Center

• Details safety and security requirements

• Establishes systematic data collection process

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VETERANS HEALTH ADMINISTRATION

GOAL 3: Develop, implement and 

influence VA education initiatives 

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VETERANS HEALTH ADMINISTRATION

Women’s Health Education

• National Women’s Health Mini-Residency Program (live and online)

– More than 1,850 Primary Care providers educated in Basic and Advanced 

Women’s Health Care

– Flagship education model for VA

• SimLEARN partnership: large mini-residency, task trainer 

dissemination 

• New Women’s health topics on My Vehu Campus and TMS

• New curriculum on Reproductive Mental Health

• Monthly provider audio-conferences 

• Upcoming VA Women’s Health Research Conference, Summer 2014 

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VETERANS HEALTH ADMINISTRATION

Women’s Health Education FY 13-14 

• Nursing Education

– Mini-Residencies

– Audio Conferences

• Women’s Health Training for 

Emergency Medicine Providers

Emergency room curriculum on 

virtual university

– https://www.myvehucampus.com

• Grants for innovative education 

projects, Telehealth pilots 

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VETERANS HEALTH ADMINISTRATION

GOAL 4: Drive the focus and set the 

agenda to increase understanding of 

the effects of military service on women 

Veterans’ lives 

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VETERANS HEALTH ADMINISTRATION

Major Goal: Understand the effects of military 

service on women’s lives

• Women’s Health Evaluation Initiative : WHEI

• Practice Based Research Networks (PBRNs)

• Studies about post-deployment health, combat and trauma 

exposure, gender-specific, reproductive and mental health 

conditions 

Systematic review of VA Women’s Health Research: 

http://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141701051 

Literature Search:

http://www.hsrd.research.va.gov/for_researchers/womens_health/search.cfm 

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VETERANS HEALTH ADMINISTRATION

WHEI Sourcebooks 

and data definitions

• Volume 1: Sociodemographics

and Use of VHA Care

• Future volumes focus on: 

• Analysis of fee basis data

• Diagnoses

• Race and Ethnicity

• Challenges met: data quality 

issues re: employee vs. 

Veteran data, changes over 

time 

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Sourcebook Volume 1:

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

Mental Health Use

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Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; 

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use 

of VHA Care, 2011.
VETERANS HEALTH ADMINISTRATION

Women Use MH more than Men

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Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; 

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use 

of VHA Care, 2011.
VETERANS HEALTH ADMINISTRATION

Increase in Women with Service-Connected 

Disabilities

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Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; 

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use 

of VHA Care, 2011.
VETERANS HEALTH ADMINISTRATION

More Service Connected Status among Women 

than Men

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Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; 

Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use 

of VHA Care, 2011.
VETERANS HEALTH ADMINISTRATION

Sourcebook Volume 2

• Sociodemographics 

• and use of Non-VA fee Care

• Urban and rural comparisons

• http://www.womenshealth.va.

gov/WOMENSHEALTH/latestin

formation/publications.asp

• Volume 3 will be released later 

in 2014

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VETERANS HEALTH ADMINISTRATION

Understanding Women Veterans

• National Survey of Women Veterans 2014 

– 38000+ participants through telephone interviews

– Report due out next year on access, quality perception, 

barriers

• More to come soon

– Women Vietnam Veterans Study

– Operation Enduring Freedom /

Operation Iraqi Freedom 

(OEF/OIF) Cohort Study 

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VETERANS HEALTH ADMINISTRATION

Key Research Questions

What do we need more research on?

• Implementation in system: providers, PACT, PCC, etc

– Comprehensive health care outcomes

Differences by subgroups, geography

• Telehealth efforts-evaluation of 

– Outcomes

– Patient perceptions and

– Veteran engagement

• Education outcomes

• Diffusion of best practices

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VETERANS HEALTH ADMINISTRATION

More research Strategies

• Develop, evaluate, and disseminate interventions to 

address:

– Evaluate Veterans’ access by gender

– Targeted outreach by age

– Awareness of VA care and

services for women 

– Comprehensive care needs

– Care delivery preferences

– Health care equity and quality by

race/ethnicity 

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VETERANS HEALTH ADMINISTRATION

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Questions? 

www.womenshealth.va.gov