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VA Womens Health Care Delivery

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VA Women's Health Care Delivery & Quality: Effectively ... Donna ... MURDOCH. POLUSNY. ENSRUD. VA Minneapolis. MAGRUDER. VA Charleston. BRADLEY ... – PowerPoint PPT presentation

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Title: VA Womens Health Care Delivery


1
VA Womens Health Care Delivery
QualityEffectively Integrating Women Veterans
into the Mindset of QUERI Stakeholders
Center for the Study of Healthcare Provider
Behavior
  • National VA QUERI Meeting
  • Phoenix, AZ ? December 11, 2008

2
Workshop Leaders
  • Patricia Hayes, PhD
  • Chief Consultant, Women Veterans Health Strategic
    Healthcare Group
  • Steve Wright, PhD
  • Director of Epidemiology, VA Office of Quality
    Performance (OQP)
  • Donna Washington, MD, MPH
  • Core Investigator and Staff Physician, VA Greater
    Los Angeles Healthcare System
  • Becky Yano, PhD, MSPH
  • Research Career Scientist, VA Greater Los Angeles
    HSRD Center of Excellence

3
Workshop Objectives
  • Educate QUERI researchers and system partners
    about what is known about
  • how women veterans use the VA,
  • their physical and mental health burdens, and
  • how VA care is organized to meet their needs
  • Highlight the WVHSHGs strategic plans and needs
    around women veterans QI
  • Report on gender disparities in VA performance
    measures
  • Discuss approaches to ensuring representation of
    women veterans in QUERI programs

4
(No Transcript)
5
Center for the Study of Healthcare Provider
Behavior
Effectively Integrating Women Veterans into the
Mindset of QUERI StakeholdersHow Do We Get
From Here to There?Becky Yano, PhD, MSPH
National VA QUERI Meeting Phoenix, AZ ? December
11, 2008
6
Perceived Barriers to Integrating Women into
QUERI Efforts
  • Too few to effectively integrate
  • Small sample sizes ? not enough cases to analyze
    subgroups ? end up wasting data
  • Difficult to recruit ? different utilization
    patterns (where are they?)
  • Primary care based recruitment may miss them
  • Womens clinics highly variable ? some
    comprehensive and some paps only

7
Perceived Barriers to Integrating Women into
QUERI Efforts
  • Greater dual use among women vets?
  • Different insurance status ? more likely to use
    VA and non-VA than male vets
  • Higher use of fee basis and contract care ?
    incomplete portrait of their care
  • Are they so different that your intervention
    doesnt map to their needs?

8
Spinal Cord Injury
Women Veterans
HIV/Hep C
Mental Health
Diabetes
Stroke
  • What is the prevalence by gender
  • outside the VA?
  • Does age, health, dxs influence
  • likelihood WVs are part of registry?
  • Would your interventions vary if
  • women were explicitly included?

Ischemic HD
Congestive HF
Polytrauma
Substance Use Disorders
9
Adapting QUERI Studies/Trials for Women Veterans
  • Mental Health QUERI
  • Womens mental health clinics (RRP)
  • Womens Health TIDES?
  • HIV/Hepatitis QUERI
  • HIV screening in womens clinics?
  • Spinal Cord Injury QUERI

10
Adapting QUERI Studies/Trials for Women Veterans
  • Congestive Heart Failure QUERI
  • Diabetes QUERI
  • Ischemic Heart Disease QUERI

11
Adapting QUERI Studies/Trials for Women Veterans
  • Stroke QUERI
  • Substance Use Disorders QUERI
  • Polytrauma QUERI

12
Gender Disparities
  • Any evidence of gender disparities in each QUERI?
  • VA EPRP measures suggest work needed in
  • Diabetes QUERI
  • Mental Health QUERI
  • Others?
  • Other evidence of gender differences in access
    to, use, costs, quality of care?

13
Hypotheses about Differences
  • Why do you think we are seeing these differences
    in VA quality of care for women?

14
Going Beyond QUERI Centers
  • How to accelerate building evidence base and
    implementing QI interventions?
  • Top WH conditions differ from those of men
  • Can QUERI Centers and/or individual researchers
    take these issues on?
  • Ex Partner Mental Health QUERI x National
    Centers for PTSD ? QI for PTSD/MST for WVs
  • Ex Less breast conserving surgery in VA vs.
    private sector ? how apply QUERI methods to
    investigate, identify determinants and remedy?

15
Technical Support
  • What kind of information/support do you need in
    order to integrate women veterans into your
    portfolio?
  • Organizational variations in care?
  • Patterns of utilization?
  • Local womens health program manager contacts?
  • Clinical, health status, demographic data?

16
Sources of Collaboration to Leverage QUERI Efforts
  • Women Veterans Health Strategic Healthcare Group
    as partner
  • Women Veteran Program Managers (dedicated FTEE/VA
    facility with WH expertise)
  • Womens Health Fellowship Program sites
  • Womens Health Clinical Centers of Excellence
    (e.g., Palo Alto)
  • Consortium of VA-based womens health researchers

17
Active VA Womens Health Researchers
BRADLEY HAMMOND KLUTE VA Puget Sound
HASKELL BRANDT JUSTICE MADDOX VA West Haven
SCHNURR VA White River Junction
MURDOCH POLUSNY ENSRUD VA Minneapolis
BRADLEY VA Roseburg
8 DCMs
SHIPHERD RESICK VOGT SEAVER VA Boston
KRESSIN VA Bedford
KREIN VA Ann Arbor
KIMERLING National Center for PTSD
SADLER VA Iowa City
2 DCMs
SAMBAMOORTHI TSENG, POGACH VA East Orange
WEISMAN Penn State
WEAVER LA VELA Hines VA
FRAYNE TIMKO VA Palo Alto
4 DCMs
BASTIAN CHIREAU VA Durham
McNEIL BORRERA VA Pittsburgh
YEE VA Albuquerque
WASHINGTON BEAN-MAYBERRY YANO VA Greater LA
MAGRUDER VA Charleston
VERNON Univ Texas
BOOTH VA Little Rock
SURIS Dallas VA
2 DCMs
LUTHER VA Gainesville
18
Questions ?
19
More VA Womens Health Care Research Has Been
Funded
  • Impact of practice structure on quality of care
    for women veterans (Yano)
  • Gender equity in VA quality (Bean-Mayberry)
  • Chronic physical and mental illness care in women
    veterans (Sambamoorthi)
  • Quality of breast cancer care in VA (Luther)
  • Fragmentation of care and unmet health care needs
    (Washington)
  • Determinants of changes in how VA womens health
    care is organized (Yano)

20
More VA Womens Health Care Research on OIF/OEF
Funded
  • Sexual violence and gynecologic health (Sadler)
  • Evaluation of MST screening/treatment (Kimerling)
  • MST effects on PTSD and behavior among Marines
    (Shipherd)
  • Physical and sexual assault in deployed women
    risks, outcomes, services (Sadler)
  • Stigma, gender and other barriers to VA care
    (Vogt)

21
Brief Research Highlights
  • New systematic literature review funded
  • Focus on women veterans research has created a
    virtual explosion of new studies and new
    published results
  • VA HSRD funded an update of the review done in
    2004 (published in Journal of General Internal
    Medicine in 2006)
  • Bevanne Bean-Mayberry, MD (PI) (GLA)

22
New Women Veterans Cohort Study
  • Womens Healthcare Evaluation of Resource
    Utilization and Outcomes Assessment (HERA)
  • OIF/OEF women veterans with matched men
  • West Haven, CT and Indianapolis, IN initial
    cohorts
  • Obtained additional resources to add other sites
    (e.g., Los Angeles, Tampa)
  • Assess health care utilization, costs and
    satisfaction 2 years after discharge and after
    2-year coverage ends
  • Compare diagnosis/treatment of stress associated
    conditions during 2-year coverage period

Source Brandt, Haskell, Justice et al
(2008-2011) VA West Haven
23
National Survey of Women Veterans
  • New national survey funded by WVHSHG
  • Objectives of new national survey are to
  • Identify current demographics, health care needs,
    and VA experiences of women veterans
  • Determine how health care needs and barriers to
    VA health care use differ among women veterans of
    different periods of military services (e.g.,
    OEF/OIF vs. earlier periods)
  • Assess women veterans preferences for and
    perceived value of different types of VA
    interventions to improve access and quality
  • From 2,500 to 3,200 will be surveyed across US
  • Equal numbers of VA users and non-users

Source Washington (2007-09) (GLA)
24
National Survey of Veterans
  • Public law dictates decennial survey of veterans
    nationwide
  • Contract for 2010 survey funded to Westat
  • Funded to oversample women veterans
  • Focus on outreach/education and issues of
    employability/transitions

25
Evolution of VA Womens Health Clinics
WHC mandate to preferred
Legislated WH service expansion
GAO Report
Comprehensive Womens Health Centers Funded
WV Health Program Act (P.L. 102-585)
GAO Report
GAO Report
OEF
Gulf War
OIF
Source Yano EM, et al. Diffusion of VA womens
health clinics. Womens Health Issues. 2006.
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