1. LEADING THE NATION IN WOMEN’S HEALTH: THE IMPORTANT ROLE OF RESEARCH Patty Hayes, Ph.D. Chief Consultant Women Veterans Health Strategic Health Care Group Department of Veterans Affairs VA Women’s Health Services Research Conference Arlington, VA  July 2010

2. 2 Overarching Goal Enhance the language, practice, and culture of VA to be more inclusive of women Veterans

3. 3 Strategic Vision  Understanding and treating the effects of military service on women’s lives All effects- of course awareness of negative effects and vulnerabilities, but also of strengths and resilience, etc.  Provide an active communication between Researchers and Program/policy Offices to inform the provision of care, and to provide the most useful research Time is short and the stakes are high: We must be able to be informed about what to do, and measure how well we do it.

4. 4 Population of Women Veterans 4 128,397 separated female OEF/OIF Veterans since 2002 Source data supplied 7/9/10 by the Office of the Actuary, Office of Policy and Planning, Department of Veterans Affairs

5. 5 There are enough women Veterans to study  Women have often been excluded from VA research designs because there were “not enough women veterans to form a statistical group”  Many VA studies are still reported only for men, even when women have been sampled  Challenge is to Provide accessible population data to allow for appropriate study design Support collaboration across sites

6. 6 6 6 Women Veterans and the VA Real growth has been from 4% to 6% of users, with a one year relative increase of 15% in 2008-2009 alone Number of Female Veterans enrolled in VA plans Number that used VA healthcare facilities

7. 7 The population of women Veterans is rapidly expanding  Prior to 2005, only 11% of eligible women Veterans used VHA health services (compared to 22% of male Veterans)  Today, 16% women Veterans use VHA- but still relatively fewer than male Veterans who are at 23% market penetration  However, 48% of OEF/OIF women have enrolled in VHA services  There are many women Veterans “in the pipeline” and women are accessing VA at an expanding rate

8. 88 Branch of Service Women as a % of Total Personnel Number of Women OfficersEnlisted Army13.7%71,10012,98358,117 Navy14.7%48,7557,61141,144 Marine Corps6.3%11,7061,13810,568 Air Force19.6%64,43011,83552,595 Coast Guard12.2%4,9501,1603,790 Reserve & Guard17.9%145,76922,131123, 638 History: Vietnam Era, 3%; Gulf War I,11% female 8 Women Active Duty Personnel by Branch (2008)

9. 9 Utility of Research on women Veterans-the convergence  Understanding the population and the sub-populations of Women Veterans  Informing program planning, development and implementation efforts, including Models of provision of health care Clinical quality, behavior change implementation Rural vs. urban, ethnicity and race factors, aging women, young women  Designing educational tools for staff, providers and Veterans—and measuring effectiveness

10. 10 Key priorities for women Veterans’ care:  Improve access to VA care  Improve care culture surrounding women Vets  Improve woman Veteran centered care  Improve coordination across providers Across women’s clinics, primary and specialty care Across women’s clinics, primary and specialty care Reproductive health services Reproductive health services Within VA and with community providers Within VA and with community providers

11. 11 A key example: Redesigning Primary Care Delivery 11 Note: Women’s clinics offering only gender-specific care (Pap clinic or gynecology care alone) do not meet the new definition for comprehensive primary care Comprehensive Primary Care for Women Veterans: Complete primary care from one designated Women’s Health Primary Care Provider at one site (CBOCs included) Care for acute and chronic illness Gender-specific primary care Preventive services Mental Health services Coordination of care

12. 12 “Hayes” Assessment of WH Field Status  “Aging Infrastructure” of women’s research, with considerable geographic dispersion  Senior researchers and research-clinicians are over- committed for own research survival and mentoring Little or No protected time for mentoring (succession plan)  The Women’s Health Fellows and other junior researchers may not have critical alignment with mentoring researchers who have direct women’s health expertise  Data sources are complex and “protected”, as well as frequently “Dirty”— or not designed with gender factors  Opportunities for start up support may be limited

13. 13 Infusion of resources  Research: Practice Based Research Network underway  Research: Collaborative Research and Initiatives  Research: Opportunities for mentoring  Program/Data Partnerships for example: Women’s Health Evaluation Initiative ( WHEI) Has allowed for data identification and reconciliation across other data sets such as VSSC, ARC,etc, and data definitions  Direct Program support for communications, cross pollination of ideas and projects  Research: Agenda setting conference-HSRD & Women’s Health—the way forward

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