Integration of Women Veterans into VA Quality Improvement Research Efforts: What Researchers Need to Know

VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street, Sepulveda, CA 91343, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 01/2010; 25 Suppl 1(S1):56-61. DOI: 10.1007/s11606-009-1116-4
Source: PubMed


The Department of Veterans Affairs (VA) and other federal agencies require funded researchers to include women in their studies. Historically, many researchers have indicated they will include women in proportion to their VA representation or pointed to their numerical minority as justification for exclusion. However, women's participation in the military-currently 14% of active military-is rapidly changing veteran demographics, with women among the fastest growing segments of new VA users. These changes will require researchers to meet the challenge of finding ways to adequately represent women veterans for meaningful analysis. We describe women veterans' health and health-care use, note how VA care is organized to meet their needs, report gender differences in quality, highlight national plans for women veterans' quality improvement, and discuss VA women's health research. We then discuss challenges and potential solutions for increasing representation of women veterans in VA research, including steps for implementation research.

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Available from: Elizabeth M Yano
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    • "To our knowledge, no research has been done to describe bisphosphonate use and outcomes in the female veteran PMO population while controlling for severity. Studies conducted in the Veterans Health Administration (VHA) are usually overwhelmingly male [22] [23], and osteoporosis studies have been no exception [24] [25]. Thus, in the bisphosphonate-treated PMO population in the VHA, we sought to characterize bisphosphonate switching patterns; to identify patient and disease characteristics that were associated with switching or discontinuation behaviors; and to investigate the possible relationship between patient medication-taking behaviors and outcomes, including cost and fracture events. "
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    ABSTRACT: Adherence and persistence with bisphosphonates are frequently poor, and stopping, restarting, or switching bisphosphonates is common. We evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans. Female veterans ages 50+ treated with bisphosphonates during 2003-2011 were identified in Veterans Health Administration (VHA) datasets. Bisphosphonate change behaviors were characterized using pharmacy refill records. Patients' baseline disease severity was characterized based on age, T-score, and prior fracture. Cox Proportional Hazard analysis was used to evaluate characteristics associated with discontinuation and the relationship between change behaviors and fracture outcomes. Generalized estimating equations were used to evaluate the relationship between change behaviors and cost outcomes. A total of 35,650 patients met eligibility criteria. Over 6,800 patients (19.1%) were non-switchers. The remaining patients were in the change cohort; at least half displayed more than one change behavior over time. A strong, significant predictor of discontinuation was ≥5 healthcare visits in the prior year (11-23% more likely to discontinue), and discontinuation risk decreased with increasing age. No change behaviors were associated with increased fracture risk. Total costs were significantly higher in patients with change behaviors (4.7-19.7% higher). Change-behavior patients mostly had significantly lower osteoporosis-related costs than non-switchers (22%-118% lower). Most bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Apr 2015 · Bone
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    • "All of these issues may create barriers to screening for IPV within VHA primary care settings due to competing demands on providers' time during routine visits. The increase in women Veterans seeking VHA care, combined with increased recognition of women's unique health care needs, has led to significant system-wide changes to VHA health care for women (Yano et al. 2010). VHA primary care settings face challenges unique to a system that has predominantly served males. "
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    ABSTRACT: Female Veterans experience intimate partner violence (IPV) at alarming rates. The Veterans Health Administration (VHA) requires foundational research to guide the development of policy and programs to detect IPV among women Veterans and provide interventions. This pilot study reports findings from in-depth qualitative interviews conducted with 12 VHA primary care providers treating female Veterans in the New England region. Although most providers indicated that they were not currently routinely screening for IPV, they expressed positive attitudes and beliefs about screening in VHA primary care settings. Themes also included the importance of a comprehensive health care response to IPV, such as interdisciplinary coordination of care and team-based approaches to detection and intervention. Barriers to routine screening were identified, as well as recommendations for training programs and clinical tools to inform the successful implementation of a standardized IPV screening and response program in VHA. Although preliminary, these findings represent an initial step in an essential line of research.
    Full-text · Article · Nov 2013 · Journal of Family Violence
    • "Despite these limitations, our findings have important implications for future research and for clinical care of returning veterans. Though overall BMI trajectories did not differ in men and women, we did find some gender differences in associations of mental health conditions and BMI, underscoring efforts to provide gender specific care for returning veterans.33 In addition, the fact that 75 % of returning veterans were overweight and obese and that those with mental health diagnoses had increased obesity risk highlights the need for all providers to counsel returning veterans about weight, and for efforts to better integrate primary and mental health care. "
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    ABSTRACT: Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period. To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years. Retrospective, longitudinal cohort analysis of veterans' health records A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011). BMI, mental health diagnoses. Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: "stable overweight" represented the largest class; followed by "stable obese;" "overweight/obese gaining;" and "obese losing." During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression. The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.
    No preview · Article · Jul 2013 · Journal of General Internal Medicine
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