Skip to main content
Top
Published in: Journal of General Internal Medicine 1/2010

Open Access 01-01-2010 | Perspective

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

Authors: Elizabeth M. Yano, PhD, MSPH, Patricia Hayes, PhD, Steven Wright, PhD, Paula P. Schnurr, PhD, Linda Lipson, MA, Bevanne Bean-Mayberry, MD, MSHS, Donna L. Washington, MD, MPH

Published in: Journal of General Internal Medicine | Special Issue 1/2010

Login to get access

Abstract

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.
Literature
1.
go back to reference Yang Y, Carlin AS, Faustino PJ, et al. Participation of women in clinical trials for new drugs approved by the Food and Drug Administration in 2000–2002. J Womens Health. 2009;18(3):303–10.CrossRef Yang Y, Carlin AS, Faustino PJ, et al. Participation of women in clinical trials for new drugs approved by the Food and Drug Administration in 2000–2002. J Womens Health. 2009;18(3):303–10.CrossRef
2.
go back to reference Brown BA, Long HL, Gould H, Weitz T, Milliken N. A conceptual model for the recruitment of diverse women into research studies. J Womens Health. 2000;9(6):625–32. Brown BA, Long HL, Gould H, Weitz T, Milliken N. A conceptual model for the recruitment of diverse women into research studies. J Womens Health. 2000;9(6):625–32.
3.
go back to reference Wood SF. Tracking inclusion of women in clinical studies. J Womens Health. 2009;18(3):301–2.CrossRef Wood SF. Tracking inclusion of women in clinical studies. J Womens Health. 2009;18(3):301–2.CrossRef
4.
go back to reference Gilliss CL, Lee KA, Gutierrez Y, et al. Recruitment and retention of healthy minority women into community-based longitudinal research. J Womens Health Gend Based Med. 2001;10(1):77–85.CrossRefPubMed Gilliss CL, Lee KA, Gutierrez Y, et al. Recruitment and retention of healthy minority women into community-based longitudinal research. J Womens Health Gend Based Med. 2001;10(1):77–85.CrossRefPubMed
5.
go back to reference Murdoch M, Bradley A, Mather SH, Klein RE, Turner CL, Yano EM. Women and war: What physicians should know. J Gen Intern Med. 2006;21(Suppl 3):S5–10.CrossRefPubMed Murdoch M, Bradley A, Mather SH, Klein RE, Turner CL, Yano EM. Women and war: What physicians should know. J Gen Intern Med. 2006;21(Suppl 3):S5–10.CrossRefPubMed
6.
go back to reference Washington DL, Yano EM, Simon B, Sun S. To use or not to use: What influences why women veterans choose VA healthcare? J Gen Intern Med. 2006;21(Suppl 3):S11–18.CrossRefPubMed Washington DL, Yano EM, Simon B, Sun S. To use or not to use: What influences why women veterans choose VA healthcare? J Gen Intern Med. 2006;21(Suppl 3):S11–18.CrossRefPubMed
7.
go back to reference Washington DL, Kleimann S, Michelini AN, Kleimann KM, Canning M. Women veterans’ perceptions and decision-making about VA health care. Mil Med. 2007;172(8):812–17.PubMed Washington DL, Kleimann S, Michelini AN, Kleimann KM, Canning M. Women veterans’ perceptions and decision-making about VA health care. Mil Med. 2007;172(8):812–17.PubMed
8.
go back to reference Frayne SM, Parker VA, Christiansen CL, et al. Health status among 28,000 women veterans: The VA Women’s Health Program Evaluation Project. J Gen Intern Med. 2006;21(Suppl 3):S40–6.CrossRefPubMed Frayne SM, Parker VA, Christiansen CL, et al. Health status among 28,000 women veterans: The VA Women’s Health Program Evaluation Project. J Gen Intern Med. 2006;21(Suppl 3):S40–6.CrossRefPubMed
9.
go back to reference Yano EM, Bastian LA, Frayne SM, et al. Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans. J Gen Intern Med. 2006;21(Suppl 3):S93–101.CrossRefPubMed Yano EM, Bastian LA, Frayne SM, et al. Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans. J Gen Intern Med. 2006;21(Suppl 3):S93–101.CrossRefPubMed
10.
go back to reference Yano EM, Washington DL, Bean-Mayberry B. Impact of Practice Structure on the Quality of Care for Women Veterans (Final Report). Sepulveda, CA: VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior; 2008. Yano EM, Washington DL, Bean-Mayberry B. Impact of Practice Structure on the Quality of Care for Women Veterans (Final Report). Sepulveda, CA: VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior; 2008.
11.
go back to reference Seelig MD, Yano EM, Bean-Mayberry B, Lanto AB, Washington DL. Availability of gynecologic services in the Department of Veterans Affairs. Womens Health Issues. 2008;18(3):167–73.CrossRefPubMed Seelig MD, Yano EM, Bean-Mayberry B, Lanto AB, Washington DL. Availability of gynecologic services in the Department of Veterans Affairs. Womens Health Issues. 2008;18(3):167–73.CrossRefPubMed
12.
go back to reference Vogt DS, Barry AA, King LA. Toward gender-aware health care: evaluation of an intervention to enhance care for female patients in the VA setting. J Health Psychol. 2008;13(5):624–38.CrossRefPubMed Vogt DS, Barry AA, King LA. Toward gender-aware health care: evaluation of an intervention to enhance care for female patients in the VA setting. J Health Psychol. 2008;13(5):624–38.CrossRefPubMed
13.
go back to reference U.S. Government Accounting Office. Actions needed to insure that female veterans have equal access to VA benefits (GAO/HRD-82-98), 1982. U.S. Government Accounting Office. Actions needed to insure that female veterans have equal access to VA benefits (GAO/HRD-82-98), 1982.
14.
go back to reference U.S. Government Accounting Office. VA health care for women: despite progress, improvements needed (GAO/HRD-92-23), 1992. U.S. Government Accounting Office. VA health care for women: despite progress, improvements needed (GAO/HRD-92-23), 1992.
15.
go back to reference Kimerling R, Street AE, Gima K, Smith MW. Evaluation of universal screening for military-related sexual trauma. Psychiatr Serv. 2008;59(6):635–40.CrossRefPubMed Kimerling R, Street AE, Gima K, Smith MW. Evaluation of universal screening for military-related sexual trauma. Psychiatr Serv. 2008;59(6):635–40.CrossRefPubMed
16.
go back to reference U.S. Department of Veterans Affairs, Veterans Health Administration. Report to the Appropriations Committee of the U.S. House of Representatives in response to House Appropriations Report No. 110–186, accompanying Public Law 110–161, The Consolidated Appropriations Act, 2008. U.S. Department of Veterans Affairs, Veterans Health Administration. Report to the Appropriations Committee of the U.S. House of Representatives in response to House Appropriations Report No. 110–186, accompanying Public Law 110–161, The Consolidated Appropriations Act, 2008.
17.
go back to reference Chou AF, Brown AF, Jensen RE, Shih S, Pawlson G, Scholle SH. Gender and racial disparities in the management of diabetes mellitus among Medicare patients. Womens Health Issues. 2007;17(3):150–61.CrossRefPubMed Chou AF, Brown AF, Jensen RE, Shih S, Pawlson G, Scholle SH. Gender and racial disparities in the management of diabetes mellitus among Medicare patients. Womens Health Issues. 2007;17(3):150–61.CrossRefPubMed
18.
go back to reference Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender disparities in the quality of cardiovascular disease care in private managed care plans. Womens Health Issues. 2007;17(3):120–30.CrossRefPubMed Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender disparities in the quality of cardiovascular disease care in private managed care plans. Womens Health Issues. 2007;17(3):120–30.CrossRefPubMed
19.
go back to reference Bird CE, Fremont AM, Bierman AS, et al. Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans? Women’s Health Issues. 2007;17:131–8.CrossRefPubMed Bird CE, Fremont AM, Bierman AS, et al. Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans? Women’s Health Issues. 2007;17:131–8.CrossRefPubMed
20.
go back to reference Bean-Mayberry B, Yano EM, Mor MK, Bayliss NK, Xu X, Fine MJ. Does sex influence immunization status for influenza and pneumonia in older veterans? J Am Geriatrics Soc. 2009;57(8):1427–32.CrossRef Bean-Mayberry B, Yano EM, Mor MK, Bayliss NK, Xu X, Fine MJ. Does sex influence immunization status for influenza and pneumonia in older veterans? J Am Geriatrics Soc. 2009;57(8):1427–32.CrossRef
21.
go back to reference Wright SM, Lucartoto MA, Hayes PM, Yano EM. An analysis of the quality of care provided to men and women in the VA health care system. Washington DC: VA Office of Quality & Performance (OQP) White Paper to the U.S. Assistant Deputy Under Secretary for Quality & Patient Safety, Veterans Health Administration; 2008. Wright SM, Lucartoto MA, Hayes PM, Yano EM. An analysis of the quality of care provided to men and women in the VA health care system. Washington DC: VA Office of Quality & Performance (OQP) White Paper to the U.S. Assistant Deputy Under Secretary for Quality & Patient Safety, Veterans Health Administration; 2008.
23.
go back to reference Goldzweig CL, Balekian TM, Rolón C, Yano EM, Shekelle PG. The state of women veterans’ health research: Results of a systematic literature review. J Gen Intern Med. 2006;21(Suppl 3):S82–92.CrossRefPubMed Goldzweig CL, Balekian TM, Rolón C, Yano EM, Shekelle PG. The state of women veterans’ health research: Results of a systematic literature review. J Gen Intern Med. 2006;21(Suppl 3):S82–92.CrossRefPubMed
24.
go back to reference Frayne SM, Yu W, Yano EM, et al. Gender and use of care: Planning for tomorrow’s Veterans Health Administration. J Womens Health. 2007;16(8):1188–99.CrossRef Frayne SM, Yu W, Yano EM, et al. Gender and use of care: Planning for tomorrow’s Veterans Health Administration. J Womens Health. 2007;16(8):1188–99.CrossRef
25.
go back to reference Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820–30.CrossRefPubMed Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820–30.CrossRefPubMed
27.
go back to reference Stetler CB, McQueen L, Demakis J, Mittman BS. An organizational framework and strategic implementation for system-level change to enhance research-based practice: QUERI series. Implement Sci. 2008;3:30.CrossRefPubMed Stetler CB, McQueen L, Demakis J, Mittman BS. An organizational framework and strategic implementation for system-level change to enhance research-based practice: QUERI series. Implement Sci. 2008;3:30.CrossRefPubMed
28.
go back to reference Nutting PA, Beasley JW, Werner JJ. Practice-based research networks answer primary care questions. JAMA. 1999;281:686–8.CrossRefPubMed Nutting PA, Beasley JW, Werner JJ. Practice-based research networks answer primary care questions. JAMA. 1999;281:686–8.CrossRefPubMed
29.
go back to reference Wasson JH, Jette AM, Johnson DJ, et al. A replicable and customizable approach to improve ambulatory care and research. J Ambul Care Manage. 1997;20(1):17–27.PubMed Wasson JH, Jette AM, Johnson DJ, et al. A replicable and customizable approach to improve ambulatory care and research. J Ambul Care Manage. 1997;20(1):17–27.PubMed
30.
go back to reference Kochevar L, Yano EM. Understanding organizational needs and context: Beyond performance gaps. J Gen Intern Med. 2006;21(Suppl 2):S25–9.PubMed Kochevar L, Yano EM. Understanding organizational needs and context: Beyond performance gaps. J Gen Intern Med. 2006;21(Suppl 2):S25–9.PubMed
31.
go back to reference Kasper AS. Health care reform and women’s interests: Present, past and future. Womens Health Issues. 2004;14(4):107–11.CrossRefPubMed Kasper AS. Health care reform and women’s interests: Present, past and future. Womens Health Issues. 2004;14(4):107–11.CrossRefPubMed
32.
go back to reference Correa-de-Araujo R. Serious gaps: How the lack of sex/gender-based research impairs health. J Womens Health. 2006;15(10):1116–22.CrossRef Correa-de-Araujo R. Serious gaps: How the lack of sex/gender-based research impairs health. J Womens Health. 2006;15(10):1116–22.CrossRef
33.
go back to reference Yano EM, Simon BF, Lanto AB, Rubenstein LV. The evolution of changes in primary care delivery underlying the Veterans Health Administration’s quality transformation. Am J Public Health. 2007;97(12):2151–9.CrossRefPubMed Yano EM, Simon BF, Lanto AB, Rubenstein LV. The evolution of changes in primary care delivery underlying the Veterans Health Administration’s quality transformation. Am J Public Health. 2007;97(12):2151–9.CrossRefPubMed
34.
go back to reference Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med. 2003;348(22):2218–27.CrossRefPubMed Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med. 2003;348(22):2218–27.CrossRefPubMed
35.
go back to reference Evans DC, Nichol WP, Perlin JB. Effect of the implementation of an enterprise-wide electronic health record on productivity in the Veterans Health Administration. Health Econ Pol Law. 2006;(1Pt 2):163–9.CrossRef Evans DC, Nichol WP, Perlin JB. Effect of the implementation of an enterprise-wide electronic health record on productivity in the Veterans Health Administration. Health Econ Pol Law. 2006;(1Pt 2):163–9.CrossRef
36.
go back to reference Bierman AS. Climbing out of our boxes: Advancing women’s health for the twenty-first century. Womens Health Issues. 2003;13(6):201–3.CrossRefPubMed Bierman AS. Climbing out of our boxes: Advancing women’s health for the twenty-first century. Womens Health Issues. 2003;13(6):201–3.CrossRefPubMed
37.
go back to reference Pinn VW. Sex and gender factors in medical studies: Implications for health and clinical practice. JAMA. 2003;289(4):397–400.CrossRefPubMed Pinn VW. Sex and gender factors in medical studies: Implications for health and clinical practice. JAMA. 2003;289(4):397–400.CrossRefPubMed
38.
go back to reference Perlin JB, Mather SH, Turner CL. Women in the military: New perspectives, new science. J Womens Health. 2005;14(9):861–2.CrossRef Perlin JB, Mather SH, Turner CL. Women in the military: New perspectives, new science. J Womens Health. 2005;14(9):861–2.CrossRef
39.
go back to reference Friedl KE. Biomedical research on health and performance of military women: Accomplishments of the Defense Women’s Health Research Program (DWHRP). J Womens Health. 2005;14(9):764–802.CrossRef Friedl KE. Biomedical research on health and performance of military women: Accomplishments of the Defense Women’s Health Research Program (DWHRP). J Womens Health. 2005;14(9):764–802.CrossRef
Metadata
Title
Integration of Women Veterans into VA Quality Improvement Research Efforts: What Researchers Need to Know
Authors
Elizabeth M. Yano, PhD, MSPH
Patricia Hayes, PhD
Steven Wright, PhD
Paula P. Schnurr, PhD
Linda Lipson, MA
Bevanne Bean-Mayberry, MD, MSHS
Donna L. Washington, MD, MPH
Publication date
01-01-2010
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue Special Issue 1/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-009-1116-4

Other articles of this Special Issue 1/2010

Journal of General Internal Medicine 1/2010 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.