» Table of Contents

HSR and QUERI Centers Committed to Improving Care for Women Veterans

Women Veterans make up a growing proportion of Veterans. It's estimated that by 2040, 18% of the Veteran population will consist of women.^[1] To help enhance the quality, delivery, and experience of healthcare for women Veterans, HSR and QUERI fund several centers — including HSR’s Women’s Health Research Network, QUERI’s EMPOWER Center, Function QUERI Center, and QUERI’s LEARN Evidence-based Policy Evaluation Center — that are partnering with the Office of Women’s Health and other national program offices to scale-up, spread, and sustain effective programs, practices, and policies for women Veterans.

The Women’s Health Research Network

The Women’s Health Research Network (WHRN) strives to systematically transform VA’s capacity to examine and reduce gender disparities in health and healthcare, and to support the delivery of evidence-based care tailored to women Veterans’ needs. WHRN provides knowledge and resources related to women’s health and works with VA partners, including the Office of Women’s Health, the Office of Mental Health, the Office of Suicide Prevention, and the NIH Office of Research in Women’s Health.

WHRN’s Women’s Health Practice-Based Research Network (WH-PBRN) and The Multilevel Stakeholder Engagement Team seek to address priorities that include:

• Primary care and prevention
• Reproductive health
• Mental health
• Post-deployment health (including military exposures)
• Access and rural health
• Care for complex chronic conditions
• Long-term care needs of older women Veterans

WHRN also promotes diversity, equity, and inclusion to enhance the care and health of women Veterans and has promoted Veteran engagement by establishing the Women’s Improvement Network, a national group of women Veterans interested in supporting and advancing VA women’s health research.

WHRN has increasingly been tapped to support VA’s response to women’s health legislation and other evidence needs. Examples include:

• As VA’s Center for Women Veterans oversaw VA’s response to the Sampson Act on Veteran-related Intimate Partner Violence (IPV), WHRN helped coordinate VA’s review of Veteran-related IPV literature and the required prevalence study and oversaw a national expert panel to come to consensus on evidence-based recommendations.

• WHRN organized a comprehensive briefing on VA military sexual trauma research for the Department of Defense. The results were incorporated in the recommendations of the Independent Commission on Sexual Assault in the Military and later published in a VA supplement in the Journal of General Internal Medicine.

Enhancing Mental and Physical Health of Women Through Engagement and Retention (EMPOWER) QUERI

The Enhancing Mental and Physical Health of Women Through Engagement and Retention (EMPOWER) 2.0 QUERI Program works with national partners such as the Office of Women’s Health, the Office of Rural Health, the Office of Mental Health, and the Office of Patient-Centered Care & Cultural Transformation to expand access to virtual, evidence-based, preventive services for women Veterans with high-priority health conditions by implementing three practices across VA:

• The Virtual Diabetes Prevention Program (DPP) provides virtual, group-based, lifestyle intervention that emphasizes moderate weight loss, diet, and physical activity to prevent type 2 diabetes.
• Reach Out, Stay Strong, Essentials (ROSE) provides group-based or individual psychoeducation to improve communication and build social support to prevent post-partum depression.
• Telephone Lifestyle Coaching (TLC) provides virtual, personalized health coaching focused on wellness and cardiovascular disease prevention.

To support national implementation and sustainment of these practices, EMPOWER 2.0 is comparing the effectiveness of two implementation strategies — Replicating Effective Programs (REP) and Evidence-Based Quality Improvement (EBQI) — on access, engagement rates, and clinical outcomes for women Veterans; rate of progress toward implementation; adaptation and experiences of the practice implementation among multilevel stakeholders; and cost and return on investment.

To date, EMPOWER 2.0 has implemented at least one of the three practices across 22 VA sites nationwide, providing training for more than 452 providers and enrolling more than 740 women Veterans in virtual preventive care services. EMPOWER has also collaborated in developing a VA-adapted version of the Stages of Implementation Completion® (SIC) tool to evaluate implementation fidelity and progress over time. In preliminary analysis of TLC implementation in four sites, EMPOWER-SIC was successful in distinguishing between REP and EBQI sites while assessing fidelity to pre-implementation activities (100% in all sites). Three sites (2 REP and 1 EBQI) achieved full implementation during the study period. The mean time to full implementation was 191 days (with a range of 138–266).

To support scale-up, spread, and sustainment of EMPOWER practices and other women’s health programs and policies, EMPOWER is also working with sites to support ongoing quality improvement and sustainment planning efforts and creating implementation playbooks for program partners.

Function QUERI Child Care Assistance Evaluation

In 2020, Congress passed legislation establishing the Veterans Child Care Assistance Program (VCAP), designed to support Veterans receiving care through VA by providing child care services by 2026. The program seeks to create on-site drop-in child care centers at VA facilities and implement a reimbursement system for external child care services. To assess the need and potential impact of these services, VCAP partnered with QUERI to conduct rapid evaluations.

Led by Megan Shepherd-Banigan, PhD, MPH, the Function QUERI Rapid Response Team (RRT) completed two key projects to support VCAP’s efforts. The first assessed the child care needs of Veterans with young children and how inadequate child care affects their healthcare engagement. The second project explored how the presence of children during healthcare visits affects the care experience for both providers and Veterans, offering valuable insights from the providers’ perspective.

Key findings from these projects suggest that Veterans using VA services face a high need for child care, and lack of it is a significant barrier to accessing care. Over 75% of Veterans surveyed reported that they required child care assistance during healthcare appointments, yet 73% reported barriers to finding child care. Lack of child care led to missed visits for nearly two-thirds of Veterans in the sample. VA providers also described how lack of child care impedes Veteran access to care, leading to missed and canceled visits. The presence of children in health clinics also inhibits patient/provider communication and impedes clinic workflow. VCAP has the potential to address this unmet need, improving access and quality of care for Veterans.

These QUERI evaluations have provided vital data to the VCAP team to inform the design of the drop-in child care centers as well as the Veteran reimbursement system, and they encourage facilities to adopt on-site child care. Findings from both evaluations have also been presented to Congress to show the importance of VCAP and the impact it will have on Veterans’ healthcare access and overall well-being. Through this program, VA will become the largest healthcare system in the United States to offer child care assistance.

For more information about FUNCTION QUERI, please contact Caitlin Kappler (Caitlin.Kappler@va.gov).

For more information on EMPOWER QUERI or to partner with them, please contact Alison Hamilton (alison.hamilton@va.gov), Bevanne Bean-Mayberry (bevanne.bean-mayberry@va.gov), Melissa Farmer (melissa.farmercoste@va.gov), or Tannaz Moin (tannaz.moin@va.gov).

LEARN’s Evaluation of Women’s Health Innovations and Staffing Enhancements (WHISE) Initiative

Since 2022, QUERI has supported the Leading Evaluations to Advance VA’s Response to National Priorities (LEARN) Center, one of QUERI’s six Evidence-based Policy Evaluation Centers that respond to evaluation priorities of senior VA leadership and other U.S. executive and legislative leaders in compliance with the Evidence Act. From the beginning, LEARN has supported VA’s Office of Women’s Health (OWH) to inform the Women’s Health Innovations and Staffing Enhancements (WHISE) Initiative. With an annual budget of $210 million, WHISE aims to fill gaps in women Veterans’ healthcare across the VA enterprise by providing funding for personnel, equipment, training, and programs to support women Veterans’ health across primary care, mental health, gynecology, and other gender-tailored specialty care.

LEARN has used a variety of qualitative and quantitative methods to understand how well WHISE is working to improve access and quality of VA healthcare for women Veterans. LEARN has helped OWH understand how different VA healthcare facilities have used the funding (e.g., what kinds of positions did they hire?), how this has improved access to important services (e.g., how many more women received pelvic floor physical therapy?), and what can be done to improve the administration of the initiative and ensure that the improvements made under it are sustained after the funding ends. LEARN has provided OWH and other VA leaders with rolling updates on findings as they are available, supporting continual improvements in WHISE.

For more information about LEARN or the WHISE evaluation, please contact Kristina Cordasco (Kristina.Cordasco@va.gov).

^[1] Women's Health Research (va.gov)