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Health Services Research & Development

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CREATE: Women Veterans Healthcare

Director: Elizabeth Yano, Ph.D., M.S.P.H.

Principal Investigators:

About the CREATE

Women Veterans are now among the fastest growing segment of new VA users. Since 2000, the number of women Veterans using VA healthcare has doubled. By 2018, 10% of all VA healthcare users will be women. This rapidly changing demographic has hastened the need for VA to better address a wide spectrum of services unique to women Veterans' complex health care needs, while ensuring access and coordination across different types of VA healthcare facilities.

This CREATE initiative will conduct research to examine the essential factors that facilitate (or slow) the pace, effectiveness and outcomes of delivery of comprehensive care for women Veterans within the VA healthcare system. Specifically, the program's goals are to:

  • Examine patient, provider and organizational barriers and facilitators to implementing comprehensive care delivery for women Veterans;
  • Assess the underlying factors associated with delivery of comprehensive care for women Veterans, and those factors' implications for the quality and experience of care women Veterans receive in VA; and,
  • Evaluate the effectiveness and impact of alternate models of delivering comprehensive care to women Veterans.

Partner Offices

Each CREATE works closely with operational partners throughout the VA System. Partners for the Women Veterans' Healthcare CREATE include:

Individual projects also include partners from:

See also:A Partnered Research Initiative to Accelerate Implementation ofComprehensive Carefor Women Veterans: The VA Women's Health CREATE


This CREATE initiative includes five funded projects:

  • Lost to Care: Attrition of Women Veterans New to VHA
    This study will examine patient, provider and organizational factors that influence why women Veterans leave VA care. The project also will explore the degree to which gender-sensitive comprehensive care is driving experience and behavior. The project will build on recent data from the Women Veterans Health Strategic Healthcare Group-funded Women's Health Evaluation Initiative that demonstrated lower-than-expected retention of women Veterans in VA care. It is expected that study results will inform efforts to sustain women Veterans' enrollment in, and continued use of VA healthcare.
    (PIs: Susan Frayne, M.D., M.P.H., and Alison Hamilton, Ph.D.)
  • Impacts of Comprehensive Women's Healthcare Delivery in the VA
    This project aims to measure national levels of comprehensive care implementation in VA medical centers and community-based outpatient clinics, and will examine the impact of structure and process variations on quality of care. The project builds on more than a decade of research on how VA healthcare is organized for women Veterans. Moreover, the project aims to improve upon validated methods, contribute significantly to theory, and integrate specific measures that will provide actionable data on determinants of successful implementation of women Veterans' care.
    (PI: Elizabeth Yano, Ph.D., M.S.P.H.)
  • Implementation of VA Women's Health Patient Aligned Care Teams (WH-PACTs)
    This study seeks to test evidence-based quality improvement approaches to adapting PACT features to women Veterans' needs, while evaluating barriers and facilitators to comprehensive women's health care delivery. It is expected that project results will help accelerate implementation of WH-PACT models, and will inform strategies for their spread and sustainability as agencies tackle similar issues within and outside of VA.
    (PI: Elizabeth Yano, Ph.D., M.S.P.H.)
  • Controlled Trial of Tele-Support and Education for Women's Healthcare in CBOCs
    This project targets comprehensive care for women Veterans at community-based outpatient clinics (CBOCs), where primary care providers often have limited access to specialists in women's health issues. While VA initiatives in specialty care access are underway, this project is the first to examine the effectiveness of using technology to provide virtual education, consultation, and ongoing communication with women's health specialists to support primary care providers. Project results should have implications for comparable models of specialty access for other populations, such as the elderly or OEF/OIF Veterans.
    (PI: Donna Washington, M.D., M.P.H.)
  • Evaluation of Quality and Coordination of Outsourced Care for Women Veterans
    This project seeks to evaluate the quality and coordination of care that VA outsources to community providers, using mammography as a case study. This study will explore new ground and is a top priority to VA purchasers of care. Results will show how well achievement of comprehensive care through arrangements with providers outside the VA is working, and will point to opportunities for improvement as needed. The study should also be useful for informing VA quality monitoring in the area of mammography for women Veterans.
    (PIs: Lori Bastian, M.D., M.P.H., and Kristin Mattocks, Ph.D.)

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