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Article Title

Expanding the VA Women’s Health Practice-Based Research Network: Increasing Capacity for Equitable Representation of Women in VA Research

Publication Date

8-10-2017

Keywords

human subjects research, organizations, program evaluation, health care workforce, VA health system, gender/sex differences in health and health care, evaluation research, HCSRN structure and operations, dissemination and implementation of innovations

Abstract

Background: The Veterans Affairs (VA) Women’s Health Practice-Based Research Network (WH-PBRN) facilitates multisite women’s health research through a network of partnered VA facilities and fosters bidirectional partnership of clinicians and researchers striving to improve the health and health care of women veterans. Initial WH-PBRN development was informed by pilot studies conducted at four inaugural sites. The WH-PBRN then expanded to 37 VA sites in 2012. To further grow into a more diverse network, a call for site applications went out March 2015; WH-PBRN expanded to 60 sites in June 2015. As a program evaluation activity, we examined representativeness of WH-PBRN sites (relative to VA sites nationally) before and after expansion.

Methods: WH-PBRN site applications included questions about facility characteristics, including items indicating level of local research support such as presence of an affiliated Health Services Research and Development (HSR&D) center at the facility. We coupled those data with aggregated, site-level, national VA administrative data from fiscal year 2014 describing characteristics of women veteran patients using each site.

Results: From pre- to post-expansion, the network grew from 37 sites, representing 146,706 women veteran outpatients, to 60 sites, representing more than half of all WV outpatients (220,465 of 391,062 women veterans nationally). Expansion successfully increased representation of diverse populations. For example, across sites, number of women veterans from a racial/ethnic minority group increased from 38% pre to 40% post. Member sites together are fairly representative of Veterans Health Administration (VHA) as a whole; for example, 43% of women veterans at the 60 WH-PBRN sites have age < 45 years (vs 42% VA-wide), 22% (vs 26%) have a rural residence, 84% (vs 91%) used primary care, and 39% (vs 41%) used mental health services. The main difference is that 35% have an HSR&D center (vs 16% VA-wide). Number of Veterans Integrated Service Networks represented increased from 17 pre to 20 post, increasing geographic heterogeneity.

Conclusion: WH-PBRN represents a large and geographically diverse nationwide network of 60 VA sites. Expansion increased the number and diversity of women veterans represented in the network. Across facilities, most women use primary care services, suggesting VHA primary care settings are an excellent venue for recruitment. Similarly, a large proportion receives mental health care: this is important since women’s mental health care remains a major focus of VHA research. The expanded WH-PBRN provides greater opportunity to increase equitable representation of women veterans in VA research, and to conduct health services research that examines diverse health care delivery systems.

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