QUERI – Quality Enhancement Research Initiative

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The Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER)

Los Angeles, CA

Principal Investigators: Alison Hamilton, PhD (Corresponding PI, VA Los Angeles), Bevanne Bean-Mayberry, MD (VA Los Angeles), Tannaz Moin, MD (VA Los Angeles)

Principal Operational Partners: Women' Health Services, Health Promotion and Disease Prevention (NCP), Mental Health Services, Primary Care-Mental Health Integration, Patient Centered Care and Cultural Transformation (OPCC&CT).

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Executive Summary:

Women Veterans are the fastest growing segment of VA healthcare users, but this dramatic growth has created challenges. Gender disparities persist in cardiovascular (CV) and diabetes risk-factor control, and rates of depression, anxiety, and mental health comorbidity are disproportionately high among women Veterans. Moreover, a high rate of women Veterans' attrition from VA care, along with organizational barriers to care, substantiate that organizational changes are needed in order to engage and retain women Veteran VA users in evidence-based, patient-centered care.

Program MyVA Goals: Improving care experiences for women Veterans. The MyVA initiative will reorient VA around Veterans' needs and empower employees to assist them in delivering excellent customer service to improve their experience with VA healthcare.

Program Objectives:

EMPOWER QUERI is designed to improve women Veterans' engagement and retention in evidence-based care for three high-priority health conditions through the following aims:

  • Apply an evidence-based implementation strategy that emphasizes local tailoring of care models, multi-level stakeholder engagement, and systematic evaluation of complex implementation processes in order to enrich organizational capacity for innovations in VA health care for women Veterans.
  • Implement personalized, proactive, patient-centered innovations in VA women' healthcare that are acceptable, feasible, satisfactory, relevant, and effective for providers and patients, thereby encouraging women' engagement, retention and sustainability of the innovations.
  • Generate implementation"playbooks" for program partners that are scalable and that serve as guidance for future implementation of a broader array of evidence-based women' health programs and policy.

Program Methods:

Three projects will be conducted by an experienced multi-disciplinary team. The implementation research studies will use a modified stepped-wedge design across four sites per study, and will apply the evidence-based Replicating Effective Programs (REP) implementation strategy.

Project Summaries:

1."Tailoring VA' Diabetes Prevention Program to Women Veterans' Needs" is a one-year quality improvement project to be conducted in VA Greater Los Angeles women' health clinics. Women Veterans with pre-diabetes will select an in-person, peer-led or online gender-specific, evidence-based diabetes prevention program (DPP) to promote healthy lifestyle changes - and lower their risk of incident diabetes.

2."Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans" will increase identification of CV risk among women Veterans, enhance patient/provider communication and shared decision-making.

3."Implementation of Tailored Collaborative Care for Women Veterans" will evaluate implementation of an evidence-based collaborative care model tailored to enhance provider- and system-level capabilities to address women Veterans' anxiety and depression treatment needs, thereby improving organizational primary care-mental health integration (PC-MHI) effectiveness, and women Veterans' engagement and retention in PC-MHI.