Increasing Access to Preventive Telehealth Services for Women Veterans

Summary

Women Veterans are the fastest-growing segment of users in the Veterans Health Administration (VA).¹  The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored;^2,3 yet gender differences continue in cardiovascular and diabetes risk factor control.^4,5 Depression is also more common among women Veterans than civilian women before and after giving birth,⁶ which is especially concerning given the link between depression and suicide.⁷ Distance from the VA, living in a rural area, and other challenges, such as negative opinions of VA care, mental health issues, discrimination based on sexual and/or gender minority identities, and harassment on VA grounds, can also keep women from regularly using VA care.

Begun in 2015, the Enhancing Mental and Physical Health of Women through Engagement and Retention Quality Enhancement Research Initiative (EMPOWER QUERI) has focused on gender-tailored care for women Veterans at the VA.⁸ Based out of the VA Greater Los Angeles Healthcare System, early EMPOWER studies found that women prefer gender-specific (women only) care and telehealth care delivered by phone, video call, or online.⁹ The new EMPOWER 2.0 program builds on that work by expanding access to telehealth, evidence-based, preventive lifestyle and mental health services for women Veterans in rural and urban-isolation areas.

EMPOWER 2.0 will work with up to 800 women Veterans across 20 VA facilities throughout the U.S. to implement three evidence-based practices:

1. Virtual Diabetes Prevention Program (DPP), a lifestyle intervention shown to prevent and/or delay progression to type 2 diabetes;¹⁰
2. Telephone Lifestyle Coaching Program (TLC), which provides telehealth, individual-level, personalized health coaching focused on wellness and cardiovascular disease prevention;¹¹ and
3. Reach Out, stay Strong, Essentials (ROSE),an intervention to prevent perinatal depression that can be delivered via telehealth.¹²

Significance

EMPOWER 2.0 will improve women Veterans’ access to telehealth preventive lifestyle and mental health services.  Increasing access to preventive care could reduce disparities in cardiovascular disease, diabetes, and depression experienced by women Veterans.^4–6 The project will also benefit the VA and other large healthcare systems, and the field of implementation science more broadly, by comparing different ways of helping sites offer the evidence-based practices. For example, the project will explore using different strategies for training providers and organizing women’s healthcare. This effort will provide valuable information on what kind of strategies work better for helping sites to achieve results quickly and at lower cost. Study findings will be used to generate “implementation playbooks,” or brief guidebooks for how to implement new evidence-based practices, to help program partners in encouraging spread of these practices across VA. Rural communities often lack access to preventive care,¹³ and by focusing on rural women Veterans, this project could also offer lessons for improving rural healthcare delivery.

The ultimate goal of EMPOWER 2.0 is improved VA telehealth care delivery and clinical health outcomes for women Veterans.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

EMPOWER 2.0 will increase access to preventive telehealth services for women Veterans, including those in rural and urban-isolation areas. potential.

Community

Health care accessibility

The EMPOWER 2.0 team is testing different training and support strategies to ensure VA women’s telehealth rollouts are successful. potential.

Community

Health care delivery

The EMPOWER 2.0 will work with VA sites to increase preventive telehealth care options for cardiovascular disease, diabetes, and depression among women Veterans at risk for health disparities. potential.

Community

Disease prevention & reduction

The EMPOWER 2.0 team will develop research reports and implementation playbooks on comparative effectiveness and cost of different strategies for implementation of telehealth care services in the VA. potential.

Policy

Scientific research reports

EMPOWER 2.0 reports will support VA program offices in developing evidence-based policies for future rollouts. potential.

Policy

Policies

This research has community and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.

Community

Historically, women Veterans have faced challenges in accessing VA care, often related to living far from VA care facilities or having negative experiences with and/or perceptions of VA care. Many women Veterans are also at risk for health disparities related to rurality, race/ethnicity, mental health concerns, and sexual and/or gender minority identities. EMPOWER 2.0 will work with VA sites to increase preventive telehealth options for women – including services like health coaching across life stages and education during pregnancy — increasing women’s ability to access care services in a way that is safe, convenient, and appropriate for them. Improving access to these tailored preventive services has the potential to improve health outcomes for women Veterans, including cardiovascular disease, diabetes, and depression.

Policy

VA provides a national, integrated healthcare system for Veterans. To ensure care services are both high quality and accessible, the VA faces the challenge of continuous quality monitoring and improvement that often requires rolling out new programs across hundreds of sites nationally to better meet Veterans’ needs. Because these rollouts can take time and resources, the EMPOWER 2.0 team is testing different training and support strategies for making sure the rollouts are successful.  The information on what strategies work best, and the comparative cost and return-on-investment of different strategies, will be used to develop research reports and guidance for VA national program offices.  These reports, in turn, will support program offices in making evidence-based policy decisions as they engage in planning for future rollouts.