Cardiovascular Risk Screening and Risk Reduction in Women Vets

Background: Women Veterans are the fastest growing segment of Veterans Health Administration
(VHA) users. This dramatic growth has created challenges for VHA. 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. Furthermore,
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 VHA users in evidence-based, patient-centered care.

Objectives: The Enhancing Mental and Physical health of Women through Engagement and
Retention (EMPOWER) QUERI addresses VHA Blueprint for Excellence Strategy 6, by advancing
"personalized, proactive, patient-centered" care models, and Transformational Strategy 7.2.g
by implementation of innovative care models in women Veterans' health care." The EMPOWER
QUERI Program is designed to improve women Veterans' engagement and retention in
evidence-based care for three high priority health conditions, i.e., prediabetes,
cardiovascular, and mental health. To achieve this impact goal, we propose a cohesive
portfolio of projects with the following aims: (1) To use an evidence-based implementation
strategy that emphasizes local tailoring of care models, multilevel stakeholder engagement,
and systematic evaluation of complex implementation processes in order to enrich
organizational capacity for innovations in women Veterans' VHA health care; (2) To implement
personalized, proactive, patient-centered innovations in VHA women's health that are
acceptable, feasible, satisfactory, relevant, and effective for both providers and patients,
thereby encouraging women Veterans' engagement and retention and sustainability of the
innovations; and, (3) To generate implementation "playbooks" for our partners that are
scalable and serve as guidance for future implementation of a broader array of evidence-based
women's health programs and policy.

Methods: Three projects will be conducted by an experienced multidisciplinary team.
"Tailoring VA's Diabetes Prevention Program to Women Veterans' Needs" is a one-year QI
project to be conducted in VA Greater Los Angeles women's health clinics. Women Veterans with
prediabetes will select an in-person, peer-led or online gender-specific, evidence-based
diabetes prevention program to address their risk behaviors and health conditions.
"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 about CV risk, and provide a supportive, coordinated
health coaching intervention to facilitate women Veterans' engagement and retention in
appropriate health services. "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.
Both implementation research studies will use a modified stepped wedge design and will apply
the evidence-based Replicating Effective Programs (REP) implementation strategy. Mixed
methods implementation evaluations will focus on investigating primary implementation
outcomes of adoption, acceptability, feasibility, and reach. Multilevel stakeholder
engagement will be prioritized. Program-wide organizational-, provider-, and patient-level
measures and tools will be utilized to enhance synergy, productivity, and impact. As a
coherent program of women's health implementation research and quality improvement, the
proposed EMPOWER QUERI will constitute a major milestone in achieving BPE strategies and
realizing women Veterans' engagement and, ultimately, empowerment in our VHA system.