Collaborative Care for Women Veterans

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, the investigators 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 the investigators'
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. This
trial pertains to "Implementation of Tailored Collaborative Care for Women Veterans," which
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.
This implementation research study will use a nonrandomized stepped wedge design and will
apply the evidence-based Replicating Effective Programs (REP) implementation strategy. Mixed
methods implementation evaluation 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 Blueprint for
Excellence (BPE) strategies and realizing women Veterans' engagement and, ultimately,
empowerment in the VHA system.

Inclusion Criteria:

- Women VA patients with possible or confirmed anxiety and/or depression and/or PTSD

Exclusion Criteria:

- Male gender

- Cognitive impairment that would preclude completion of informed consent