Women Veterans Cohort Study 2

女性退伍军人队列研究(WVCS)的目的是确定独特的慢性 在伊拉克和阿富汗服役的女退伍军人的医疗风险和需求 冲突(OIF/OEF/OND)。在这些冲突中，妇女在军队中的总体代表性 服务增加到20%，超过50%的女性退伍军人参加了VHA护理 而在之前的时代，这一比例为11%。因此，有必要了解患者的独特医疗需求 女性退伍军人对未来的规划至关重要。在WVCS第1波的5年中，我们 创建，a)所有退伍军人管理局登记的OIF/OEF/OND退伍军人的电子数据库队列 冲突(N&GT；800,000)；以及b)已每年完成调查的潜在退伍军人队列 为期3年(N&GT；700)。到目前为止，我们发现，与男性相比，女性退伍军人 OEF/OIF/OND更有可能有肌肉骨骼和精神健康状况 (抑郁或适应障碍)，不太可能接受治疗 心血管危险因素。他们的门诊使用率和成本也更高 药房和门诊护理。进一步跟踪这些队列和补充数据 如果我们要了解独特的疾病轨迹和治疗需求，收集数据是必不可少的 如果我们要告知OIF/OEF/OND退伍军人的结构和交付 向女退伍军人提供医疗保健，以改变疾病和残疾的轨迹；以及 大幅减少VHA未来的医疗支出。拟议的为期4年的WVCS 2将 利用总体队列的两个WVCS 1组件纵向确定1) 预测因素，2)精神和心理社会调节因素，3)治疗模式，和4) 护理疼痛肌肉骨骼疾病、精神健康状况和心血管疾病风险的障碍 女性退伍军人独有的经历。我们的目标是1)确定疾病的类型 与男性相比，女性OEF/OIF/OND退伍军人的发病和进展，2)确定 女性疾病进展的独特的精神和心理社会调节因素 OIF/OEF/OND退伍军人，3)为女性OIF/OEF/OND退伍军人确定独特的护理模式， 以及4)确定为女退伍军人提供护理的障碍。主要研究内容 方法将包括：1)收集和分析现有和新可用的退伍军人管理局电子产品 健康记录和行政数据，2)扩大集水区的额外调查 (从洛杉矶和达勒姆新招聘)，以及3)来自4名妇女的焦点小组的业绩 以健康实践为基础的研究网络网站(西黑文、洛杉矶、达勒姆和北汉普顿 VAS)，以获得重要的定性数据。 意义重大。WVCS第2波将提供关键信息，帮助VHA 实现其提供公平、高质量、全面的医疗服务的目标 所有退伍军人管理局设施的敏感和安全的环境，以便VHA可以继续发挥其作为 在为女退伍军人提供保健方面处于全国领先地位，从而提高了标准 对各地妇女的关爱。

The purpose of the Women Veterans Cohort Study (WVCS) is to identify the unique chronic healthcare risks and needs of women Veterans who served during the Iraq and Afghanistan conflicts (OIF/OEF/OND). During these conflicts the overall representation of women in military service has increased to 20%, and over 50% of women Veterans have enrolled for VHA care compared to 11% in prior eras. Thus, the need to understand the unique healthcare needs of women veterans is essential for future planning. During the 5-years of WVCS Wave 1 we created, a) an electronic database cohort of all VHA enrolled Veterans of OIF/OEF/OND conflicts (N>800,000), and b) a prospective Veteran cohort that has completed surveys annually for 3 years (N>700). We have found so far that compared to men, women Veterans of OEF/OIF/OND are more likely to have musculoskeletal and mental health conditions (depression or adjustment disorders) and are less likely to receive management for cardiovascular risk factors. They also have higher rates of outpatient utilization and costs for pharmacy and outpatient care. Further tracking of these cohorts and complementary data collection is essential if we are to understand the unique disease trajectory and treatment needs of women OIF/OEF/OND veterans, and if we are to inform the structure and delivery of healthcare to women Veterans so as to alter the trajectory of disease and disability, and substantially reduce future healthcare expenditures by VHA. The proposed 4-year WVCS 2 will leverage the two WVCS 1 components of the overall cohort to identify longitudinally, the 1) predictors of, 2) psychiatric and psychosocial moderators of, 3) treatment patterns for, and 4) barriers to care for painful musculoskeletal conditions, mental health conditions, and CVD risk uniquely experienced by women Veterans. Our aims are to 1) determine the pattern of disease onset and progression among women OEF/OIF/OND Veterans compared to men, 2) determine the unique psychiatric and psychosocial moderators of disease progression for women OIF/OEF/OND Veterans, 3) determine unique care patterns for women OIF/OEF/OND veterans, and 4) determine the barriers to care that arise for women Veterans. The main research methods will include, 1) collection and analysis of existing and newly available VA electronic health record and administrative data, 2) additional surveys to an expanded catchment area (new recruitment from LA and Durham), and 3) performance of focus groups from 4 Women's Health Practice Based Research Network sites (West Haven, LA, Durham and Northhampton VAs) to obtain important qualitative data. Significance. The WVCS Wave 2 will provide critical information that will help the VHA to achieve its goal of providing equitable, high quality, comprehensive healthcare services in a sensitive and safe environment at all VA facilities, so that VHA may continue its role as a national leader in the provision of health care for women Veterans, thereby raising the standard of care for women everywhere.