SINCE THE REVOLUTIONARY WAR, AMERICA’S WOMEN HAVE EARNED AMERICA’S GRATITUDE AND RESPECT FOR THEIR CONTRIBUTIONS TO THE MILITARY AND TO THE NATION. VA WILL CONTINUE TO IMPROVE OUR BENEFITS AND SERVICES FOR WOMEN VETERANS AS WE TRANSFORM INTO A 21ST CENTURY ORGANIZATION. Secretary of Veterans Affairs Eric K. Shinseki March 10, 2010 Sourcebook: Women Veterans in the Veterans Health Administration Volume 3: Sociodemographics, Utilization, Costs of Care, and Health Profile Prepared for: Women’s Health Services Office of Patient Care Services, Veterans Health Administration Department of Veterans Affairs 810 Vermont Ave., NW Washington, DC 20420 Prepared by: Women’s Health Evaluation Initiative (WHEI) VA HSR&D Center for Innovation to Implementation (Ci2i) VA Palo Alto Health Care System 3801 Miranda Ave. (152-MPD) Palo Alto, CA 94304 Susan M. Frayne, MD, MPH, WHEI Director Ciaran S. Phibbs, PhD, WHEI Associate Director Fay Saechao, MPH, Project Manager and Lead Technical Writer Natalya C. Maisel, PhD, Technical Writer Sarah A. Friedman, MSPH, Technical Writer Andrea Finlay, PhD, Technical Writer Eric Berg, MS, Senior Data Analyst Vidhya Balasubramanian, MS, Data Analyst Sharon K. Dally, MS, Data Analyst/Technical Writer Lakshmi Ananth, MS, Data Analyst Yasmin Romodan, MPH, Program Evaluation Assistant Jimmy Lee, MS, Program Evaluation Assistant Samina Iqbal, MD, Senior Clinical Consultant Women’s Health Services Patricia M. Hayes, PhD, Chief Consultant Sally Haskell, MD, Deputy Chief Consultant for Clinical Operations and Director of Comprehensive Women’s Health Laurie Zephyrin, MD, MPH, MBA, FACOG, Director, Reproductive Health Alison Whitehead, MPH, Management Analyst Anupama Torgal, MPH, Management Analyst Jodie G. Katon, MS, PhD, Consultant, Reproductive Health Recommended citation: Frayne SM, Phibbs CS, Saechao F, Maisel NC, Friedman SA, Finlay A, Berg E, Balasubramanian V, Dally SK, Ananth L, Romodan Y, Lee J, Iqbal S, Hayes PM, Zephyrin L, Whitehead A, Torgal A, Katon JG, Haskell S. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 3. Sociodemographics, Utilization, Costs of Care, and Health Profile. Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs, Washington DC. February 2014. Acknowledgements: We express appreciation to our reviewers, who made substantive contributions to this Sourcebook: Rachel Kimerling, PhD, Kristin Mattocks, PhD, Joanne Pavao, MPH, Susan Schmitt, PhD, Jonathan Shaw, MD, MS, Elizabeth Tarlov, PhD, RN, Donna Washington, MD, MPH, Jean Yoon, PhD, MHS, and Donna Zulman, MD, MS. We also gratefully acknowledge important contributions to development of medical conditions by other members of the Women’s Health Services’ Cardiovascular Health Workgroup, including Melinda Davis, MD and Claire Duvernoy, MD, and other members of the Women’s Health Services’ Reproductive Health Workgroup, including Katherine Hoggatt, PhD, MPH, Amanda Johnson, MD, and Kristin Mattocks, PhD. We are grateful to other contributors who helped in the development of this Sourcebook including Xiaoyu Bi, PhD, Maggie Czarnogorski, MD, Eva Durazo, MPH, Melissa Lanzendorfer, RN, BSN, MBA, and Alyssa Pomernacki, MPH. Finally, the WHEI team profit- ed greatly in the development of this report from the support of the VA HSR&D Center for Innovation to Implementation (Ci2i), the Health Economics Resource Center (HERC), and the Women’s Health Section of the Medical Service at VA Palo Alto Health Care System. Our deepest gratitude goes to the women Veterans who have served our country across the generations. This report is based on program evaluation analyses conducted by the Women’s Health Evaluation Initiative at the VA Palo Alto Health Care System in Palo Alto, California. This work was funded by Wom- en’s Health Services, Veterans Health Administration, Department of Veterans Affairs. The findings and conclusions in this document are those of the authors who are responsible for its contents, and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this document should be construed as an official position of the Department of Veterans Affairs. Sourcebook Vol. 3 Table of Contents Executive Summary .............................................................................................................................1 Key Findings ............................................................................................................................................. 3 Key Implications for Policy and Practice ................................................................................................. 7 Sociodemographics .......................................................................................................................... 7 Utilization ......................................................................................................................................... 9 Cost ............................................................................................................................................... 12 Health Profile ................................................................................................................................. 12 Introduction .................................................................................................................................... 17 Background ............................................................................................................................................ 17 Methods ................................................................................................................................................ 19 Part 1. Sociodemographics .............................................................................................................. 21 Cohort Size ............................................................................................................................................ 21 Age ....................................................................................................................................................... 22 Race/Ethnicity ....................................................................................................................................... 25 Urban/Rural Status ................................................................................................................................ 27 Service-Connected Disability Rating Status ........................................................................................... 28 OEF/OIF/OND Status ............................................................................................................................. 31 Part 2. Total Utilization: VHA or Non-VA (Fee) Medical Care, Combined, FY12 .............................. 39 Overview of Parts 2, 3, and 4 ................................................................................................................. 39 Total Outpatient Care ............................................................................................................................ 42 Part 3. VHA Utilization, FY12 ........................................................................................................... 45 VHA Outpatient Care ............................................................................................................................. 45 Primary Care ................................................................................................................................. 47 Gynecology Care ........................................................................................................................... 58 Mental Health/Substance Use Disorder (SUD) Care ..................................................................... 59 Telephone and Telehealth Care ..................................................................................................... 66 Part 4. Non-VA (Fee) Medical Care Utilization, FY12 ....................................................................... 69 Non-VA (Fee) Medical Care Outpatient Care......................................................................................... 69 Mammography Services through the Non-VA (Fee) Medical Care System ................................... 77 Part 5. Cost of Care, FY12 ................................................................................................................ 83 Total Cost................................................................................................................................................ 84 VHA Outpatient Cost ...................................................................................................................... 85 VHA Inpatient Cost......................................................................................................................... 86 Non-VA (Fee) Medical Care Cost .................................................................................................... 87 i Sourcebook Vol. 3 Part 6. Health Profile - Overview..................................................................................................... 89 Overview of Parts 6, 7 and 8 .................................................................................................................. 89 Domain Frequencies Among Women Veteran Patients ........................................................................