title: Strategies for transforming reproductive healthcare delivery in an integrated healthcare system: a national model with system-wide implications.
abstract: OBJECTIVE
  As the number of women serving in the US military has grown, so too has the number of women using the US Department of Veterans Affairs Healthcare System (VA). This poses tremendous opportunity to integrate reproductive health services across a national healthcare system. This review summarizes the approaches used to assess, rapidly design, and integrate VA's first National Reproductive Health Program.
  
  
  RESULTS
  Compared with the civilian population, women Veterans have poorer health status including increased likelihood of medical comorbidities and mental health conditions. Given these complex health needs, a health systems approach that integrates reproductive health with other needs is essential in this vulnerable population.
  
  
  CONCLUSIONS
  Delivery of high-quality reproductive healthcare must incorporate a systems perspective. Promoting major organizational and cultural change in a national system has required use of an evidence-based strategic framework, which has relied on several key tenets including the following: understanding the population of women Veterans served, developing research-clinical partnerships, building interdisciplinary initiatives for system-wide integration of reproductive healthcare, and developing innovative tools for enhancing care delivery. This approach can serve as a model for other healthcare systems committed to developing an integrated system of reproductive healthcare and addressing reproductive health conditions in women with complex needs.
authors.affiliation: aReproductive Health, Women's Health Services, Office of Patient Care Services, US Department of Veterans Affairs, Washington, District of Columbia bDepartment of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, New York cVA Puget Sound Healthcare System dUniversity of Washington School of Public Health, Seattle, Washington eVA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System fHealth Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Zephyrin
authors.forename: Jodie G
authors.initials: JG
authors.lastname: Katon
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D019033:Delivery of Health Care, Integrated; D005260:Female; D018166:Health Care Reform; D006801:Humans; D033183:Interdisciplinary Communication; D009936:Organizational Innovation; D055818:Public-Private Sector Partnerships; D011787:Quality of Health Care; D034121:Reproductive Health Services / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D016387:Women's Health