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LISTEN: Kristin Mattocks details improvements in delivery of health care for veterans

Voices of UMassMed podcast features newly appointed associate dean for veterans affairs at UMMS

By Sarah Willey and Bryan Goodchild

UMass Medical School Communications

November 10, 2020

For the past 15 years of her career in medical research, Kristin Mattocks, MD, MPH, has been working to improve the quality of community care for all veterans, with a strong focus on women.

“Women sometimes don’t think of themselves as veterans and don’t think that they deserve that care,” said Dr. Mattocks, professor of population & quantitative health sciences and the newly appointed associate dean for veterans affairs, in a new Voices of UMassMed podcast. “I’ve really focused on understanding that process of care for women veterans, where they go to get care, the quality of that community care.”

Mattocks said delivery of health care for all veterans has improved, in part due to the COVID-19 pandemic.

“The number of telehealth appointments has just gone through the roof,” she said. “Something that really came out of the disaster of COVID has actually been this realization that, wow, maybe we don’t have to do care the way that we thought we had to do it. Maybe we can do more nonurgent telehealth appointments.”

Mattocks said the new VA community-based outpatient clinic being built on UMass Medical School’s Worcester campus will expand the school’s longstanding relationship with the VA, increase training programs for medical students and faculty, and most importantly, benefit the veterans who are currently receiving care from three different sites in the Worcester area.

“Veterans will be able to get primary care, mental health care, they’ll be able to get specialty care, and within probably another year or so they’ll be able to get some of the subspecialty services,” she said.

To listen to the full podcast, visit: umassmed.edu/news/voices. To be notified when a new episode is available, subscribe on SoundCloud or iTunes.

Edited highlights from the Voices of UMassMed podcast interview:

How did you get interested in veteran’s health?
I did my graduate work at Yale and when I graduated, I got an offer from the Veterans Affairs facility. When I started working at the VA, I didn’t really know much about veterans. In the past 15 years, I’ve grown a lot as a researcher and a policy person.

Can you talk about your expertise in the health among women veterans?
In graduate school, my focus was really on understanding disparities, disadvantaged populations or underserved populations. And it turns out that the VA has been the perfect opportunity to do that. Women veterans only comprise about 8 to 10 percent of the overall VA population. And so, you’re talking about a very, very small minority of patients that we have in the VA. When we first arrived, there were a lot of complaints from women veterans about not getting the care they needed in the VA. For example, when they would go to get a PAP smear, they would be working with residents or physicians who hadn’t done a pap smear in 15 or 20 years, because there just weren’t women in the VA. Over the course of 15 years, the VA has improved its delivery of care for women. We’ve done all kinds of things, from reconfiguring exam rooms so that exam tables don’t point to the door; the door is not open. We’ve done a lot to make sure that our primary care and women’s health providers are trained in women’s health, so people know how to do pap smears, breast exams and things like that.

My own research has focused on an even a smaller number of women veterans, which are those women who are who are pregnant, so if a woman veteran does get pregnant, she’s going to have to leave the VA and get obstetrical care in the community. The VA pays for it, but as you can see, it’s set up kind of different. I’ve really focused on understanding that process of care for women veterans, where they go to get care, the quality of that community care. Women veterans have histories of sometimes military sexual trauma, PTSD, combat-related injuries and things like that. Thinking about them as a population has been an opportunity for me to dig deep into understanding disparities and vulnerable populations.

You mentioned that 8 to 10 percent of the VA patient population comprises women. Is that because women comprise that percentage of our armed forces and veteran population, or are women disproportionately getting their health care outside the VA?
If you look across the board into the military, about 15 to 20 percent of new recruits are women, same with National Guard and Reserve. So there actually is a greater proportion of women in the military. But as you indicated, not all those women end up making it into the VA. Women sometimes don’t think of themselves as veterans and don’t think that they deserve that care. And so, part of our mission has also been making them feel welcome in the VA.

What do you hope to tackle in your new role as associate dean for veterans affairs at UMass Medical School?
There are so many exciting things. One of the best things is we are in the process of building a new community-based outpatient clinic right on the UMass Medical School campus. We have a couple of clinics in Worcester right now [that] will all be relocating into that new clinic. It provides an outstanding opportunity to further develop the relationships between UMass Medical School and VA.

What I hope to do is have more medical residents and fellows training there. I hope to increase research partnerships between VA and UMass Medical School. I hope eventually we can have more clinical relationships between UMass Medical School and VA. It’s going to open next August, so we’re looking forward to then.

How will having this brand new clinic benefit the veterans who will be receiving their care?
Numerous ways. Because we have three different sites of care in Worcester right now, it’ll be wonderful to consolidate those at one place. Veterans will be able to get primary care, mental health care, specialty care, and, within probably another year or so they’ll be able to get some of the subspecialty services. We have audiology, optometry, blind rehab, podiatry, so it’ll be a one-stop shop. The other thing is that veterans really like being able to see to see UMass Medical providers.

Can you describe what it was like for you when the final steel beam was raised and hoisted into place at the VA construction site?
First of all, it was just incredible to see the progress that had been made on the building and to be a part of the beam ceremony. It was incredible to be there on that day to have veterans, UMass Medical School veterans and folks sign the actual beam, and then to see it get hoisted all the way on top of the building. I don’t think there were many of us who didn’t have tears in our eyes.

Your career has really been consumed by research on improving health care for veterans, and coordination of care and equity of care. Can you explain how COVID has impacted the veteran community?
Back in March and April when this all started, we, just like all other health care facilities, shut doors to in-person visits unless they were extremely urgent. What has come out of that has been incredible, because like other health care systems, a healthy amount of our care became virtual. Interestingly, the VA was already good at doing virtual care. We had a number of years ago implemented being able to do a video appointment with your health care provider. The number of these telehealth appointments has just gone through the roof and I find in talking to patients and providers, that people like this mode, being able to stay at their homes and see their provider. Providers end up feeling like veterans end up getting greater access to care, because they don’t have to worry about travel times, and they can schedule more appointments. And so, something that really came out of the disaster of COVID has been this realization that, wow, maybe we don’t have to do care the way that we thought we had to do it. With COVID cases the way they are right now, I see this type of care continuing for some time.

How has your work pivoted during the COVID pandemic?
I did an interesting paper a couple of months ago on, again, pregnancy and, and how pregnant veterans care changed during COVID. Women very much lamented the fact that they didn’t have in-person prenatal care appointments anymore. The biggest hit for COVID among pregnant women is the severe limitation placed on who can be in the delivery room. Lots of people didn’t have anyone to visit them once the baby was born. I’ve been trying to keep my focus on understanding the longer-term impacts of COVID, not necessarily people who contract COVID, but how health care has changed and the way that we do things has changed.

As the new VA clinic opens at UMass Medical School, what are your hopes about the clinic and for improving care for veterans?
I think one of my biggest goals is to bring more veterans’ health issues into UMass Medical School. I’d love to have more training seminars. There is a veterans’ clerkship right now that’s a wonderful program, but to really expand that and to make more UMass Medical School researchers are aware of veterans issues, thereby [creating] more opportunities for collaboratio. I think that there’s so much potential for partnership between between VA and UMass Medical School. The possibilities are endless.