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Health Services Research & Development

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HSR&D In Progress

March 2017

In this Issue: VA Healthcare for Women Veterans
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Attrition of Women Veterans New to VA

Feature Article

Among women new to VA healthcare in 2006, our earlier work showed that 30% did not return in the subsequent two years. This rate of attrition was of major concern, especially with women continuing to be the fastest growing segment of new VA patients, and with access to high-quality, comprehensive women's health (WH) care among the top VA priorities. Therefore, this ongoing, mixed-methods study of women Veterans new to VA healthcare aims to:

  • Identify predictors of attrition (i.e., patient experiences with VA care, VA organizational factors, community healthcare resources, and patient factors);
  • Determine whether patterns of attrition are changing over time;
  • Understand perspectives of women Veterans: what factors led them to leave or to stay; and
  • Explore plans for future VA use among new women Veteran patients currently using VA.

Early findings show that among women Veterans who used VA outpatient care in FY2009, those who lived farther from a VA facility were more likely to leave VA care, as were younger women, women with lower service-connected disability or with fewer medical conditions, and women who used VA less frequently. New women patients had nearly four-fold higher odds of leaving VA than established women patients. Preliminary analyses examining women Veteran primary care patients who were new to VHA in FY2011 revealed that those who saw a Designated Women's Health Primary Care Provider had lower odds of leaving VA than did women who saw other primary care providers.

Impact: By examining patient experiences of VA care and assessing patient and facility characteristics that contribute to attrition, results from this study will identify potential subgroups at risk of attrition and targets for intervention at practice and policy levels. As VA seeks to make its services welcoming and accessible to women Veterans and sensitive to their health care needs, those lost to the system represent a group requiring special targeting. Their experiences may provide clues about how to optimize women's healthcare in VA settings, such as by ensuring that women have access to Designated Women's Health Primary Care Providers.

Principal Investigators: Susan Frayne, MD, MPH, is part of HSR&D's Center for Innovation to Implementation (Ci2i): Fostering High-Value Care in Palo Alto, CA, and Alison Hamilton, PhD, MPH, is part of HSR&D's Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP); both are Principal Investigators for the Women Veterans Healthcare CREATE .

Friedman S, Frayne S, Berg E, et al. Travel time and attrition from VHA care among women Veterans: How far is too far? Medical Care. April 1, 2015;53(4 Suppl 1):S15-22.

Attrition of Women Veterans New to VA project abstract

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