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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1050 — Women in VHA: Who Leaves and Who Stays?

Friedman SA, Women’s Health Evaluation Initiative, VA Palo Alto HSR&D Center of Excellence; Phibbs CS, Health Economics Resource Center, VA Palo Alto Healthcare System; Hamilton AWashington DL, and Yano E, VA Greater Los Angeles HSR&D Center of Excellence; Hayes PM, Women Veterans Health Strategic Health Care Group, VA Central Office; Haskell S, Women Veterans Health Strategic Health Care Group, VA Central Office; VA Connecticut Healthcare System; Frayne SM, Women’s Health Evaluation Initiative, VA Palo Alto HSR&D Center of Excellence;

Nationally, 30% of women Veterans new to VHA do not return within 3 years. In a research/operations partnership, we investigated whether attrition is higher among new women patients, controlling for other factors, and explored factors contributing to their attrition.

Data came from ADUSH Enrollment files and VHA utilization databases. We examined predictors of attrition (alive but did not return for VHA outpatient care in 2nd-3rd years after first FY06 visit) using two logistic regression models: Model 1 tests whether, among women Veterans with an FY06 face-to-face visit, new users (no outpatient services in three years before first FY06 visit) are as likely to leave VHA as return users, controlling for age, service-connected status, receipt of fee-basis care, receipt of inpatient care, and outpatient utilization, and allowing for non-linearity in age and visit counts. Model 2 tests whether, among the subset of women new to VHA, these control variables predict attrition. Only adjusted odds ratios (AORs) significant at p < .05 are reported.

Of the full cohort (n = 232,491), 11% had attrition. New women were more likely than returning women to leave VHA (30% vs. 8%; AOR: 2.8). Among the 13% who were new, odds of attrition were lower in those 45+ years old (versus 18-44 year olds) (45-64 AOR: 0.72; 65+ AOR: 0.88), and in those with service-connected status (AOR: 0.92), fee-basis use (AOR: 0.84), or any primary care visit (AOR: 0.65), and higher in those with inpatient use (AOR: 1.26). Also in new users, frequent use in their first year of care was associated with especially low attrition (9+ visits [versus 1 visit] AOR: 0.10).

Attrition is higher in new women patients, even after controlling for other factors. Among new women, odds of attrition vary by age: those older than 45 years were most likely to stay, even among Medicare eligible women. Attrition was lower in new women who used primary care.

To reduce the loss of new women patients, strategies may include age-relevant services for the youngest new VHA patients, and continued aggressive efforts to assure access to primary care for patients entering the system.

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