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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;

Objectives:
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.

Methods:
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.

Results:
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).

Implications:
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.

Impacts:
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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