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2015 HSR&D/QUERI National Conference Abstract

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3027 — Turning 65: A Tipping Point in Women Veterans' Use of VA Primary Care

Bi X, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto CA; Stanford University School of Medicine; Phibbs CS, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto CA; Stanford University School of Medicine; Saechao FS, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto CA; Finlay AK, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto CA; Maisel NC, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto CA; Hamilton AB, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles HCS;University of California Los Angeles; Frayne SM, VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto CA; Stanford University School of Medicine;

Objectives:
Little is known about the impact of becoming Medicare eligible (at age 65) upon veterans' decisions to continue using Veterans Health Administration (VHA) primary care (PC) over time. We examined how annual VHA PC use changed among women veterans from age 60 to 70. We hypothesized that the VHA PC use would increase with age until 65, then decline with age.

Methods:
Using VHA outpatient data, we identified 4,930 women veterans nationally who were enrolled in VHA care by 60, actively used VHA PC services before 65 (at least 2 PC visits within the 5 years before 65, at least one of which was within the 2 years before 65), turned 65 in 2006-2008, and were alive after turning 65. Accounting for intra-individual correlations among repeated measures, we estimated the number of VHA PC visits per age from 60 to 70, controlling for service-connected disability, rural/urban status, drive time between patient residence and VA, and number of medical conditions at 65, and censoring on death age.

Results:
Mean annual number of VHA PC visits was 2.0 at age 60, controlling for other variables. Estimated number of VHA PC visits increased from 60 to 64, and then decreased from 65 to 70. The largest year-to-year increase (11.2%) and decrease (5.7%) was from 60 to 61 and in the year after turning 65, respectively. Women veterans with high levels of service-connected disability, living in highly rural areas, having a shorter drive time, or having more chronic medical conditions, were more likely to continue to use VHA PC at 65.

Implications:
Women veterans' progressively increasing annual use of VHA PC services reverses direction starting at 65, with an especially large decrease at 65.

Impacts:
Given that a large bolus of women veterans will turn 60 in the next few years, their increasing demand on VHA PC services is expected. However, that trend may reverse as today's middle-aged women continue to age beyond 65 years. If this phenomenon proves to represent attrition from VHA as a result of Medicare eligibility, VHA will need to examine drivers of older women's health care choices.