4088 — Revolving Doors: Portal of Entry to VA for New Women Veteran Patients Influences Speed of Exit

Lead/Presenter: Fay Saechao, COIN - Palo Alto
All Authors: Saechao FS (HSR&D Center for Innovation to Implementation (Ci2i), Palo Alto, CA) Hamilton AB (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, CA, and the UCLA David Geffen School of Medicine) Phibbs CS (Ci2i and the Stanford University School of Medicine) Berg E (Ci2i) Kimerling R (Ci2i and the National Center for PSTD, VA Palo Alto Health Care System) Finlay AK (Ci2i) Breland JY (Ci2i) Washington DL (CSHIIP and the UCLA David Geffen School of Medicine) Yano EM (CSHIIP and the UCLA Fielding School of Public Health) Frayne SM (Ci2i and the Stanford University School of Medicine)

Objectives:
Many women Veterans new to the Veterans Health Administration (VA) discontinue VA use soon after joining. Since first impressions can have persistent impact, and since primary care (PC) settings are designed to enhance continuity, we examined whether attrition is lower for women with PC vs. other portals of entry into VA.

Methods:
The study cohort included all women Veterans new to VA (no outpatient/inpatient VA or fee basis use in the prior 8 years) with at least one in-person VA outpatient visit in fiscal year (FY) 2011. The index year for VA utilization began at the first qualifying outpatient visit, and portal of entry was based on the setting of that visit. Attrition was defined as no VA utilization in years 2 and 3 after the index year. We characterized attrition rate by portal of entry, and then conducted logistic regression for attrition as a function of portal of entry (PC versus other), first unadjusted and then adjusted for age, urban/rural status, service-connected status, and log travel time from residence to home VA.

Results:
Among the 20,004 women new to VA in FY11, 68.9% had a PC portal of entry; other portals included Emergency Department/Urgent Care (10.0%), Mental Health (6.1%), Specialty Care (3.2%), and Other (9.6%). Rate of attrition was 17.2% for women with a PC portal of entry, and 22.4% for all others. Attrition rate varied by specific portal of entry: Emergency Department/Urgent Care (19.9%), Mental Health (20.7%), Specialty Care (22.5%), and Other clinics (26.9%). Odds of attrition for women with PC versus any other portal of entry were 0.72 (95% CI 0.67-0.78) (unadjusted) and 0.77 (95% CI 0.72-0.84) (adjusted).

Implications:
Among new women Veteran VA patients, PC was the most common portal of entry. Women entering through PC had lower risk of attrition. This could reflect continuity-oriented systems of care in PC settings, or differences in women's intentions around VA use that drive their choice of portal of entry.

Impacts:
In the context of VA's commitment to access, findings highlight the importance of ensuring that women are entering VA through key portals of care that promote coordinated, Veteran-centric care.