Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1072 — Women's Health Primary Care Providers: Antidote to Attrition from VA among Women Veterans New to VA?

Lead/Presenter: Susan Frayne, COIN - Palo Alto
All Authors: Frayne SM (HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System; Stanford University School of Medicine) Phibbs CS (HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System; Stanford University School of Medicine) Saechao F (HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System) Berg E (HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System) Yano EM (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles; UCLA Fielding School of Public Health) Washington DL (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles; UCLA Geffen School of Medicine) Friedman SA (HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System; UCLA Fielding School of Public Health) Finlay AK (HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System) Hoggatt KJ (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles; UCLA Fielding School of Public Health) Hamilton AB (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles; UCLA Geffen School of Medicine)

Objectives:
Excess risk of attrition has been documented among women Veterans (WVs) new to VA; impressions formed during early encounters with providers may influence women's decisions about leaving. Seeking to improve women's experiences of VA care, national VA policy (1330.01) mandates WVs' access to comprehensive care from Women's Health Primary Care Providers (WH-PCPs) proficient in women's health care. For WVs newly joining VA, we examined whether seeing a WH-PCP predicted lower risk of attrition from VA.

Methods:
Among WVs with 1+ VA primary care (PC) visits in fiscal year (FY)2011 who were new to VA (no VA or fee basis use in prior 8 years), we used national VA WH-PCP workforce data, linked to national VA utilization data, to identify women with 1+ visits with a WH-PCP in the year following the first outpatient visit. Attrition was defined as no VA care in person-specific years 2-3 thereafter.

Results:
Among all 18,398 new WV PC patients nationally, 63% saw a WH-PCP in their first year in VA. Across facilities, 11% to 95% of WVs (median 71%) saw a WH-PCP. The attrition rate was 12% for women who saw a WH-PCP versus 23% for others; this pattern was similar at VAMCs and CBOCs. Odds of attrition were significantly lower for women who saw a WH-PCP than for those who saw other PC providers in an unadjusted logistic regression model (OR 0.43, 95% CI 0.40-0.46) and also after controlling for age, race/ethnicity, marital status, urban/rural residence, service-connected disability, PC site (VAMC/CBOC) and fee basis care receipt (adjusted OR 0.49, 95% CI 0.45-0.53).

Implications:
Over half of new women PC patients received care from a WH-PCP at least once within a year of joining VA, although this varied markedly by facility. Those who saw a WH-PCP had less than half the odds of subsequent attrition from VA use.

Impacts:
Receipt of care from a WH-PCP appears highly protective against the excess attrition seen among WVs new to VA. Reducing variability across VA in uptake of policy mandating access to WH-PCPs may enhance patient experience of care, encouraging new WVs to select VA as their long-term provider of choice.