Travel Time and Attrition From VHA Care Among Women Veterans

How Far is Too Far

Bibliographic Data

ID9100713
AuthorsSarah Friedman (0000-0001-7231-2976, University of California, Los Angeles, corresponding author), Sarah A Friedman, Susan M Frayne (0000-0002-4675-2270, VA Palo Alto Health Care System, corresponding author), Eric Berg, Eric A Berg (VA Palo Alto Health Care System, corresponding author), Alison B Hamilton, Alison Brown (0000-0003-3998-7212, University of California, Los Angeles), Donna L Washington (0000-0001-7917-4609, VA Palo Alto Health Care System, corresponding author), Fay Saechao (VA Palo Alto Health Care System, corresponding author), Natalya C Maisel (VA Palo Alto Health Care System, corresponding author), Julia Y Lin (0000-0003-0518-9829), Julia Lin (0000-0002-4259-7656, University of California, Los Angeles), Katherine J Hoggatt (0000-0002-9431-5438, VA Palo Alto Health Care System), Ciaran S Phibbs (0000-0002-4353-3507, VA Palo Alto Health Care System, corresponding author)
Year2015
Volume53
IssueSupplement 4Suppl 1
PagesS15-S22
Publication date2015-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000296
PMID25767970
PMCIDPMC4386926
OpenAlexW2312250585
LanguageEN
Citations received15
References cited10

BACKGROUND: Travel time, an access barrier, may contribute to attrition of women veterans from Veterans Health Administration (VHA) care. OBJECTIVE: We examined whether travel time influences attrition: (a) among women veterans overall, (b) among new versus established patients, and (c) among rural versus urban patients. RESEARCH DESIGN: This retrospective cohort study used logistic regression to estimate the association between drive time and attrition, overall and for new/established and rural/urban patients. SUBJECTS: In total, 266,301 women veteran VHA outpatients in the Fiscal year 2009. MEASURES: An "attriter" did not return for VHA care during the second through third years after her first 2009 visit (T0). Drive time (log minutes) was between the patient's residence and her regular source of VHA care. "New" patients had no VHA visits within 3 years before T0. Models included age, service-connected disability, health status, and utilization as covariates. RESULTS: Overall, longer drive times were associated with higher odds of attrition: drive time adjusted odds ratio=1.11 (99% confidence interval, 1.09-1.14). The relationship between drive time and attrition was stronger among new patients but was not modified by rurality. CONCLUSIONS: Attrition among women veterans is sensitive to longer drive time. Linking new patients to VHA services designed to reduce distance barriers (telemedicine, community-based clinics, mobile clinics) may reduce attrition among women new to VHA

Attrition · Confidence interval · Logistic regression · Odds · Odds ratio · Residence · Rural area · Rurality · Demography · Diabetes Management and Education · Emergency and Acute Care Studies · Internal Medicine · Medicine · Primary Care and Health Outcomes · Gerontology