Health Care Fraud and Abuse Control Program Report for Attrition from VA Care Much Lower for New Women Patients Receiving Primary Care from a Women’s Health Provider

Attrition from VA Care Much Lower for New Women Patients Receiving Primary Care from a Women's Health Provider

BACKGROUND:
VA serves a growing number of women. Data suggest women new to VA are more likely than established patients to stop using VA care. This study assessed whether receiving care from a women's health primary care provider (PCP) was associated with lower risk of attrition among new women VA primary care patients. The study cohort consisted of all women Veterans new to VA in FY2017 with an in-person FY2017 primary care visit (n=15,057). Attrition was defined as no VA use in the two-year follow-up period after the first FY2017 visit. "Use" during the follow-up period included in-person or video/telephone care at a VA facility or through VA-purchased community care. Analyses were adjusted for age, race and ethnicity, military service-connected disability, rurality of residence, and drive time to care. To avoid overestimating attrition during the COVID-19 pandemic, sensitivity analyses excluded women with follow-up periods that included dates after February 2020.

FINDINGS:

• Among women Veterans new to VA, attrition rates were much lower among women who saw a women's health PCP compared to those who did not (9% vs. 21%).
• Sensitivity analyses excluding women with follow-up periods after February 2020 (i.e., the start of the COVID-19 pandemic) had nearly identical results.
• Among the study cohort, 78% of women saw a women's health PCP during their index year.

IMPLICATIONS:

• The overall attrition rate among new women patients was roughly half the rate found in prior work based on a FY2009 cohort (25%), possibly reflecting VA's efforts to redesign its women's health delivery system.
• Given the stark contrast in attrition rates between women who do and do not see women's health PCPs, ensuring that all women Veterans have access to this care would support VA's mission to provide high quality, patient-centered care responsive to their needs.

LIMITATIONS:

• Unmeasured characteristics of VA care may impact attrition.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR (IIR 18-116, CRE 12-019). Drs. Breland, Phibbs, and Frayne, and Ms. Saechao and Mr. Berg are with HSR's Center for Innovation to Implementation (Ci2i). Drs. Hamilton, Yano, and Washington are with HSR's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP). Drs. Hamilton and Yano are supported by HSR Research Career Scientist Awards (RCS 21-135 and RCS 05-195, respectively).

Breland JY, Saechao F, Hamilton AB, Yano EM, Berg E, Phibbs CS, Washington DL, Iqbal S, Frayne SM. Women's Health Primary Care Practitioners and Attrition from Veterans Health Administration Care. JAMA Network Open. March 18, 2026;9(3):e262307.