# Attrition of Women Veterans New to VHA in the Community Care Era

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2020 · —

## Abstract

Project Background: The Veterans Health Administration (VA) outsources care through its Community Care
(CC) program, a top VA priority. With the 2014 passage of the Veterans Choice Act came rapid expansion of
CC. While expanded CC is meant to enhance choice and access, emerging evidence raises concerns about
how VA patients experience it. Early CC implementation has been challenging, e.g., with limited availability of
CC providers and fragmented care coordination between VA and CC providers. Patient experiences of CC
may have special relevance for women, who use far more CC than men. Furthermore, nearly one in five new
women Veteran VA patients stops using, or “attrits” from, VA care, which is three-fold higher odds of attrition
than other women in VA. Our team has learned through our current CREATE study that patient experiences of
care can impact attrition: in preliminary analyses, odds of attrition in a fiscal year (FY) 2011 cohort were lower
for women who received CC care. However, in this post-expansion era of CC, it is not known whether CC will
continue to protect against attrition, whether the attrition rate among women will improve or worsen, how
specific types of CC may influence women's decisions to continue in versus leave VA care, or what patient
subgroups are at particular risk for CC-related attrition.
Project Objectives: The Specific Aims are to (1) model CC and other factors expected to predict attrition from
VA; (2) examine the longitudinal attrition trajectory pre/post expansion of CC; (3) characterize the facility-level
context of CC, to triangulate with Aims 1 & 2 results and inform Aim 4; and (4) examine women's experiences
of care and their perspectives on the relationship between CC and plans for future VA use.
Project Methods: Guided by a conceptual model that combines the Andersen Behavioral Model and
Consumer Choice Theory, we will conduct a mixed methods study designed to achieve integration at all levels:
design, methods, interpretation, and reporting. For Aim 1, we will analyze existing data sources in an FY17
national cohort of new women (N~23,000) and new men (N~200,000) VA primary care patients. For Aim 2, we
will model the attrition trajectory in sequential national cohorts (FY07-FY19Q2) of all women Veterans new to
VA, and separately, men. For Aim 3, we will conduct semi-structured interviews at two timepoints with
clinician/staff key stakeholders (n=30) involved in CC at ten purposively selected sites. For Aim 4, we will
conduct semi-structured interviews at two timepoints with new women Veteran primary care patients (n=70) at
Aim 3 sites who received a CC referral in FY20. Key stakeholders and women Veterans will be asked to
provide recommendations for organizational/policy changes that would improve CC and retention of Veterans
in VA care.
Significance and Relevance to Veterans' Health: Understanding the potential association between CC
experiences and attrition among women Veterans represents a critical topic...

## Key facts

- **NIH application ID:** 9939307
- **Project number:** 5I01HX002626-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** SUSAN FRAYNE
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-05-01 → 2022-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9939307

## Citation

> US National Institutes of Health, RePORTER application 9939307, Attrition of Women Veterans New to VHA in the Community Care Era (5I01HX002626-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9939307. Licensed CC0.

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