{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:27:16Z","timestamp":1786724836830,"version":"build-2736575974"},"reference-count":40,"publisher":"Oxford University Press (OUP)","funder":[{"name":"VA HSR CRE","award":["12-019"],"award-info":[{"award-number":["12-019"]}]},{"name":"VA HSR IIR","award":["18-116"],"award-info":[{"award-number":["18-116"]}]},{"name":"VA Office of Women\u2019s Health"},{"name":"Women\u2019s Health Evaluation Initiative"},{"name":"VA Health Systems Research (HSR) Senior Research Career Scientist","award":["RCS 05-195"],"award-info":[{"award-number":["RCS 05-195"]}]},{"name":"VA HSR Research Career Scientist Award","award":["21-135"],"award-info":[{"award-number":["21-135"]}]},{"name":"VA HSR Career Development","award":["11-261"],"award-info":[{"award-number":["11-261"]}]},{"name":"VA HSR Career Development","award":["13-279"],"award-info":[{"award-number":["13-279"]}]},{"name":"VA HSR Career Development","award":["15-257"],"award-info":[{"award-number":["15-257"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Women veterans represent a numeric minority group in the Veterans Health Administration (VA). Responding to documented gaps in their care, the VA Office of Women\u2019s Health in 2010 launched the Comprehensive Women\u2019s Health Care Policy, designed to transform VA health care for women nationally. Before this policy, there was a high rate of attrition (i.e., discontinuation of VA use) among women Veterans new to VA care. We examined whether attrition rates declined among women veterans new to VA across the 7-year period before and after this 2010 policy. Women were benchmarked against men for these analyses, because the policy was women-specific.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>For this retrospective longitudinal analysis of existing national VA databases, we identified date of first VA outpatient use (index date) for all veterans new to VA in fiscal year (FY) 2007-2013. We considered a patient to have attrited if they had no VA-based or outsourced outpatient or inpatient care in years 2 and 3 following the index date (e.g., through FY2016 for those with an index date in FY2013). In sex-stratified analyses, we conducted logistic regression analyses to predict the odds of attrition as a function of fiscal year of the index date, with adjusted regression analyses controlled for age, race\/ethnicity, and service-connected disability status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final cohort of new veteran VA outpatients included n\u2009=\u2009131,313 women and n\u2009=\u20091,753,240 men. Among new women patients, the attrition rate was 23% in FY2007 and 17% in FY2013; among new men it was 23% in FY2007 and 21% in FY2013. Among women, the odds of attrition were lower for those with an FY2013 index date than for those with an FY2007 index date (adjusted OR 0.72 [0.68-0.76]). Reduction of attrition was less pronounced for men over this same time period (adjusted OR 0.89 [0.88-0.91]). Focusing on changes that occurred after the rollout of the women\u2019s health policy, attrition decreased post-FY2010 among women but not among men. Specifically, women with an FY2013 index date had lower odds of attrition than those with an FY2010 index date (adjusted OR 0.92 [0.88-0.98]), but attrition increased over that time period for men (adjusted OR 1.05 [1.04-1.07]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although causal conclusions are not possible, findings from this national longitudinal study suggest a beneficial impact of the 2010 Comprehensive Women\u2019s Health Policy upon attrition from VA care among new women veteran VA patients. The effects of more recent legislation expanding veterans\u2019 health care access deserve attention, to confirm whether in this changed landscape, women veterans continue to remain in VA for their health care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag366","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:13:33Z","timestamp":1785237213000},"source":"Crossref","is-referenced-by-count":0,"title":["Declining Attrition of New Women Patients After Veterans Health Administration Rollout of Comprehensive Women\u2019s Health Care Policy"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4675-2270","authenticated-orcid":false,"given":"Susan M","family":"Frayne","sequence":"first","affiliation":[{"name":"VA Health Systems Research Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine , Stanford, CA 94305,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciaran S","family":"Phibbs","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Health Economics Resource Center (HERC), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Department of Pediatrics (Neonatal Medicine), Stanford University School of Medicine , Palo Alto, CA 94305,","place":["United States"]},{"name":"Department of Health Policy, Stanford University School of Medicine , Stanford, CA 94305,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fay","family":"Saechao","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9431-5438","authenticated-orcid":false,"given":"Katherine J","family":"Hoggatt","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for Data to Discovery and Delivery Innovation (3DI), San Francisco VA Health Care System , San Francisco, CA 94121,","place":["United States"]},{"name":"Department of Medicine, University of California , San Francisco, CA 94143,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M","family":"Yano","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , North Hills, CA 91343,","place":["United States"]},{"name":"Department of Medicine, UCLA Geffen School of Medicine , Los Angeles, CA 90095,","place":["United States"]},{"name":"Department of Health Policy & Management, UCLA Fielding School of Public Health , Los Angeles, CA 90095,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7917-4609","authenticated-orcid":false,"given":"Donna L","family":"Washington","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , North Hills, CA 91343,","place":["United States"]},{"name":"Department of Medicine, UCLA Geffen School of Medicine , Los Angeles, CA 90095,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A","family":"Friedman","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno , Reno, NV 89557,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Berg","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea K","family":"Finlay","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"National Center on Homelessness Among Veterans, Department of Veteran Affairs , Menlo Park, CA 94025,","place":["United States"]},{"name":"Division of Health Systems Science, Department of Medicine, UMass Chan Medical School , Worcester, MA 01605,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Y","family":"Breland","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine , Stanford, CA 94305,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia E","family":"Gammage","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , North Hills, CA 91343,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3998-7212","authenticated-orcid":false,"given":"Alison B","family":"Hamilton","sequence":"additional","affiliation":[{"name":"VA Health Systems Research Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , North Hills, CA 91343,","place":["United States"]},{"name":"Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine , Los Angeles, CA 90095,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026081410270689200_usag366-B1","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1176\/appi.ps.201400059","article-title":"Problems with using patient retention in the evaluation of mental health providers: differences in type of dropout","volume":"66","author":"Brown","year":"2015","journal-title":"Psychiatr Serv"},{"key":"2026081410270689200_usag366-B2","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.whi.2021.11.011","article-title":"Women veterans\u2019 attrition from the VA health care system","volume":"32","author":"Chrystal","year":"2022","journal-title":"Womens Health Issues"},{"key":"2026081410270689200_usag366-B3","doi-asserted-by":"publisher","first-page":"S510","DOI":"10.1007\/s11606-013-2347-y","article-title":"Factors related to attrition from VA healthcare use: findings from the national survey of women veterans","volume":"28","author":"Hamilton","year":"2013","journal-title":"J Gen Intern Med"},{"key":"2026081410270689200_usag366-B4","volume-title":"Study of Barriers for Women Veterans to VA Health Care. Veterans Health Administration","author":"US Department of Veterans Affairs","year":"2024"},{"key":"2026081410270689200_usag366-B5","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.whi.2021.11.008","article-title":"Discontinuity of women veterans\u2019 care in patient-centered medical homes: does workforce gender sensitivity matter?","volume":"32","author":"Than","year":"2022","journal-title":"Womens Health Issues"},{"key":"2026081410270689200_usag366-B6","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1177\/0022167819847328","article-title":"Why women veterans do not use VA-provided health and social services: implications for health care design and delivery","volume":"64","author":"Evans","year":"2024","journal-title":"J Humanist Psychol"},{"key":"2026081410270689200_usag366-B7","doi-asserted-by":"publisher","first-page":"100411","DOI":"10.1016\/j.hjdsi.2020.100411","article-title":"The role of healthcare system hassles in delaying or forgoing care","volume":"8","author":"Brunner","year":"2020","journal-title":"Healthc (Amst)"},{"key":"2026081410270689200_usag366-B8","doi-asserted-by":"publisher","first-page":"100429","DOI":"10.1016\/j.hjdsi.2020.100429","article-title":"Greater patient-centered medical home implementation was associated with lower attrition from VHA primary care","volume":"8","author":"Yoon","year":"2020","journal-title":"Healthc (Amst)"},{"key":"2026081410270689200_usag366-B9","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1186\/s12875-021-01593-8","article-title":"The success of behavioral economics in improving patient retention within an intensive primary care practice","volume":"22","author":"Groden","year":"2021","journal-title":"BMC Fam Pract"},{"key":"2026081410270689200_usag366-B10","volume-title":"Sourcebook: Women Veterans in the Veterans Health Administration. Volume 5: Longitudinal Trends in Sociodemographics and Utilization, Including Type, Modality, and Source of Care","author":"Breland","year":"2024"},{"key":"2026081410270689200_usag366-B11","author":"U.S. General Accounting Office","year":"1982"},{"key":"2026081410270689200_usag366-B12","author":"U.S. General Accounting Office","year":"1992"},{"key":"2026081410270689200_usag366-B13","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/s1049-3867(02)00198-6","article-title":"The organization and delivery of women\u2019s health care in department of veterans affairs medical center","volume":"13","author":"Yano","year":"2003","journal-title":"Womens Health Issues"},{"key":"2026081410270689200_usag366-B14","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1046\/j.1525-1497.2003.20512.x","article-title":"Patient satisfaction in women\u2019s clinics versus traditional primary care clinics in the veterans administration","volume":"18","author":"Bean-Mayberry","year":"2003","journal-title":"J Gen Intern Med"},{"key":"2026081410270689200_usag366-B15","author":"U.S. Department of Veterans Affairs","year":"2025"},{"key":"2026081410270689200_usag366-B16","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.2105\/AJPH.2006.092999","article-title":"The veterans health administration and military sexual trauma","volume":"97","author":"Kimerling","year":"2007","journal-title":"Am J Public Health"},{"key":"2026081410270689200_usag366-B17","doi-asserted-by":"publisher","first-page":"S103","DOI":"10.1016\/j.whi.2011.04.025","article-title":"New women veterans in the VHA: a longitudinal profile","volume":"21","author":"Friedman","year":"2011","journal-title":"Womens Health Issues"},{"key":"2026081410270689200_usag366-B18","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1089\/jwh.2021.0033","article-title":"Mini-residencies to improve care for women veterans: a decade of re-educating Veterans Health Administration primary care providers","volume":"31","author":"Baier Manwell","year":"2022","journal-title":"J Womens Health (Larchmt)"},{"key":"2026081410270689200_usag366-B19","author":"Department of Veterans Affairs","year":"2017"},{"key":"2026081410270689200_usag366-B20","volume-title":"National Veteran Health Equity Report 2021. Focus on Veterans Health Administration Patient Experience and Health Care Quality.","author":"Washington","year":"2022"},{"key":"2026081410270689200_usag366-B21","doi-asserted-by":"publisher","first-page":"S39","DOI":"10.1097\/MLR.0000000000000298","article-title":"Readying the workforce: evaluation of VHA\u2019s comprehensive women\u2019s health primary care provider initiative","volume":"53","author":"Maisel","year":"2015","journal-title":"Med Care"},{"key":"2026081410270689200_usag366-B22","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1007\/s11606-022-07575-5","article-title":"Retaining providers with women\u2019s health expertise: decreased provider loss among VHA women\u2019s health faculty development program attendees","volume":"37","author":"Farkas","year":"2022","journal-title":"J Gen Intern Med"},{"key":"2026081410270689200_usag366-B23","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/j.whi.2014.07.005","article-title":"Association between women veterans\u2019 experiences with VA outpatient health care and designation as a women\u2019s health provider in primary care clinics","volume":"24","author":"Bastian","year":"2014","journal-title":"Womens Health Issues"},{"key":"2026081410270689200_usag366-B24","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1097\/MLR.0000000000000323","article-title":"Associations between provider designation and female-specific cancer screening in women veterans","volume":"53","author":"Bean-Mayberry","year":"2015","journal-title":"Med Care"},{"key":"2026081410270689200_usag366-B25","doi-asserted-by":"publisher","first-page":"2593","DOI":"10.1007\/s11606-025-09451-4","article-title":"Availability of women\u2019s health clinics, primary care providers, and women veterans\u2019 ratings of care experiences","volume":"40","author":"Rose","year":"2025","journal-title":"J Gen Intern Med"},{"key":"2026081410270689200_usag366-B26","doi-asserted-by":"publisher","first-page":"e262307","DOI":"10.1001\/jamanetworkopen.2026.2307","article-title":"Women\u2019s health primary care practitioners and attrition from Veterans Health Administration care","volume":"9","author":"Breland","year":"2026","journal-title":"JAMA Netw Open"},{"key":"2026081410270689200_usag366-B27","author":"Department of Veterans Affairs","year":"2020"},{"key":"2026081410270689200_usag366-B28","author":"VA expands maternity care coordination for Veterans","year":"2023"},{"key":"2026081410270689200_usag366-B29","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1093\/tbm\/ibx081","article-title":"Care coordination for pregnant veterans: VA\u2019s maternity care coordinator telephone care program","volume":"8","author":"Cordasco","year":"2018","journal-title":"Transl Behav Med"},{"key":"2026081410270689200_usag366-B30","author":"U.S. Department of Veterans Affairs","year":"2025"},{"key":"2026081410270689200_usag366-B31","first-page":"e263\u201372","article-title":"The patient-centered medical home in the Veterans Health Administration","volume":"19","author":"Rosland","year":"2013","journal-title":"Am J Manag Care"},{"key":"2026081410270689200_usag366-B32","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1007\/s11606-024-08647-4","article-title":"Impact of evidence-based quality improvement on tailoring VA\u2019s patient-centered medical home model to women veterans\u2019 needs","volume":"39","author":"Yano","year":"2024","journal-title":"J Gen Intern Med"},{"key":"2026081410270689200_usag366-B33","author":"U.S. Department of Veterans Affairs","year":"2025"},{"key":"2026081410270689200_usag366-B34","doi-asserted-by":"publisher","first-page":"S130","DOI":"10.1016\/j.whi.2011.04.029","article-title":"National variations in VA mental health care for women veterans","volume":"21","author":"Oishi","year":"2011","journal-title":"Womens Health Issues"},{"key":"2026081410270689200_usag366-B35","author":"Maher","year":"2017"},{"key":"2026081410270689200_usag366-B36","doi-asserted-by":"publisher","first-page":"100484","DOI":"10.1016\/j.hjdsi.2020.100484","article-title":"Promoting learning health system feedback loops: experience with a VA practice-based research network card study","volume":"8","author":"Golden","year":"2021","journal-title":"Healthc (Amst)"},{"key":"2026081410270689200_usag366-B37","first-page":"105","volume-title":"Frontiers in Econometrics.","author":"McFadden","year":"1974"},{"key":"2026081410270689200_usag366-B38","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1111\/1475-6773.12511","article-title":"Key provisions of the patient protection and affordable care act (ACA): a systematic review and presentation of early research findings","volume":"51","author":"French","year":"2016","journal-title":"Health Serv Res"},{"key":"2026081410270689200_usag366-B39","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.23.0251","article-title":"Loyalty to loyalty metrics: evaluating the use of \u201clikelihood to recommend\u201d in health care experience","volume":"5","author":"Milani","year":"2024","journal-title":"NEJM Catal Innov Care Deliv"},{"key":"2026081410270689200_usag366-B40","author":"U.S. Department of Veterans Affairs","year":"2025"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag366\/70651248\/usag366.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag366\/70651248\/usag366.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T15:28:49Z","timestamp":1786721329000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag366\/8761729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":40,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag366","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"article-number":"usag366"}}