Travel Time and Attrition From VHA Care Among Women Veterans: How Far is Too Far?
Open accessAbstract
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.
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In a case-control quasi-experiment among 266,301 women in the Veterans Health Administration, there was a positive relationship between travel distance and attrition, more so among new patients.
“The findings indicated a positive relationship between travel distance and attrition, more so among new patients.”
From The Empirical Foundations of Telemedicine Interventions in Primary Care (2016) · cites this paper as [76]
The Abstract Results and Discussion report that longer drive time was associated with higher attrition, with a stronger association among new patients. The Methods (Study cohort) confirm 266,301 women, but the Abstract Research Design and Methods (Data sources) call this a retrospective cohort study, not a case-control quasi-experiment. (LLM, conf=0.89)
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- Authors
- Friedman, S. A., Frayne, S. M., Berg, E., Hamilton, A. B., Washington, D. L., Saechao, F., Maisel, N. C., Lin, J. Y., Hoggatt, K. J., & Phibbs, C. S.
- Affiliations
- University of California, Los Angeles (US)
- VA Palo Alto Health Care System (US)
- Corresponding author
- Friedman, Sarah A.
- Frayne, Susan M.
- Berg, Eric
- Washington, Donna L.
- Saechao, Fay
- Maisel, Natalya C.
- Phibbs, Ciaran S.
- Venue
- Medical Care
- Published
- 2015-04
- Volume
- 53
- Issue
- Supplement 4Suppl 1
- Pages
- S15-S22
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC4386926
- OpenAlex
- W2312250585
- Cited by
- 53
- References
- 22
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 7 · 2017: 7 · 2016: 3 · 2015: 1
- FWCI
- 14.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (TL1TR000121)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Education › Education and Military Integration
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- travel time, drive time, attrition, women veterans, Veterans Health Administration, health care access, urban-rural differences, telemedicine, mobile clinics, community clinics
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Automobile Driving, Female, Persons with Disabilities, Health Services Accessibility, Health Status Indicators, Humans, Middle Aged, Patient Acceptance of Health Care, Retrospective Studies, Rural Population, Time Factors, Travel, United States, Urban Population, Women's Health, Veterans Health
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