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The health and health care of rural Veterans
is a major priority for the VA Health
Services Research and Development Service
(HSR&D). The VA research community has
undertaken highly partnered, rigorous work
to develop and test innovative implementation
strategies that help ensure delivery
of evidence-based care for rural Veterans.
Indeed, several HSR&D-funded centers,
known as Centers of Innovation (COINs),
focus on strategies for optimizing care
among rural Veterans.
The COIN located in Salt Lake City, Utah
(Informatics, Decision-Enhancement and
Analytic Sciences Center (IDEAS 2.0))
partners with the Veterans Rural Health
Resource Center, Western Region, and
includes a significant focus on rural health.
Recent work from IDEAS 2.0 found that
women Veterans in rural areas identified
access to local dental, mental health, and
gender-specific care options as important
health care needs.1
The COIN located in West Haven, Connecticut,
(Pain Research, Informatics,
Multi-morbidities, and Education (PRIME)
Center) partners with at least nine VA and
non-VA entities. One goal of PRIME is
development of strategies that will reduce
ethnic, racial, geographic, gender-and agerelated
disparities in access to and delivery
of effective pain care. PRIME investigators
have examined geographic variations in the
use of telementoring as a means to improve
pain management for Veterans.2
In 2014, HSR&D funded the Collaborative
Research to Enhance and Advance
Transformation and Excellence (CREATE)
Initiative. CREATEs consist of interrelated
research projects to produce deliverables
and new knowledge that offer a distinct
advantage over pursuing individual projects
separately. The CREATE hosted by the VA
HSR&D COIN (Center for Mental Healthcare
and Outcomes Research (CeMHOR))
in North Little Rock, Arkansas focuses on
the delivery of high-quality mental health
care to rural Veterans. Four projects are in
progress in partnership with the VA Office
of Mental Health Services, the VISN
16 Mental Health Service Line, and the VA
Office of Rural Health. The projects address
access to, engagement in, and quality of
care through a coordinated set of initiatives
that target the community-based outpatient
clinic setting. An important preliminary
finding from these projects is that rural
Veterans include systems of care, and experiences
of care and treatment in how they
think about access to health care. This finding
suggests that these concepts should be
considered in future interventions for access
to care among rural Veterans.
Like HSR&D, the VA Quality Enhancement
Research Initiative (QUERI) has a
strong commitment to partnered projects
that improve access to health care for rural
Veterans. For example, the Virtual Specialty
QUERI is evaluating the use of clinical
video-telehealth with home-based cardiac
rehabilitation (CR) for Veterans who live
far from CR services. Key partners for this
initiative include the Office of Rural Health,
VA Telehealth Services, and the VA Office
of Connected Care. In 2015, QUERI and
the VA Office of Rural Health funded a
partnered evaluation center known as the
National Rural Evaluation Center (NREC).
NREC is in the process of conducting a nationwide
needs assessment for rural Veterans
and examining the relationship between
social determinants of health and domains
of access to health care.
To understand the barriers to accessing
care among rural Veterans, the NREC is
conducting geospatial analyses that examine
variations in access to care among
rural Veterans across the United States.
The NREC leveraged existing VA and non-
VA data including the Survey of Enrollees
(SOE) and the Survey of Healthcare Experiences
by Patients (SHEP). To better understand
the views of Veterans themselves,
NREC investigators have conducted over
200 qualitative interviews with Veterans living
in rural areas across the country. Early
findings suggest that access to care among
rural Veterans is a function of the number
of barriers rather than a specific access
domain. Interestingly, many Veterans who
live in areas with poor geographic access
(i.e., living more than 40 miles from VA
health care), report that they perceive themselves
as having good access to care.
Despite progress through these partnered,
innovative projects, the research timeline
is a major challenge in conducting highly
partnered research that impacts rural health
care. It typically takes one to two years to
obtain funding for a given project. Once
funded, the research project typically takes
place over one to three years meaning that,
at minimum, three years elapse before the
average project has results to share with the
clinical and administrative communities.
Rural Veterans need real time solutions that
move more quickly through this timeline.
Current research initiatives to improve
health and health care of rural Veterans are
critical and are expected to yield actionable
outcomes. However, it is essential that new,
innovative funding mechanisms are identified
that can enhance partnerships between
researchers and VA program.
-
Brooks E, et al. "Listening to the Patient: Women
Veterans' Insights About Health Care Needs, Access,
and Quality in Rural Areas," Military Medicine 2016;
181(9):976-81.
- Carey EP, et al. "Implementation of Telementoring for
Pain Management in Veterans Health Administration:
Spatial Analysis," Journal of Rehabilitation Research
and Development 2016; 53(1):147-56.
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