December 2021

In This Issue: HSR&D Advances Research in Providing Healthcare for Veterans in Rural Settings
» Table of Contents

Overview: HSR&D Advances Research in Providing Healthcare for Veterans in Rural Settings

The CDC has conducted a series of studies that show a significant gap in health between people living in rural areas compared to those living in urban areas. Americans living in rural areas are more likely to die from heart disease, cancer, and stroke than those living in urban settings. Moreover, rural Americans have higher rates of smoking, high blood pressure, and obesity – and have higher rates of poverty and less access to healthcare.¹ Nearly 3 million Veterans who use the VA healthcare system reside in rural settings. While rural areas may offer a more peaceful setting, they may also present challenges such as higher poverty rates (49% of VA enrollees in rural settings earn less than $35,000 annually) and fewer healthcare resources, including fewer physicians and specialists. Another consideration is that Veterans living in rural settings tend to be older, with 55% older than age 65.² Older Veterans are more likely to be “complex” patients diagnosed with diabetes, obesity, high blood pressure, and heart conditions.

In addition to 172 medical centers, VA offers healthcare services at more than 1,100 Community-Based Outpatient Centers (CBOCs); however, Veterans living in rural areas may still find access to care difficult. VA’s Office of Connected Care improves Veterans’ access to healthcare by engaging Veterans and care teams outside of traditional healthcare visits through technologies, including telehealth. Connected Care also is enhancing healthcare coordination across VA and with community care providers as authorized under the VA MISSION Act of 2018, which strengthens VA’s ability to deliver Veterans high-quality care through community care providers. A Veteran is eligible for community care if VA cannot provide care within its designated standards. If a Veteran’s drive time is 30 minutes or more for primary care, mental health, non-institutional extended care, or 60 minutes or more for specialty care, the Veteran is eligible to visit a non-VA community provider.

HSR&D contributes to VA’s efforts to provide optimal care for Veterans who live in rural settings through several of its centers, including:

• The Charleston Health Equity and Rural Outreach Innovation Center (HEROIC) works to improve access and equity in healthcare for all Veterans by eliminating geographic, racial/ethnic, and gender-based disparities.
• The Center for Health Equity Research & Promotion (CHERP) aims to improve the equity of health and healthcare for vulnerable Veteran populations, including those who live in rural areas with limited healthcare resources.
• The Virtual Care CORE (COnsortia of REsearch) works to facilitate research that evaluates and improves the use of virtual care to enhance the accessibility, capacity, and quality of VA healthcare. Virtual care is particularly valuable to Veterans who reside in rural settings.

HSR&D’s Quality Enhancement Research Initiative (QUERI) supports several programs that focus on rural healthcare, including:

• Center for the Evaluation of Enterprise-Wide Initiatives (CEEWI) was formed in partnership with VA’s Office of Rural Health (ORH). CCEWI supports the ORH mission by focusing on the implementation, sustainment, and expansion of effective programs to improve the health and wellbeing of Veterans living in rural settings.
• Social Work Effectiveness for Rural Veterans Evaluation (SERVE) assesses the effectiveness of the Social Work PACT (Patient-Aligned Care Teams), which were implemented in 2016 in a joint effort by the National Social Work Programs Office and the Office of Rural Health.
• Virtual Care QUERI Program supports clinical operations partners in the roll-out of evidence-based practices that incorporate virtual care technologies to improve access to high quality care for Veterans who reside in rural settings.

References

1. About Rural Health. CDC, Centers for Disease Control and Prevention.
2. Rural Veterans. VA Office of Rural Health.