Rural Health Care Delivery Research Articles

Strengthening rural healthcare outcomes through digital health: qualitative multi-site case study

BackgroundRural populations experience ongoing health inequities with disproportionately high morbidity and mortality rates, but digital health in rural settings is poorly studied. Our research question was: How does digital health influence healthcare outcomes in rural settings? The objective was to identify how digital health capability enables the delivery of outcomes in rural settings according to the quadruple aims of healthcare: population health, patient experience, healthcare costs and provider experience.MethodsA multi-site qualitative case study was conducted with interviews and focus groups performed with healthcare staff (n = 93) employed in rural healthcare systems (n = 10) in the state of Queensland, Australia. An evidence-based digital health capability framework and the quadruple aims of healthcare served as classification frameworks for deductive analysis. Theoretical analysis identified the interrelationships among the capability dimensions, and relationships between the capability dimensions and healthcare outcomes.ResultsSeven highly interrelated digital health capability dimensions were identified from the interviews: governance and management; information technology capability; people, skills, and behaviours; interoperability; strategy; data analytics; consumer centred care. Outcomes were directly influenced by all dimensions except strategy. The interrelationship analysis demonstrated the influence of strategy on all digital health capability dimensions apart from data analytics, where the outcomes of data analytics shaped ongoing strategic efforts.ConclusionsThe study indicates the need to coordinate improvement efforts targeted across the dimensions of digital capability, optimise data analytics in rural settings to further support strategic decision making, and consider how consumer-centred care could influence digital health capability in rural healthcare services. Digital transformation in rural healthcare settings is likely to contribute to the achievement of the quadruple aims of healthcare if transformation efforts are supported by a clear, resourced digital strategy that is fit-for-purpose to the nuances of rural healthcare delivery.

Rural local government and healthcare delivery in an Eastern Indian state

Based on field research in the remote and tribal-dominated Kandhamal district in the eastern Indian state of Odisha during 2019-20, the study examines the extent to which Constitutionally-created rural self-governance institutions (village Panchayats) fulfilled their mandated healthcare functions. Primary data was collected from villagers, front-line public health officials, elected local government (Panchayat) members and party cadres through focus group discussions and interviews. Employing the Foucauldian governmentality framework, the analysis moves away from a depoliticized understanding of decentralized delivery of rural health. The study concludes that Panchayats’ contributions to rural health are influenced by politically motivated factors, which may not be compatible with considerations of democracy and efficiency. Panchayat performance in the study villages remained poor as the state allowed them only regulated freedom and did not create space for their autonomy to flourish. Rural health decentralization led to new forms of governmentality as Panchayats were instrumentally used to consolidate state power at the rural grassroots. Top-down management of political process in these areas makes local government mechanical outpost of the ruling party.

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives.

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Victoria, Australia. Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Overcoming Geographic Barriers: Surgical Care in Rural Populations

AbstractThis chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations. Here, we discuss the complex and unique interplay of challenges within rural hospital infrastructure, workforce shortages, and patient factors emphasizing financial strain, closure of rural hospitals, and limited access to specialty providers and resources. Current evidence focuses on volume–outcome relationships, the safety of common surgical care at rural hospitals, and the impact of rural hospitals joining larger health systems. Strategies to optimize care delivery include site-of-care optimization, improved care coordination, dissemination of specialty expertise, and policy programs to support the rural workforce. Recent federal policies, including the rural emergency hospital program, underscore the delicate balance between sustaining essential local health care services and the financial realities of rural health care delivery. We then conclude with evidence-based strategies to bridge the urban-rural health care gap, ensuring equitable access to high-quality surgical care regardless of geographic location.

Applying Advanced Practice Nurses in Rural Japan: A Mixed-Methods Perspective.

Introduction Rural hospitals, particularly those in geographically isolated regions like Shimane Prefecture, Japan, face significant healthcare delivery challenges. These include limited resources, an aging population, and a scarcity of healthcare professionals. Advanced practice nurses (APNs) have emerged as pivotal in addressing these gaps, offering specialized patient assessment, diagnosis, and management skills. This study aimed to evaluate the demand for APNs in rural community hospitals, focusing on the specific educational needs and clinical competencies required to improve healthcare outcomes in these settings. Method Employing a mixed-methods approach, this research combined qualitative insights from stakeholder interviews with quantitative data analysis of electronic health records (EHRs) at Unnan City Hospital. This sequential exploratory design aimed to capture comprehensive educational needs and outcomes, integrating the depth of qualitative data with the breadth of quantitative evidence to tailor a curriculum for APNs in rural healthcare contexts. Results The study revealed a critical demand for APNs skilled in managing common medical issues in rural settings, such as infections, circulatory failures, and respiratory problems. Stakeholder interviews highlighted the necessity for a curriculum that enhances clinical competencies and emphasizes soft skills like communication and leadership. An analysis of EHRs identified 21 specific diseases across six categories, underlining the importance of targeted education on these prevalent conditions. Conclusion The findings underscore the urgent need for specialized education programs for APNs in rural hospitals to address these communities' unique healthcare challenges. Developing a curriculum that focuses on clinical and soft skills essential for rural healthcare delivery can significantly enhance the quality of care. This study advocates for implementing such tailored educational programs to empower APNs, thereby contributing to healthcare equity and improving patient outcomes in rural settings.

Measure Twice, Change Once: Using Simulation to Support Change Management in Rural Healthcare Delivery.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Enhancing the Retention of Healthcare Workers in Rural Areas: A Systematic Review

Introduction: Rural areas globally face significant challenges in retaining healthcare workers, impacting the delivery of essential health services and exacerbating health disparities. This systematic review aimed to evaluate the effectiveness of various strategies implemented over the last 15 years to enhance healthcare worker retention in rural settings, with the goal of identifying evidence-based interventions that can inform policy and practice to improve rural healthcare delivery. Methods: The review focused exclusively on interventional studies and clinical trials published from 2007 to 2022. A comprehensive search of multiple databases, including PubMed, MEDLINE, Embase, CINAHL, and the Cochrane Library, was conducted using specific search terms related to healthcare worker retention in rural areas. Inclusion criteria targeted studies evaluating quantifiable outcomes of retention strategies, with exclusion criteria set to omit non-interventional studies, research focused on urban settings, and non-English publications. The study selection, data extraction, and quality assessment processes were rigorously conducted to ensure the reliability of the findings. Results: Twelve studies met the inclusion criteria, revealing a broad range of interventions from financial incentives and educational programs to supportive workplace interventions and community engagement strategies. Financial incentives demonstrated a notable positive impact on retention, with risk ratios ranging from 1.2 to 1.75, indicating a 20% to 75% increase in retention rates. Supportive workplace interventions also showed effectiveness, with a risk ratio of up to 1.4. However, the results for educational and community engagement strategies were more variable, suggesting the need for tailored approaches. Conclusions: The review highlights the effectiveness of targeted interventions in enhancing the retention of healthcare workers in rural areas, particularly financial incentives and supportive workplace interventions. These findings underscore the importance of implementing multifaceted, evidence-based strategies tailored to the unique challenges of rural healthcare settings to improve workforce stability and healthcare delivery.

Rural Posting in Public Health Practices: Principles and Strategies

In addressing the global challenge of rural healthcare delivery, this study highlights fundamental principles and strategies to enhance accessibility and outcomes. The study found that understanding rural communities’ socio-cultural, economic, and geographic nuances is the first step for public health specialists to adapt their methods effectively. Community engagement fosters trust and active participation, reducing health inequities. Interdisciplinary teamwork involving doctors, nurses, pharmacists, and community health workers amplifies healthcare delivery’s reach and effectiveness. Telemedicine and technology offer remote areas access to high-quality healthcare, with telemedicine, electronic health records, and mobile apps enabling consultations and information exchange. Customised health education programs empower rural communities by raising awareness and promoting prevention, reducing preventable diseases through improved health literacy. Implementable strategies include mobile clinics for remote access, rural hubs for expert consultations, and incentives to sustain a rural healthcare workforce. Collaborations between governments, businesses, and NGOs ensure comprehensive rural healthcare. Data-driven policy decisions optimise resource allocation and healthcare efficiency. A holistic approach grounded in contextual awareness, community engagement, and technological innovation is vital for rural healthcare improvement. Public health practitioners can enhance rural health outcomes by applying these concepts and strategies.

A mixed-methods pilot examination of Montana, North Dakota nurse practitioner telepresence behaviors through web-camera eye-tracking and qualitative descriptive interviews.

The use of telehealth for mental health-related encounters has increased exponentially since the COVID-19 pandemic. However, little is known how nurse practitioners (NPs) in rural areas establish connection and presence with patients through telehealth. To leverage web-camera eye-tracking technology coupled with qualitative interviews to better understand rural NPs' perceptions, beliefs, experiences, and visual cues of connection and presence during mental health-related telehealth encounters. This mixed-methods study employed web-camera eye-tracking technology to measure eye contact, facial/body movements with microexpressions, and auditory expressions during a simulated mental health-related telehealth visit. A qualitative descriptive methodology was used to conduct semistructured interviews with participants regarding utilization of telehealth in rural mental health care delivery. Sticky software, R, and STATA were used for the quantitative eye-tracking and demographic data analyses. Qualitative findings were analyzed using inductive thematic analysis. Ten NPs participated in the eye-tracking aspect of the study; among them, three completed semistructured interviews. Eye-tracking areas of interest were significant for the number of fixations ( p = .005); number of visits ( p < .001); time until notice ( p < .001); and time viewed ( p < .001). The category Workflow had the greatest number of thematic units ( n = 21) derived from semistructured interviews. Although an accessible means of obtaining data, web-camera eye tracking poses challenges with data usability. This prompts further attention to research, optimizing the telehealth milieu to lessen patient and provider frustrations with technological or environmental issues. Nurse practitioners provide a key voice in the design and deployment of telehealth platforms congruent with the comprehensive assessment and presence of remote care delivery.

The power of ChatGPT in revolutionizing rural healthcare delivery.

The power of ChatGPT in revolutionizing rural healthcare delivery.

A comparison of critical access hospitals and other rural acute care hospitals in Pennsylvania.

As the Flex Program celebrates its 25th anniversary, we examined changes in critical access hospital (CAH) financial performance, investigated whether CAH status has reduced hospitals' financial vulnerability, and identified factors influencing financial performance. We collected data on acute care hospitals in Pennsylvania's rural counties for 2000-20. Our sample contained 1,444 hospital-year observations. We used trend analysis to compare the financial performance of CAHs and rural prospective payment system (PPS) hospitals (non-CAHs). We investigated the effect of CAH status on financial performance and identified the time-variant factors impacting financial performance using fixed-effects regression analysis. The median total margin of CAHs lagged behind that of non-CAHs. When compared to non-CAH costs over the same period, the median cost per patient day incurred by CAHs has increased, with the rate of increase being significantly higher in the most recent decade. Our findings show that while CAH status does not appear to have a direct impact on the total margin, it is significantly associated with a higher cost per patient day. CAHs in Pennsylvania appear to be facing a double whammy of declining margins and rising costs compared to non-CAHs. Our findings demonstrate how crucial the Flex program has been in sustaining CAHs in Pennsylvania ever since its inception. Our findings have implications for rural health care delivery as well. While providing financial support and operational flexibility to CAHs should be a continuing policy priority, a long-term policy goal should be to envision an economic development strategy that capitalizes on the unique strengths of each of the rural archetypes.

Rural and nonrural racial variation in mentally unhealthy days: Findings from the behavioral risk factor surveillance system in North Carolina, 2015–2019

Rural-nonrural health disparities are well documented, yet researchers rarely consider how mental health is experienced across racial groups in rural areas. Black Americans frequently demonstrate better mental health than White Americans, which is puzzling, given their exposure to interpersonal and structural racism and discrimination. To determine if this paradoxical mental health patterning occurs within the context of rurality, we used zero-inflated negative binomial regression to model 2015–2019 North Carolina Behavioral Risk Factor Surveillance System respondents' self-reported days with stress, depression, and problems with emotions (“mentally unhealthy days”) in the past 30 days. The rate of mentally unhealthy days was 1.10 times as great for rural respondents than nonrural respondents (95% CI 1.04–1.17, p ​= ​0.002), in the negative binomial portion of the model. However, this relationship was moderated by racial identity. Rural White respondents had 1.26 times as many mentally unhealthy days as rural Black, nonrural Black, and nonrural White respondents (95% CI 1.08–1.47, p ​= ​0.003). Probing the interaction of rurality and racial identity indicated that rural residence was associated with more mentally unhealthy days for White respondents and fewer mentally unhealthy days for Black respondents. Because of expectations that are rooted in the social system of whiteness, we posit that White Americans' mental health could be more susceptible to the barriers to mental health that are associated with rural residence. Our findings also suggest that it may be insufficient to examine the association between rurality and mental health without documenting how health is experienced across racial groups. This study enhances understanding of potential social determinants that could underlie Black-White racial patterning in mental health. To advance rural health promotion and health care delivery, future research should investigate which underlying determinants may facilitate mental wellbeing for rural Black Americans and identify which mechanisms influence rural White Americans' relative mental health deficit.

Acknowledging the Role of Community Health Workers in Providing Essential Healthcare Services in Rural India-A Review.

In underserved communities, the community health worker (CHW) concept has been employed to improve health and lessen unfavourable health consequences. In India's rural healthcare delivery system, auxiliary nurse midwives (ANMs), accredited social health activists (ASHA workers), and Anganwadi workers (AWWs) are the primary field-level frontline officials who come into direct contact with the population. They bear a large portion of the burden of carrying out health services. This review investigated the various contributions made by these CHWs, ANMs, ASHA workers, and AWWs to the advancement of basic healthcare in Indian rural areas. The goal of reviewing this paper was to learn more about what CHWs do to provide the target demographic with high-quality healthcare. A thorough literature search was conducted using crucial databases including PubMed, Google, and Google Scholar. Recent studies were examined to determine how well CHWs perform essential healthcare services in low and middle-income nations. Numerous studies demonstrate how their work has a good effect on society. The length of time CHWs spend at work each day and how well they perform as a whole depends on several variables. This review study showed that, globally, there is a growing interest in CHWs' performance. In terms of incentives, pay, and training expenses, CHWs are thought to be a more affordable option than other types of health workers. They are recognised as the main factors in providing promotive, preventive, curative and rehabilitative healthcare services, achieving enhanced neonatal and maternal health and the development of children and adolescents. The current review also examined previous studies on the work done by CHWs and their potential benefits for enhancing primary healthcare in rural India. It focused on the routine work done by these health workers to increase service accessibility and access to high-quality healthcare, particularly for individuals living in rural areas. Hence, it is necessary to evaluate the functions and general status of community health workers (CHWs), as well as recognise their role, to improve their efficiency in providing basic healthcare services to society and make necessary changes in the future.

An Appraisal of Prevailing Issues in Rural Tribal Health Care System in India

Better health is one of the most important aspect of the overall development and progress of any country. In the context of India, tribals are an integral part, which are 8.6 percent of the total population of the country. Scarce public health care services in India and related issues are currently the most discussed topic with recent outbreak of Covid-19 affecting human life terribly and still persisting. Health care issue affects every individual in the society. In tribal areas health care issues become even more important because as it seems that this section of society is still comparatively in unprivileged condition and not properly exploited the benefits of development process.India's development cannot be imagined without improvement of rural and tribal health. This article highlights major issues prevailing in the rural tribal health care system of India, which arises many barriers to tribal health and the holistic development of the country. Based on the blending results of several multi-factual studies, it is known that there exist many issues prevailingin the rural tribal health care delivery system. Many issues are there which are responsible for poor and complex tribal health status among the tribes, such as, low awareness about health, different religious and cultural beliefs, unrealistic health practices, living in difficult and inaccessible areas, financial problems, various infectious diseases, nutritional deficiencies, and poor public health care facilities, etc. These issues have attracted renewed attention from physicians, health policy experts, various health agencies as well as the general public, particularly tribal societies, which are most affected by these issues. Keywords: Health Status; Health Infrastructure; Rural Health Care Services; Tribal Culture And Practices; Health Policy; Public Involvement And Awareness.

Rural healthcare delivery and maternal and infant outcomes for diabetes in pregnancy: A systematic review.

AimThe aim of this systematic review was to examine the literature regarding rural healthcare delivery for women with any type of diabetes in pregnancy, and subsequent maternal and infant outcomes.MethodsEight databases were searched in September 2020, including Medline, EMCare, CINAHL, EMBASE, Maternity and Infant Care, Cochrane, Rural and Remote Health and Aboriginal and Torres Strait Islander Health bibliography. Studies from high‐income countries in rural, regional or remote areas with interventions conducted during the antenatal period were included. Intervention details were reported using the template for intervention description and replication template. Two reviewers independently assessed for risk of bias using the RoB2 and ROBINS I tools.ResultsThree articles met the inclusion criteria: two conducted in Australia and one in the United States. A multidisciplinary approach was reported in two of the included studies, which were modified specifically for their respective rural settings. All three studies reported rates of caesarean section, birthweight (grams) and gestational age at birth as maternal and infant outcomes. One study was considered at moderate risk of bias, and two studies were at serious risk of bias.ConclusionThere is a significant gap in research relating to healthcare delivery for women with diabetes in pregnancy in rural areas. This lack of research is concerning given that 19% of individuals in high‐income countries reside rurally. Further research is required to understand the implications of healthcare delivery models for diabetes in pregnancy in rural areas.

Rural-urban disparities in mortality from gastrointestinal (GI) cancer.

644 Background: There are notable economic, social, and political challenges to rural healthcare delivery in the US. Patients with GI cancer have high symptom burden and complex needs, challenging healthcare infrastructure. We investigated U.S. rural-urban disparities in age-adjusted mortality rates (AAMRs) from GI cancers. Methods: We utilized the CDC Wonder database to analyze deaths from GI cancer from 1999 to 2019. Per the 2013 US Census classification, we created population categories using the NCHS Urban-Rural Classification Scheme: large metropolitan (population, ≥1 million), small-or-medium-sized metropolitan (50,000-999 999), and rural (&lt;50,000) areas. We calculated AAMRs and stratified results by age, sex, and race/ethnicity. We estimated annual percentage change (APC) in AAMR using a linear regression model of the log-scale with interactions between subgroup and year to examine differential changes over time. Results: We identified 3,020,133 deaths from GI cancers. The overall APC in AAMR was -0.9%, 95%CI, -0.8 to -1.0%. Rural areas noted least improvement in AAMR (APC, -0.6%; 95% CI, -0.4 to -0.6%, interaction p &lt; 0.001) compared to large (APC, -1.2%; 95% CI, -1.1 to -1.3%) and small-or-medium-sized (APC, -0.8%; 95% CI - 0.7 to -0.9%) metropolitans. AAMR in rural areas decreased from 49.2/100,000 in 1999 to 43.8/100,000 in 2019 (p &lt; 0.001; 2019 rural AAMR was highest across all areas) (Table). Across all areas, men had greater AAMRs (p&lt;0.001) and lower reduction in APC (interaction p &lt; 0.001) than women. Non-Hispanic Black individuals (NHBs) had highest AAMRs among all racial/ethnic groups and across all areas (p&lt;0.001). Among those with age≥65 years, NHBs had the highest AAMRs; 367.3/100,000 in 1999 and 266.7/100,000 in 2019, and NHBs living in rural areas had the lowest APC. All racial/ethnic groups saw reductions in AAMRs across all areas. Conclusions: In this national analysis over 2 decades, rural residents with GI cancer experienced greater mortality, and the least improvement in mortality over time. Our findings support ongoing congressional policy to urgently develop infrastructure and improve cancer care access in rural areas. [Table: see text]

Development and initial validity and reliability of the Rural Practice Awareness and Skills Scale.

The purpose of this study was to develop and provide initial evidence of the validity and reliability of the Rural Practice Awareness and Skills Scale (RPASS). A pool of 63 items was reviewed by an expert panel, subjected to 2 additional face validity checks, and reduced to 39 items. The scale was then completed by 333 participants, and an exploratory factor analysis and confirmatory factor analysis were conducted. Results revealed a 3-factor, 20-item scale with evidence of reliability and convergent validity. RPASS has utility for advancing research to support recruitment and retention of rural health providers and ultimately enhance rural health care delivery.

Abstract 12773: Sources of Health Information and Health-Seeking Patterns of Filipinos in Rural Communities in the Philippines

Background: Rural healthcare delivery and access have various obstacles due to limited infrastructure for health promotion, limited health information sources, reliance on medical advice from multiple sources, and a lack of skilled rural healthcare practitioners. The disparity in access to healthcare is ultimately why healthcare in rural communities is inadequate. Aims: This cross-sectional study describes sources of health information and health-seeking behaviors (e.g., type of healthcare provider, response to illness) of adults (aged ≥ 18) living in rural, largely underserved communities in the Philippines. Methods: Participants completed a survey assessing health information sources and health-seeking habits. Descriptive statistics and χ 2 -tests were used to compare age groups (young vs. old 60]) and sex. Results: Surveys were completed by 1203 persons (65% female, age 50 ±18 years). The preferred source of health information was friends and family (57%), followed by social media (28%) and healthcare providers (15%). Participants said they sought healthcare largely from physicians (60%), herbalists (12%), nurses (5%), and quack doctors (5%) or a combination of providers (12%). When they were ill, the majority (70%) visited a healthcare provider, while 48%, 39%, and 30% self-medicate, sought advice from a rural health clinic, or pray, respectively. There were no variations in the sources of information, care provider preferences, or illness response between the sexes. Younger persons were more inclined to seek health information on social media and from a physician. By contrast, older persons were more likely to seek advice from friends and relatives and contact a herbalist or quack physician. Conclusions: Our results highlight the need for well-structured programs and campaigns to address the population's demands understandably. Additionally, it emphasizes the importance of enhancing the quality of information available to rural communities and integrating friends and relatives, social media, and healthcare providers to provide evidence-based health information. Finally, more research is required to identify why so many people sought medical advice from friends and family members rather than licensed healthcare professionals.

Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs: A Systematic Review.

In the unique context of rural Veterans' health care needs, expansion of US Department of Veterans Affairs and Community Care programs under the MISSION Act, and the uncertainties of coronavirus disease 2019 (COVID-19), it is critical to understand what may support effective interorganizational care coordination for increased access to high-quality care. We conducted a systematic review to examine the interorganizational care coordination initiatives that Veterans Affairs (VA) and community partners have pursued in caring for rural Veterans, including challenges and opportunities, organizational domains shaping care coordination, and among these, initiatives that improve or impede health care outcomes. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search 2 electronic databases (PubMed and Embase) for peer-reviewed articles published between January 2009 and May 2020. Building on prior research, we conducted a systematic review. Sixteen articles met our criteria. Each captured a unique health care focus while examining common challenges. Four organizational domains emerged: policy and administration, culture, mechanisms, and relational practices. Exemplars highlight how initiatives improve or impede rural health care delivery. This is the first systematic review, to our knowledge, examining interorganizational care coordination of rural Veterans by VA and Community Care programs. Results provide exemplars of interorganizational care coordination domains and program effectiveness. It suggests that partners' efforts to align their coordination domains can improve health care, with rurality serving as a critical contextual factor. Findings are important for policies, practices, and research of VA and Community Care partners committed to improving access and health care for rural Veterans.

Strategic Implications of COVID-19: Considerations for Georgia’s Rural Health Providers

Whether rural hospitals and providers have seen a surge in COVID-19 cases or a reduction in patients seeking care since the pandemic began, their financial condition has been negatively impacted. Many providers have now received some emergency funding through the Coronavirus Aid, Relief, and Economic Security Act and the Payroll Protection Program but these are likely only short-term fixes. For many, the crisis has exacerbated already existing problems. Notable among these problems are volume declines, supply chain disruptions, and workforce concerns. While these problems require immediate action, two longer-term systemic changes to rural healthcare delivery are needed to address them. Proactive adoption of telehealth is essential to stake a value-added position in delivery of healthcare. Creating a regional ecosystem that both supports, and receives support from, local businesses and potential workforce members is vital to building and maintaining a thriving organization. Rural healthcare providers must consider these strategies to ensure that they are able to continue delivering their mission of improving the health of the populations they serve.