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Of the 23 million Veterans in this country,
roughly 8 million are enrolled in the Veterans
Health Administration (VHA), and approximately
40 percent of these Veterans live in
rural and highly rural areas. Rural Veterans face
unique health care challenges for a variety of
reasons, including disparate access to higher
quality services, shortages in qualified health
professionals, and limited transportation options.
On average, these rural Veterans travel
between 60-120 minutes for inpatient care, and
30-90 minutes for primary care. This population
also has fewer financial resources compared
to urban Veterans. One-third of OEF/
OIF Veterans live in rural or highly rural areas;
three-fourths of rural Veterans are over the age
of 55.
The health needs of rural Veterans receive
more attention now due to greater commitment
and new resources within the VHA. The
Office of Rural Health (ORH) was established
in March 2007 in response to The Veterans
Benefits, Health Care and Information Technology
Act of 2006. ORH is part of the Office
of the Assistant Deputy Under Secretary for
Health (ADUSH) for Policy and Planning
(10A5), led by Patricia Vandenberg. ORH's
mission is to improve access to and quality of
care for enrolled rural Veterans by developing
evidence-based policies and innovative practices
that support the unique needs of those
residing in geographically rural areas. ORH
carries out its mission by working closely with
internal VA program offices, field units, rural
health experts, and partners to develop new
methods to provide the best possible solutions
to the challenges faced by Veterans living in
rural areas.
In fiscal year 2009, Public Law 110-329 appropriated
$250 million for new rural health
initiatives. Key major initiatives for this funding
include: national and local telehealth expansion,
Home Based Primary Care, local outreach
clinic expansion, community outreach,
rural provider outreach and education, rural
Veteran education, geriatric care, mental health
programs, women's health initiatives, and local
transportation programs. Many of these initiatives
are designed at the local level to target the
needs of specific rural and highly rural Veteran
populations. Also in 2009, Public Law 110-387
contained provisions for the development of
rural health pilot programs to further focus
on peer outreach and support for Veterans,
improved access to community mental health
centers and Indian Health Service facilities,
and enhanced contract care authority to better
involve private providers in the care of highly
rural Veterans.
An additional $250 million in rural health appropriations
was provided to ORH in fiscal
year 2010 to continue improving access to and
quality of care. These funds support a wide
variety of existing and new initiatives, including
the hiring of much needed health care professionals
in underserved areas, evaluating new
models and sites of care, purchasing telehealth
and other equipment, initiating new mobile
care units, providing education sessions for VA
and non-VA health professionals on local rural
Veteran needs, fee-based and contracted care,
and new rural Community-Based Outpatient
Clinics (CBOCs).
To assist in the implementation, maintenance,
and oversight of these initiatives, a network
of 21 regionally based VISN Rural Health
Consultants (VRCs) works directly with ORH
staff to support each VISN in managing their
rural health funded projects. In addition to the
VRCs, ORH established three Veterans Rural
Health Resource Centers located in Salt Lake
City, Utah; Iowa City, Iowa; and White River
Junction, Vermont. The Centers' goals include
conducting, coordinating, and disseminating
studies and analysis related to issues that
impact Veterans living in rural areas. Finally, a
16-member Veterans' Rural Health Advisory
Committee evaluates program activities, identifies
barriers to receiving services, and offers
recommendations for ORH policies that impact
rural Veteran care.
In order to demonstrate the impact of ORH
funding, in conjunction with other VA program
offices, ORH staff members are finalizing
a nationwide rural measurement strategy
that will include national measures and
VISN-level project measures. Links with relevant
HSR&D Centers of Excellence and
Quality Enhancement Research Initiative
(QUERI) groups will be an important part of
this process.
In my new role as Director of ORH, I plan to
continue these collaborative efforts by building
on 28 years of federal service at the Indian
Health Service (IHS) and with Tribal programs,
where I most recently served as Deputy
Director of the Office of Public Health Support.
I also worked in a variety of rural settings
as a nurse practitioner and public health nurse,
and had progressive leadership roles in the
field as well as at IHS headquarters. I received
my doctoral degree from The Johns Hopkins
University, with an emphasis in public health
management and policy. In addition to my
recent arrival, Sheila Warren, M.P.H., joined
ORH as Deputy Director this fall, and additional
staff members are coming on board to
help implement the goals and activities of the
office to meet the mission of ORH.
Our nation's rural and highly rural Veteran
population is large, dispersed, and racially,
ethnically, and culturally diverse. ORH will
continue to collaborate with numerous areas
of the VA, along with other government offices
and private organizations and partners,
to increase access to safe, effective, efficient,
and compassionate health care for this unique
group of Veterans.
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