3095 — An Evidence Synthesis of Rural Health Care
Spoont MR (CCDOR), Greer NL
(CCDOR Minneapolis Evidence-based Synthesis Program), Fitzgerald PM
(CCDOR Minneapolis Evidence-based Synthesis Program), Su JC
(CCDOR), Wilt TJ
(CCDOR Minneapolis Evidence-based Synthesis Program)
There are approximately 3 million veterans enrolled in the VA health care system who live in rural areas; nearly 37% of the almost 8 million veterans who are current users of VA health care. Given that only 17% of US residents live in rural areas, rural residents are disproportionately represented among veterans using VA services. This trend is likely to continue, as more than one-third of OEF/OIF veterans are from rural areas. As part of the VA implementation of the Rural Veterans Care Act of 2006, and funded through the VA Evidence Synthesis Program, we conducted a systematic review of the literature between 1990 and early 2010 regarding potential disparities between rural and urban areas in health care provision and delivery. The review was intended to address key clinical questions for VHA’s Office of Rural Health.
We searched MEDLINE, PsycINFO, and CINAHL using standard search methodology from 1990 through March 2010.
We reviewed 1,492 abstracts. Of those, 127 met our inclusion criteria. Study reporting and results varied depending on patient and disease characteristics, outcome definitions, study design, and the definition of "rural" used in the study. Some areas of ambulatory care have been minimally researched, including areas that are important to the VA (e.g., traumatic brain injury).
Significant areas of rural health care remain understudied. Data of limited quality and quantity suggest that rural areas are generally disadvantaged relative to urban areas in terms of availability of specialists, provider expertise, and ease of primary care treatment access. However, assumptions about rural health care being of lesser quality are not uniformly supported by the evidence, and depend on the medical condition being considered, patient demographic characteristics, and outcome parameters being assessed.
Future research on rural health should fill in gaps in the evidence base. Research designs need to move away from documenting differences between rural and urban areas and focus on determining what health care differences underlie disparities in health outcomes, and which patients are most likely to experience those disparities.