Health Services Research & Development

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The Health Needs of Rural Veterans

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.