Journal of Rural Health最新文献

{"title":"Rural and Urban Disparities in Healthcare Utilization and Cost at the End-of-Life in Quebec: A Retrospective Study.","authors":"Delphine Bosson-Rieutort, Juliette Duc, Jean-Frédéric Boulianne, Sébastien Barbat-Artigas, Erin C Strumpf","doi":"10.1111/jrh.70143","DOIUrl":"10.1111/jrh.70143","url":null,"abstract":"<p><strong>Background: </strong>The end-of-life (EoL) is a critical period as individuals can face multiple health problems, increasing healthcare utilization and cost. Knowing that regional healthcare availability may contribute to some variations, we aimed to describe rural and urban disparities in healthcare utilization and costs during the last year of life among Quebec residents aged 66 years or older.</p><p><strong>Methods: </strong>We used a retrospective cohort of individuals who died between April 1, 2014 and March 31, 2018. Data included medical visits, emergency visits, hospitalizations, community care, and long-term care (LTC). Costs were extracted from administrative databases or financial reports and used to estimate total, health-related and social individual costs. Regions of residence were categorized as urban, mid-urban, mid-rural and rural. Generalized linear models were employed to examine variations in service utilization and cost.</p><p><strong>Results: </strong>The cohort comprised 21,117 individuals. Service utilization was generally higher for most health-related than social services. Regional differences in utilization were limited in primary care but variations were observed for LTC and community care. Conversely, average social costs, mostly driven by LTC, nearly doubled health-related costs. Additionally, costs differences between regions were mostly driven by increased utilization rather than higher fees.</p><p><strong>Conclusion: </strong>Some urban regions showed higher levels of service use and associated costs. However, this was not uniformly observed across all urban regions, nor were rural regions consistently associated with lower utilization or costs. Factors beyond urbanization level, such as individual healthcare needs, population characteristics or healthcare offer, are critical to understanding EoL service use and costs.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70143"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Rural Hospitals to Participate and Remain in Accountable Care Organizations.","authors":"Emily J Lawton, Jenah McCarty, Thomas E Vaughn, Fred Ullrich, Keith J Mueller","doi":"10.1111/jrh.70179","DOIUrl":"10.1111/jrh.70179","url":null,"abstract":"<p><strong>Purpose: </strong>Little is known about factors driving rural providers-who face unique challenges-to participate and remain in accountable care organization models. The purpose of this study was to investigate the specific factors that rural hospitals evaluate when weighing both initial and continued participation in Medicare as well as commercial ACO models. Furthermore, we explored policy implications to improve ACO models' capacity to attract, retain, and promote success of rural providers.</p><p><strong>Methods: </strong>Semistructured, in-depth interviews were conducted with rural hospital executives with direct knowledge of ACO agreement terms and factors driving ACO participation. The interview guide contained seventeen open-ended questions. Interviews were recorded, transcribed, coded using codebooks informed by the interview guide, and analyzed using a thematic analysis approach.</p><p><strong>Findings: </strong>Interviewees identified five primary multi-faceted motivations for participation: (1) financial incentives-shared savings, upside-only risk initially, and upfront funding for some providers, (2) getting ahead of the curve of the move to value-based reimbursement, (3) importance placed on capacity to push toward improving population health or quality, (4) additional forms of resource gain, and (5) key outside factors. The specific ACO design affects rural providers' decision-making on timing and selection of particular models. Importantly for future policy development, multiple respondents raised concerns about moving to risk in ACO models, leading them to consider dropping out.</p><p><strong>Conclusions: </strong>Findings from this qualitative study provide an in-depth understanding that is vital to achieving CMS's goal of increasing participation in value-based care. In turn, this could further improve health care quality for countless lives.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70179"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13251898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental Supports, Expectations, and Barriers to Leisure-Time Physical Activity During Pregnancy: A Rural-Urban Comparison.","authors":"Carly Williamson Rogers, Alex Crisp, Katrina Wilhite, Alexis Thrower, Elly Marshall, J P Marrero-Rivera, Jacob B Gallagher, Bethany Barone Gibbs, Kara M Whitaker, Sharon E Taverno Ross","doi":"10.1111/jrh.70166","DOIUrl":"10.1111/jrh.70166","url":null,"abstract":"<p><strong>Background: </strong>Physical activity (PA) during pregnancy has well-documented benefits, yet pregnant rural residents may face additional barriers to PA.</p><p><strong>Objective: </strong>To examine whether leisure-time physical activity (LTPA) and correlates of LTPA, including exercise outcome expectations, barriers, and environmental supports for PA, differ by rurality, and explore whether rurality moderates the associations between these correlates and LTPA during pregnancy.</p><p><strong>Methods: </strong>Pregnant individuals from Iowa and West Virginia (n = 374) completed questionnaires assessing LTPA, exercise outcome expectations and barriers during each trimester, and environmental supports for PA at the first trimester. Rurality status was categorized as urban, micropolitan, or small town rural using Rural-Urban Commuting Area codes. Robust linear mixed effects models included trimester as a fixed effect and a random intercept for participant. Environmental supports were analyzed using a robust linear model restricted to first-trimester data. Models were adjusted for site, age, pre-pregnancy body mass index, education, parity, and minority status.</p><p><strong>Results: </strong>In unadjusted models, small-town rural participants engaged in less LTPA than urban participants (9.02 vs. 12.14 MET-h/week, p = 0.021), though this was not significant after adjustment. Small-town rural participants reported fewer environmental supports for PA than urban participants (β = -0.42 SD, p = 0.002). Rurality did not moderate the associations between examined correlates and LTPA.</p><p><strong>Conclusions: </strong>Rurality was not associated with LTPA, exercise expectations, or barriers after adjustment. Although small-town rural participants reported fewer environmental supports for PA, this was not associated with LTPA, warranting further investigation in larger samples to determine whether improving environmental supports would translate into increased LTPA during pregnancy.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70166"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The National Physician Shortfall: Congress Steps Into the Breach.","authors":"Eli Y Adashi, I Glenn Cohen","doi":"10.1111/jrh.70150","DOIUrl":"10.1111/jrh.70150","url":null,"abstract":"<p><p>As recently as November 2024, the National Center for Health Workforce Analysis (NCHWA) of the Health Resources and Services Administration (HRSA) made note of the latest census data of U.S. physicians [1]. It was the conclusion of the NCHWA that the U.S. is presently home to a total of 933,788 \"professionally active\" physicians of whom 800,355 are \"reported as patient care practicing physicians [1].\" The NCHWA went on to project a \"shortage of 187,130 full-time equivalent (FTE) physicians in 2037\" as well as the possibility that \"nonmetro areas will experience greater shortages of physicians than metro areas [1].\" The NCHWA further estimates that \"75 million people live in a primary care Health Professional Shortage Area (HPSA)\" and that \"a total of 122 million people live in a mental health HPSA [1].\" Note was also made of the reality that \"the maldistribution of the health care workforce results in severe shortages in rural communities [1].\" Seeking to address the extant challenges, a bipartisan group of members of the Senate Committee on Finance stepped into the breach [2]. Led by Sen. Ron L. Wyden (D-OR), it was the intent of the Senators to introduce legislation that will assist teaching hospitals in the training of more physicians by reforming Medicare's Graduate Medical Education (GME) rules [2]. In this Commentary, we review the evolution of the aforementioned draft legislation as well as assess the likelihood of the materialization thereof.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70150"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Telehealth Use and Health Care Costs Among Rural Medicare Fee for Service Beneficiaries During the COVID-19 Pandemic.","authors":"Yvonne Jonk, Heidi O'Connor, Deborah Thayer","doi":"10.1111/jrh.70152","DOIUrl":"10.1111/jrh.70152","url":null,"abstract":"<p><strong>Purpose: </strong>To address rural-urban differences in health services use and costs among Medicare fee-for-service (FFS) beneficiaries by telehealth use before and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>The study population consisted of a nationally representative 5% sample of Medicare FFS beneficiaries aged 65 years and older during 2019-2020. Rural-Urban Continuum Codes identified rural-urban residential locations. Propensity scores were used to correct for selection bias and identify matching cohorts of telehealth and non-telehealth users. Differences in health services use and costs by telehealth use were addressed using difference in differences logistic and generalized linear models.</p><p><strong>Findings: </strong>Telehealth use curbed the decline in in-person outpatient visits for rural and urban beneficiaries early in the pandemic. During 2020, both rural and urban telehealth users had significantly lower probabilities of being hospitalized compared to 2019 (marginal effects [ME]: rural -0.22, urban -0.18), and were less likely to visit the emergency department (ED) (ME: rural -0.23, urban -0.20). Yet, telehealth users were more likely to be hospitalized than non-telehealth users during 2020 (ME: rural 0.018, urban 0.011) and more likely to visit the ED (ME: rural 0.032, urban 0.024). While total costs were significantly higher for telehealth users (rural $8484, urban $7272) than non-telehealth users (rural $6749, urban $5201) during 2020, total costs were reduced by a greater amount ($9200) for rural telehealth users than urban ($8000) and rural non-telehealth ($6900) counterparts.</p><p><strong>Conclusions: </strong>While telehealth users realized higher total costs of care in 2019-2020, rural telehealth users realized greater declines in total costs than rural non-telehealth users and urban beneficiaries.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70152"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring the Relational Playbook for Cardiology Teams to the Rural Hospital Medicine Setting: A Multi-Method Pre-Implementation Evaluation.","authors":"Heather M Gilmartin, Paige Perry, Brigid Connelly, Marguerite Daus, Amy Ladebue, Edward Hess, Brianne Morgan, John P Nolan, Heidi Sjoberg, Soumya Subramaniam, Melver L Anderson, Chelsea Leonard","doi":"10.1111/jrh.70165","DOIUrl":"10.1111/jrh.70165","url":null,"abstract":"<p><strong>Purpose: </strong>The Relational Playbook for Cardiology Teams is a 6-month, evidence-based leadership development program designed to foster supportive learning environments within the Veterans Health Administration (VA). The Playbook features 50 leadership practices and resources, including readings, clinical examples, videos, and podcasts for flexible, asynchronous learning. Participants complete monthly independent study and implement 11 interventions during team meetings or one-on-one interactions. While rural healthcare settings may benefit from the Playbook, adaptations are needed to ensure acceptability, appropriateness, and feasibility. This study aimed to tailor the Playbook for rural hospital medicine using a theory-informed multi-method pre-implementation approach.</p><p><strong>Methods: </strong>Clinical leaders in medicine, nursing, social work, and pharmacy were recruited from three rural VA hospitals. Facility-level data were drawn from the 2023 VA Support Service Center Capital Assets database and the VA Hospital Medicine Survey. Observational data from site visits were collected using a structured template and analyzed through team-based rapid qualitative content analysis.</p><p><strong>Findings: </strong>In 2024, we conducted three site visits at intermediate-complexity VA hospitals serving rural Veterans. Clinical leaders at each site reported potential barriers to engagement, including leadership instability, physician burnout, and limited time for professional development. Tailoring strategies were recommended, including expanding recruitment to all clinical leaders, streamlining site visits, and using publicly available data to contextualize site-specific challenges.</p><p><strong>Conclusion: </strong>A multi-method pre-implementation approach enabled effective adaptation of the Playbook, improving its relevance for rural settings. Early engagement and flexible implementation are key to successful adaptation. Future evaluation will assess impact on team dynamics and Veteran care.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70165"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Evaluation of a Telemedicine Pharmacist-Physician Management Model to Increase Access to Medication for Alcohol and Opioid Use Disorders for Rural Veterans.","authors":"Amy J Kennedy, Madeline C Frost, Carol A Malte, Olivia V Fletcher, Margaret Gray, Marie E Kenny, Amy W Liu, Simone Samawat, Toby I Sinton, Courtney Tuegel, Jessica J Wyse, Hildi J Hagedorn, Eric J Hawkins, Geetanjali Chander","doi":"10.1111/jrh.70158","DOIUrl":"10.1111/jrh.70158","url":null,"abstract":"<p><strong>Background: </strong>Alcohol and opioid use disorders (AUD, OUD) cause significant morbidity and mortality among Veterans, yet only a minority receive evidence-based treatment.</p><p><strong>Objective: </strong>Beginning in February 2022, we piloted a telemedicine pharmacist-physician management model (PPMM) in 6 Veterans Health Administration (VHA) primary care community-based outpatient clinics (CBOCs) across one VHA Health Care System to improve rural Veteran access to medications for opioid and alcohol use disorder (MOAD).</p><p><strong>Methods: </strong>Veterans with AUD and/or OUD receiving primary care in participating CBOCs during the year following implementation were eligible for referral. Data obtained from study records and VHA electronic health records assessed patient sociodemographic and clinical characteristics and MOAD receipt among referred Veterans.</p><p><strong>Results: </strong>There were 2274 Veterans diagnosed with AUD (n = 2062) and/or OUD (n = 307) receiving primary care from CBOCs during the study period. Of this population, 111 (4.9%) Veterans were referred and received PPMM services (AUD: n = 93; OUD: n = 9; AUD and OUD: n = 9), the mean age was 52 years, 92% were male, 68% White, and 39% lived in rural zip codes. Of the 102 Veterans referred to PPMM with AUD, 71% received medication. Of the 18 Veterans referred with OUD, 78% received medication. Most Veterans who were newly initiated on MOAD (N = 74) received medication within 72 h (N = 50, 68%).</p><p><strong>Conclusions: </strong>In this pilot implementation of same-day telemedicine PPMM, high rates of MOAD receipt were seen among referred Veterans. However, most Veterans with AUD/OUD seen in participating clinics were not referred. Further evaluation of barriers and/or facilitators to referral are needed to increase program uptake.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70158"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Well-Being and Occupational Class in Small Businesses in the Rural United States.","authors":"Laxmi D Adhikari, Sampada Wagle, Bhagyashree Katare","doi":"10.1111/jrh.70172","DOIUrl":"10.1111/jrh.70172","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the possible differences in psychological distress, depressive symptoms, level of stress, productivity, and anxiety among employees in blue-collar and white-collar occupational settings of small businesses in rural areas of the United States.</p><p><strong>Methods: </strong>Cross-sectional surveys were employed. Data were collected in 2024 from 1910 employees aged 18 years or older working in rural small businesses across the 48 contiguous US states, randomly selected from the panel maintained by the online survey company. Multiple linear regression and a linear probability model were used to assess the association between occupational class and employees' mental well-being.</p><p><strong>Findings: </strong>Employees in the blue-collar industry reported more frequent depressive symptoms (0.212, p < 0.01) and a higher level of anxiety before work (0.994, p < 0.01). Employees in the white-collar industry had a 7.9% higher probability of having work-related stress. However, no significant differences were observed in psychological distress, productivity, or work anxiety among employees in both blue-collar and white-collar industries. Demographic disparities were also observed in both occupational classes. Older employees were more productive. Work-related stress and anxiety were also significantly lower among older employees (50 to 64 years old and above). Female employees experienced depressive symptoms more frequently in blue-collar industries and reported greater work stress in white-collar industries.</p><p><strong>Conclusion: </strong>Occupational classes often shape employees' work perceptions, influencing their productivity and overall well-being. Understanding these class-based differences is essential to promoting employee well-being in rural small business settings in the United States.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70172"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-Level Medicaid Expansion and Hospital, Federally Qualified Health Center, and Rural Health Clinic Availability.","authors":"Elliott Paintsil, Sebastian Linde","doi":"10.1111/jrh.70159","DOIUrl":"10.1111/jrh.70159","url":null,"abstract":"<p><strong>Background: </strong>Medicaid expansion in early adopter states has been linked to reduced uncompensated care and improved financial stability of healthcare organizations; however, less is known about its longer-term effects, outcomes among later adopters, and differences across rural and urban settings.</p><p><strong>Objective: </strong>To examine the longer-term association between state Medicaid expansion and the availability of hospitals, federally qualified health centers (FQHCs), and rural health clinics (RHCs) in states expanding Medicaid in 2014, 2015, and 2016, and to assess differences across rural and urban counties.</p><p><strong>Design: </strong>We applied difference-in-differences methods for staggered policy adoption. Covariates included county population, median age, median household income, and racial/ethnic composition. Outcomes were the county-level total number of hospitals, FQHC sites, and RHC sites, analyzed for all counties and rural/urban subsamples.</p><p><strong>Setting: </strong>U.S. counties, during 2010-2019 period.</p><p><strong>Participants: </strong>Two thousand eight hundred and fourteen counties (1319 expansion; 1495 nonexpansion) across 44 states.</p><p><strong>Results: </strong>Medicaid expansion was associated with slightly more hospitals (0.094; 95% CI -0.003 to 0.190; p <0.1) and FQHC sites (0.511; 95% CI 0.214-0.807; p <0.01), but no significant change in RHC sites (-0.032; 95% CI -0.310 to 0.247). Relative to 2013, these correspond to county-level increases of 4.9% for hospitals and 26.7% for FQHCs. Effects appeared in both rural and urban areas, with larger relative gains in rural counties. Event-study plots indicated that effect sizes increased over time.</p><p><strong>Conclusion: </strong>Counties exposed to Medicaid expansion experienced sustained growth in hospital and FQHC presence, but not in RHCs, possibly reflecting supply side constraints. Policymakers should recognize that stabilization effects may strengthen gradually following expansion.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70159"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-Urban Differences in the Incorporation of Workforce Planning and Development in the Strategic Planning Process of US Hospitals.","authors":"Bettye A Apenteng, Samuel T Opoku, Samuel Anokye-Mensah, Carolyn Puobebe, Kwabena G Boakye, Linda Kimsey, Angela H Peden, Charles F Owens","doi":"10.1111/jrh.70168","DOIUrl":"10.1111/jrh.70168","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of healthcare systems relies on how well workforce planning and development strategies align with organizational goals, given the detrimental impact of workforce shortages on patient safety and healthcare quality. This study examines the determinants and rural-urban differences in the integration of workforce planning and development into strategic planning in US hospitals.</p><p><strong>Methods: </strong>Data for this study were obtained from the 2022 American Hospital Association Annual Survey and the 2021 Medicare Hospital Cost Report. The study outcome was measured with a composite score, calculated as the count of workforce planning and development activities incorporated into strategic planning. A Poisson regression analysis was conducted to identify the determinants of strategically aligned workforce planning and development, and to assess rural-urban differences.</p><p><strong>Results: </strong>Of the 2749 hospitals analyzed, most were urban, non-profit, and system-affiliated, with an average of 170 beds. Factors such as system affiliation and organizational size were positively linked to the incorporation of workforce planning into hospitals' strategic planning efforts. Conversely, for-profit ownership, critical access hospitals, and locations in the South were associated with less integration of workforce planning and development into strategic planning.</p><p><strong>Conclusion: </strong>Structural, institutional, and regional factors may influence the extent to which hospitals incorporate workforce planning and development in their strategic planning processes. Efforts to align workforce planning and development with strategic planning across US hospitals may require interventions to enhance institutional capacity and foster a culture of long-term planning for sustainability.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 2","pages":"e70168"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}