Journal of Rural Health最新文献

{"title":"Rural Patients’ Transitional Care Experiences: A Qualitative Analysis of Provider Notes","authors":"Samantha B. Randolph,&nbsp;Nicholas A. Rattray,&nbsp;Claire E. Donnelly,&nbsp;Mindy E. Flanagan,&nbsp;Laura J. Myers,&nbsp;Joanne Daggy,&nbsp;Cathy C. Schubert,&nbsp;Scotte R. Hartronft,&nbsp;Peter Kaboli,&nbsp;Dawn M. Bravata","doi":"10.1111/jrh.70225","DOIUrl":"https://doi.org/10.1111/jrh.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural patients face an increased risk of 30-day mortality after hospitalization, compared to their urban counterparts. The Department of Veterans Affairs (VA) Geriatric Learning Health System's operational partners sought to identify care-related and contextual factors associated with mortality among rural patients being discharged from hospital to home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined clinical notes from medical records of 200 (<i>N</i> = 100 rural; <i>N</i> = 100 urban) Veterans ≥65 years-old who were discharged alive to home after a medical or neurological index admission but who died within 30 days of discharge. Text related to the post-discharge course was abstracted verbatim for qualitative analysis. Inductive and deductive codes were used to generate themes describing features of patients’ experiences from hospital discharge to death. Cases exemplifying qualitative themes were identified to represent findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Three themes described key elements of patients’ journeys from discharge to end of life that distinguished rural patients’ experiences from urban patients: geographic distance barriers to accessing care settings (i.e., lengthy drive times), declining the offer of home health services, and high caregiver burden. These experiences negatively impacted patients—contributing to moments of discordance and uncertainty among the patients, care team, and caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural patients faced unique challenges during their transitional journeys. These findings provide targets for future studies seeking to reduce rural–urban disparities mortality for community-dwelling older patients transitioning from hospital to home.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146402","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":"Adoption of AI and its Use Cases in Urban and Rural Hospitals","authors":"Nicole M. Summers-Gabr","doi":"10.1111/jrh.70224","DOIUrl":"10.1111/jrh.70224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>AI can support hospitals’ business workflow as well as their patient care. This study investigates whether rural hospitals' AI adoption is influenced by their proximity to metro areas, which often offer better infrastructure, skilled labor, and other resources, with particular attention to differences across individual clinical and business operation use cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the 2024 American Hospital Association's Annual Survey (<i>n</i> = 6173 hospitals), the likelihood of AI adoption for eight clinical and six business uses by geography was explored. Hospital ownership type and size were controlled. Geography was determined at the county level and used the Rural–Urban Continuum Code (RUCC), with metropolitan hospitals as 1–3, non-metro or rural as 4–9, and then non-metro and rural were further divided by metro adjacency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Across the country, almost 30% of hospitals adopted AI for clinical tasks and 26% adopted AI for administrative tasks. However, the farther a hospital was from a metro area, the less frequently it adopted AI. Compared to metro hospitals, non-metro metro-adjacent hospitals were 29.6% less likely (odds ratio [OR] = 0.70, confidence interval [CI]: 0.53–0.93, <i>p</i> &lt; 0.05) and non-metro not-adjacent hospitals were 61.7% (OR = 0.38, CI: 0.26–0.52, <i>p</i> &lt; .001) less likely to use AI for clinical purposes. As for administrative uses, compared to metro hospitals, non-metro metro-adjacent hospitals were 48.9% (OR = 0.51, CI: 0.40–0.66, <i>p</i> &lt; 0.001) less likely and non-metro not-adjacent hospitals were 70.4% (OR = 0.30, CI: 0.22–0.39, <i>p</i> &lt; 0.001) less likely to use AI. This same pattern persisted for most individual-use cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI adoption remains limited in hospitals, particularly in non-metro areas. The impact on adoption rate differences is unclear, but it is an important consideration moving forward to reduce urban–rural health disparities and improve business operations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076491","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":"Methadone Versus Buprenorphine/Naloxone: Treatment Outcome Differences Among Individuals Receiving Medications for Opioid Use Disorders in Rural Treatment Settings—A 1-Year Retrospective Cohort Study","authors":"Anna MacCamy,&nbsp;Lisa Khairy,&nbsp;Tara Wasser,&nbsp;Gurkanwal Gill,&nbsp;Leslie Kenefick,&nbsp;Alex Schmidt,&nbsp;Nicole Akana,&nbsp;Luke Hall,&nbsp;Kibeom Kwon,&nbsp;Nicole Limberg,&nbsp;Kirsi Kirk-Lewis,&nbsp;Megan Lewis,&nbsp;Matt Owen,&nbsp;Sterling M. McPherson,&nbsp;André Q. Miguel","doi":"10.1111/jrh.70219","DOIUrl":"10.1111/jrh.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medication for opioid use disorder (MOUD) is the gold standard of treatment for opioid use disorder (OUD). Methadone and buprenorphine have shown to be the most effective MOUD, yet little is known about the compared efficacy when treating OUD in community-based rural treatment settings. This study aims to explore treatment outcome differences among patients initiating methadone or buprenorphine/naloxone in community-based rural treatment programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data for this 1-year retrospective cohort study were extracted from electronic medical records of 561 individuals initiating treatment between January 2019 and December 2019 at four MOUD clinics located in rural Oregon. Between-group comparisons were conducted using chi-square for dichotomous variables and ANOVA for continuous variables. Kaplan Meier and generalized estimating equations were used to determine treatment retention and opioid use over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 561 patients, 74.5% were dispensed methadone while 25.5% were prescribed buprenorphine/naloxone. Those dispensed methadone were more likely to be unemployed (57.7% vs. 44.8%, <i>p</i> = 0.01) and diagnosed with severe OUD (93.5% vs. 83.9%, <i>p</i> = 0.04). There were no significant group differences on other treatment intake demographics nor opioid use or treatment retention over a 12-month period. Clinic site was a significant predictor of proportion of negative urine tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both methadone and buprenorphine/naloxone performed comparably well in reducing opioid use and retaining patients in treatment. In comparison to medication type, clinical site and time in treatment had a larger impact on participant outcomes. These findings suggest that the use of both methadone and buprenorphine/naloxone should be encouraged in the context of rural MOUD treatment programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076483","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 Rural WAVE (Wellness and Veteran Engagement) Initiative","authors":"Kimber J. Parry,&nbsp;Colleen M. Blue,&nbsp;Sabrina C. Clark,&nbsp;Jennifer L. Conzemius,&nbsp;J. Hale-Gallardo,&nbsp;Lotoya Halliburton,&nbsp;Bret L. Hicken,&nbsp;Tiera J. Lanford-Davey,&nbsp;Chanee Lynch,&nbsp;Jonathan W. Miao,&nbsp;Yolaunda Mincey,&nbsp;Wesley R. Walls,&nbsp;G. Michael White,&nbsp;Nathan Witt,&nbsp;Heather A. King","doi":"10.1111/jrh.70211","DOIUrl":"10.1111/jrh.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Up to 70% of Veterans experience challenges with community reintegration. Volunteerism is associated with increased community connection, improved mental health, and lower suicide rates. However, volunteer opportunities are sometimes limited in rural areas. The Rural WAVE (Wellness and Veteran Engagement) Initiative was developed for the Department of Veterans Affairs (VA) Center for Development &amp; Civic Engagement (CDCE) and aims to connect Veterans in rural areas to volunteer activities in local communities. This brief report describes Rural WAVE and the main findings from its evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed-methods evaluation of Rural WAVE was informed by the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework and includes event and volunteer activity administrative data, volunteer (civilian and Veteran) and VA staff interviews, and site visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Since launching in 2021, 17 Veteran Health Administration (VHA) facilities have adopted Rural WAVE. As of October 2025, outcomes included 223 activities/events, 111 volunteers, 2944 volunteer hours, and 3388 rural Veteran contacts. Rural Veteran volunteers reported improved mental health, a sense of purpose and meaning, and opportunities for camaraderie with other Veterans. CDCE staff reported improved accountability and motivation fostered by regular meetings with other sites, which promoted progress, idea sharing, and improved morale. Project site visits facilitated evaluation, strengthened relationships, and increased the Initiative's visibility among VA leadership.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural WAVE positively impacts Veteran and civilian volunteers and site staff. CDCE adopted Rural WAVE as part of their national programming in October 2025, achieving a sustainable future and new opportunities for growth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076506","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":"The Potential Role of Nonclinical Patient Support Service Staff in Reducing Emergency Department Visits and Hospitalizations of Urban and Rural Patients of Health Centers Funded by the Health Resources and Services Administration","authors":"Nadereh Pourat,&nbsp;Weihao Zhou,&nbsp;Leigh Ann Haley,&nbsp;Alison Feise,&nbsp;Jamie Ryan","doi":"10.1111/jrh.70223","DOIUrl":"10.1111/jrh.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Payers such as Medicaid are concerned about high rates of potentially avoidable acute care utilization by beneficiaries called high-need, high-cost (HNHC) and frequently seen by Health Resources and Services Administration-funded health centers. Yet, health center HNHC patients have comparatively lower acute care utilization than patients of other primary care providers, possibly due to better access to nonclinical staff who provide patient support services, such as care coordination and self-management education. Furthermore, rural areas face provider shortages that may impact staffing capacity. We examined the association between capacity of staff who provide patient support services and rates of emergency department (ED) visits and hospitalizations at health centers by urban-rural status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used number of full-time equivalent (FTE) outreach workers and patient and community education specialists reported in the Uniform Data System with Medicaid claims data for HNHC Medicaid beneficiaries in California. We developed a negative binomial regression model to assess this relationship, accounting for patient demographics and health status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We found a reduced rate of ED visits per patient per year given 4 or more hours per week of outreach workers versus none overall (−0.24) and for health center patients in rural areas (−1.02). Similarly, 4 or more hours per week of patient and community education specialists versus none was associated with fewer hospitalizations overall (−0.04) and among patients of urban (−0.04) health centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings suggest more care coordination and patient self-management education capacity at primary care providers may be correlated with reduced acute care utilization in rural and urban areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076552","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":"Comparing Physicians’ Perceptions of Access to Behavioral Health Resources in Rural and Urban Practices","authors":"C. Holly A. Andrilla,&nbsp;Natalia V. Oster,&nbsp;Xiaochu Hu,&nbsp;Rosha McCoy,&nbsp;Nailah Russell,&nbsp;Jennifer Faerberg,&nbsp;Michael Dill,&nbsp;Bianca K. Frogner","doi":"10.1111/jrh.70226","DOIUrl":"10.1111/jrh.70226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural communities face persistent shortages of behavioral health clinicians, requiring primary care physicians to assume expanded mental health care roles. Our study assessed physicians’ access to behavioral health resources, such as referral networks, licensed and non-licensed mental health providers, and telehealth supports, and examined whether perceived sufficiency of access upon referral differs between rural and urban physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the 2022 National Sample Survey of Physicians, a nationally representative survey of active US physicians. Practice ZIP Codes were categorized as rural or urban using Rural Urban Commuting Area (RUCA) codes. Descriptive statistics were calculated, and weighted logistic regression assessed the association between rurality and physician perceived sufficiency for mental health providers upon referral. Models were adjusted for physician demographics, specialty, and practice characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Most respondents practiced in urban settings (93.1%). Fewer than half of physicians (38.1%) reported access to licensed mental health providers, and only 10% reported access to call-in services or non-licensed support providers. A quarter (24.4%) of respondents agreed that patients had sufficient access upon referral. Rural physicians more often reported referral relationships with accessible mental health providers (55.3% vs. 44.5%). In adjusted models, rurality was not associated with sufficient access to behavioral health services upon referral.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While rural behavioral health workforce shortages receive much attention, both rural and urban physicians reported limited access to mental health resources. These findings highlight gaps in behavioral health infrastructure across geographical settings and opportunities to strengthen referral networks, telehealth support, and integration of mental health services across practice settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076480","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":"Medical Debt Among Insured Adults: The Impact of Insurance and Transportation Barriers by Metropolitan Status","authors":"Jacqueline Wiltshire,&nbsp;Edlin Garcia Colato,&nbsp;Kayla Torres Benson,&nbsp;Caress Dean,&nbsp;Dale Sanders","doi":"10.1111/jrh.70221","DOIUrl":"10.1111/jrh.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medical debt is a significant barrier to health equity in the United States, disproportionately affecting rural populations. Understanding how insurance and transportation barriers contribute to this burden is critical for informing interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using 2022 Health Reform Monitoring Survey data (<i>N</i> = 7761), we applied generalized linear models (GLMs) to examine associations of insurance-related and transportation barriers with medical debt among insured adults. Analyses assessed whether these relationships varied by metropolitan statistical area (MSA) status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Overall, 18.2% of respondents had medical debt, with prevalence higher among nonmetropolitan than metropolitan residents (24.2% vs. 17.4%, <i>p</i> &lt; 0.001). Insurance-related barriers were prevalent: 10.4% could not get authorization for care, 9.5% could not find providers accepting their insurance, and 8.0% did not receive health plan information. Transportation difficulties affected 3.7% of respondents and were more common among nonmetropolitan residents (4.9% vs. 3.6%, <i>p</i> = 0.049). In adjusted models, nonmetropolitan residents had a 17% higher risk of medical debt than metropolitan residents (RR = 1.17, 95% CI: 1.01–1.35, <i>p</i> = 0.037, where RR stands for risk ratio). Insurance authorization, provider acceptance, and health plan information barriers were associated with greater medical debt (RR range: 1.34–1.46, all <i>p</i> &lt; 0.01). Insurance authorization and transportation barriers were associated with medical debt among nonmetropolitan residents, with no significant interaction by MSA status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Medical debt among insured adults is more prevalent among nonmetropolitan residents and is associated with insurance-related access barriers. Policies that streamline insurance procedures and improve transportation may help reduce financial hardship and advance rural health equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070455","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":"National Trends in Emergency Department Boarding and Interfacility Transfers by Rurality","authors":"Elizabeth S. Bermudez,&nbsp;Aidan Mullen,&nbsp;Nicholas M. Mohr,&nbsp;Molly Jeffery","doi":"10.1111/jrh.70222","DOIUrl":"https://doi.org/10.1111/jrh.70222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Emergency department (ED) boarding negatively impacts patient care nationwide. Rural hospitals are uniquely challenged as ED volumes increase despite declining inpatient capacity. Interfacility transfers are a growing component of rural ED operations and remain underexamined in evaluation of ED boarding. This study assessed trends in ED boarding and interfacility transfers by rurality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We conducted a repeated cross-sectional analysis using National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2001 to 2022 and a health system from 2019 to 2025. Outcomes included (1) yearly ED boarding proportions stratified by disposition and rurality and (2) yearly interfacility transfer proportions by rurality. We defined rurality using Metropolitan Statistical Area and Rural-Urban Commuting Area codes. Results were further stratified by medical and behavioral health patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>National ED boarding increased from 5.1% in 2001 to 11.3% in 2022, significant in urban (annual percentage change [APC] 5.3%, 95% CI 3.8%–6.8%) and rural (APC 9.1%, 5.1%–13.1%) hospitals. Health system ED boarding increased from 4.1% in 2019 to 10.8% in 2025, significant in urban (APC 13.6%, 7.1%–20.6%) and rural (APC 31.2%, 16.3%–48.1%) hospitals. ED boarding was highest for behavioral health transfers and increased significantly in rural health system hospitals. Health system medical transfer ED boarding increased faster in rural hospitals (<i>p</i> = 0.002), and annual medical transfer proportions were higher in rural EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ED boarding is increasing nationally. Rural transfer proportions exceed that of urban EDs and are an overlooked component of rural ED boarding. These findings have important policy implications with recent reimbursement changes and national boarding quality measures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149028990","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":"Administrative Capacity and Equity in Rural Health Funding: A Policy Analysis of HRSA's Rural Health Network Development Program.","authors":"Arissa M Spitalny, Angie R Wootton","doi":"10.1111/jrh.70243","DOIUrl":"https://doi.org/10.1111/jrh.70243","url":null,"abstract":"<p><strong>Purpose: </strong>Rural communities face health inequities driven by poverty, workforce shortages, transportation barriers, and fragmented access to preventive and specialty medical care. The Rural Health Network Development (RHND) Program, funded by the Health Resources and Services Administration's Federal Office of Rural Health Policy, supports integrated rural health networks that collaborate to achieve efficiencies, expand access, coordinate services, and improve outcomes.</p><p><strong>Methods: </strong>A qualitative policy analysis was conducted to examine how RHND's competitive design and administrative requirements distribute benefits and burdens, and whether they expand rural residents' opportunities to attain health care and access health care systems. The analysis drew on publicly available federal policy and program materials, including statutory authority, HRSA Notices of Funding Opportunity, performance reporting guidance, FY2025 rural health grant award information, federal program evaluations, and relevant peer-reviewed research. Using New York as an illustrative case example, the analysis examined how funding design shapes participation, administrative burden, and equity across rural organizations and communities.</p><p><strong>Findings: </strong>Participation constraints for lower-capacity organizations, compliance burdens, and limited institutionalized community engagement were identified. This suggests that RHND's current design may favor organizations with greater administrative readiness while creating barriers for smaller or lower-capacity rural providers.</p><p><strong>Conclusions: </strong>More equitable review structures, capacity-adjusted reporting, and stronger community participation mechanisms could better align RHND with its goals. Without such reforms, RHND risks reproducing inequity through policy design rather than reducing it through investment.</p>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289685","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":"Geographic Access to Low-Dose CT Lung Cancer Screening in Tennessee: Disparities by Socioeconomic Variables, Rurality, and Appalachian Status","authors":"Sima Namin,&nbsp;Martin Whiteside,&nbsp;R. Eric Heidel,&nbsp;Jonathan S. Wall,&nbsp;Jennifer Ferris,&nbsp;Rajiv Dhand","doi":"10.1111/jrh.70202","DOIUrl":"10.1111/jrh.70202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lung cancer screening enables earlier detection and improved outcomes, yet geographic inequities persist in access to low-dose computed tomography (LDCT). We quantified tract-level access to LDCT screening in Tennessee and examined disparities by rurality and Appalachian status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compiled an inventory of LDCT-capable sites and measured access using a 30-min enhanced two-step floating catchment area (E2SFCA) index with three banded decay weights. Access was compared across four strata (urban Appalachia, rural Appalachia, urban non-Appalachia, and rural non-Appalachia) using Kruskal–Wallis and pairwise Wilcoxon tests (Holm adjustment). Rank-based associations between E2SFCA and tract sociodemographics were evaluated using Spearman correlations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 198 LDCT sites in Tennessee. Urban residents account for 74.10% of those living within ≤20 min, whereas rural residents constitute the majority (63.50%) of the 30–45-min band. Access differed across strata (Kruskal–Wallis <i>χ</i>² = 277.46, <i>p </i>&lt; 2.2 × 10⁻¹⁶): Medians (per 1000) were highest in urban non-Appalachia (0.464) and urban Appalachia (0.430), and lower in rural Appalachia (0.210) and rural non-Appalachia (0.197); all urban–rural contrasts were significant. Regional patterns diverged: West Tennessee showed the largest coverage gap (13.9% zero-access tracts), East Tennessee had the lowest capacity among served tracts (median = 0.339; overall median = 0.293), and Middle Tennessee showed the strongest overall access (overall median = 0.380; 73/647 zero-access; 11.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural communities face longer travel times to access LDCT screening sites with more zero-access tracts than urban communities. Our findings support interventions such as adding service points in West Tennessee and expanding capacity in East Tennessee. Strengthening navigation and referral pathways for rural and Appalachian residents is also necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698154","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}