OFFICE OF RURAL HEALTH STRUCTURE
To reduce barriers to care for rural Veterans, the Office of Rural Health (ORH) uses a "study, innovate, spread" approach centered on key issues (i.e., transportation, outreach, technology, workforce, special populations, case work) managed by program analysts. Additionally, ORH engages with several rual health affiliates.
The national Veterans Rural Health Resource Centers (VRHRC) are located at host VA Medical Centers in Togus, Maine; Iowa City, Iowa; and Salt Lake City, Utah. Each of the resource centers provides expertise on program innovation, studies and best practice dissemination. They also facilitate achievement of the legislatively enumerated functions (Public Law 109-461, Section 212 as amended by Public Law 112-54, Section 110):
- Improve understanding of the challenges faced by Veterans living in rural areas
- Identify disparities in the availability of health care to Veterans living in rural areas
- Formulate practices or programs to enhance the delivery of health care to Veterans living in rural areas
- Develop special practices and products for the benefit of Veterans living in rural areas and for implementation of such practices and products in the Department system wide
VRHRC functions include:
Administration and Operations - Oversee the day-to-day operation of the VRHRC, providing operations and clinical leadership, and administrative support
Studies - Respond to requests from ORH to prepare longer-term studies of matters affecting Veterans living in rural areas of the United States
Innovations - Develop and pilot test innovations in the delivery of care and services to rural Veterans, functioning as field-based "laboratories" for clinical and non-clinical pilot projects that address well-defined needs of Veterans living in rural communities
Promising Practices Dissemination and Technical Assistance
- Disseminate ORH Rural Promising Practices through mentored implementation to targeted stakeholders, inside and outside VA, that emerge from clinical and non-clinical pilot projects
- Provide technical assistance and program consultation on programs, pilots, projects and issues affecting rural Veterans to internal VA and external stakeholders
The National Rural Studies Team provides advice and expertise on rural Veteran studies and research. The team oversees the ORH rural research agenda and responds to requests for rapid-response issue briefs, short-term rural Veteran focused data analysis, and tasking for medium- to long-term rural focused studies. The team also analyzes and reports findings based on the Veterans Health Administration’s (VHA) annual Survey of Enrollees, as well as data from the U.S. Census Bureau, VA Office of the Actuary, VHA Support and Service Center, and a wide variety of other data sources.
The GeoSpatial Outcomes Division (GSOD) team applies geospatial solutions to support rural policy analysis, strategic planning, rural geographic database design, and implementation in support of rural Veteran health care.
The United States is divided into 18 Veterans Integrated Services Networks (VISN), each of which has a VISN Rural Consultant (VRC). VRCs serve as the primary interface between ORH and VISN rural activities. VRCs:
- Work closely with internal and external stakeholders in their respective VISNs to introduce, implement and evaluate rural projects, as well as report on the budget and effectiveness of each to ORH as appropriate.
- Facilitate information sharing regarding rural access issues within and across VISNs
- Advise ORH on matters affecting rural Veterans
As part of the 2015-2019 Rural Health Strategic Plan, the Office of Rural Health (ORH) and VA Health Services Research and Development (HSR&D) established the National Rural Evaluation Center (NREC). This Center will enable the U.S. Department of Veterans Affairs (VA) to better understand the needs of rural Veterans, and allocate resources and targeted solutions more effectively—as well as better measure outcomes. The NREC’s work will stem from the first of its kind national rural Veterans health needs assessment.
NREC's rural Veterans health needs assessment will:
- Help to better align VA resources to increase access, improve outcomes and reduce disparities among the rural Veteran population,
- Provide benchmarks for access, health outcomes, satisfaction and more, that ORH can use to better assess the effectiveness of its rural health programs
- Help identify areas of need that can be addressed by other federal, state, private and community-based entities that have Veteran focused programs, and
- Evaluate effectiveness and implementation strategies of ORH Rural Promising Practices
The needs assessment will characterize geographic disparities, as well as benchmark measures of access, health care utilization, quality, satisfaction and health outcomes for rural Veterans down to individual health market level. To accomplish this, NREC will identify community-based "contextual" factors (i.e., behavioral, environmental, socio economic) that contribute to identified geographic disparities.
NREC will also identify “hot spots” of need and capture best practices and opportunities for partnerships with federal, state and community-based organizations to address local factors that could improve rural Veterans’ health and well-being. NREC’s work will be guided by Fortney et al model of access (2011) and the Healthy People 2020 framework.