People living in rural areas often have difficulty obtaining quality health care. Compared to residents of cities and suburbs, they experience higher rates of chronic diseases and disability and death from injuries. Remote location and economic, cultural, educational, and social factors combine to create daunting health challenges.
The third Thursday of November–November 21, this year–is National Rural Health Day, a chance to highlight the work of various organizations in addressing the healthcare needs of rural communities. We take the opportunity of this National Rural Health Day to describe how PCORI is addressing these issues.
Our authorizing legislation requires that PCORI’s research portfolio take into account “the potential for differences in the effectiveness of health care treatments used with various subpopulations.” Rural residents are among these subgroups. The legislation also references several major issues in rural health today: chronic conditions, the burden of disease, and disparities in care delivery. We’re committed to funding research that addresses these issues and effectively incorporates the perspectives of rural patients and clinicians into the process of deciding which projects to support.
Understanding Barriers to Rural Health
For the approximately 60 million Americans—nearly one in five—who live in rural areas, limited access to healthcare professionals is a critical barrier to achieving favorable health outcomes. Compared to metropolitan regions, rural and frontier regions contain more than twice as many “Health Professional Shortage Areas” designated by the US Department of Health and Human Services. The reduced healthcare access is a major factor in rural patients’ greater disease burdens and poorer outcomes from chronic conditions, including hypertension, diabetes, and arthritis.
PCORI is investing in research that will build a body of evidence on effective strategies for health care in rural areas. The first step is to identify relevant high-priority research questions. Earlier this year, we hosted a workshop in Wichita, Kansas to solicit input from rural communities regarding research topics we should support. We’ve also explored related issues at workshops in Memphis and Albuquerque.
Funding Rural Health Research
PCORI’s portfolio of research projects is addressing questions we’ve received from members of the rural healthcare community. For example, one project is examining the effectiveness of telemedicine to connect rural patients with specialty care. Researchers at the University of Rochester are using simple, inexpensive web-based software, similar to Skype, to link neurologists at centers of excellence to rural patients who have Parkinson's disease.
Another study that incorporates telemedicine, led by the University of New Mexico, tests a home-based care model to improve treatment for chronic kidney disease among Zuni Indians.
The Zuni Pueblo is in the midst of a crisis of chronic kidney disease, primarily due to high rates of obesity and diabetes. End-stage renal disease as a result of chronic kidney disease is 15 times as high among Zuni Indians as among white Americans.
The researchers will test an initiative that includes home visits from Zuni community health workers, advanced point-of-care technology for diagnosis and assessment of treatment response, and telemedicine. The findings may influence how health care is delivered to Zuni and other rural, high-risk communities.
Another PCORI-funded study, being conducted by researchers at the University of Montana, is aimed at improving the process by which patients in rural areas are discharged from the hospital. The goal is to reduce the need for a return to the hospital, which is an especially heavy burden when the healthcare facility is far from the patient’s home. In the discharge process being tested, clinicians and patients collaborate in thorough planning of the patient’s care once at home. The researchers expect this approach to reduce hospital readmissions by 30 percent and improve patients’ return to active lives.
Because people in rural communities have few interactions with the healthcare system, communicating new information to residents and clinicians can be more difficult than in other settings. A project at the University of Iowa tests a new outreach and education strategy to improve dementia care for rural older adults. To reduce inappropriate medication use and encourage evidence-based care, the researchers plan to develop a toolkit and online training program. Lessons learned from this project may aid effective outreach to improve care for rural patients who suffer from a wide variety conditions.
Some other PCORI-funded projects focus on mental health needs of rural African Americans, cardiovascular disease risk reduction in Appalachians, and the Navajo Community Outreach and Patient Empowerment Program. Our Advisory Panels have also suggested future research questions that consider rural populations in terms of health interventions to reduce major vascular events, use of telemedicine and non-physician practitioners to improved mental health outcomes, trauma care at local hospitals versus trauma centers, and heart attack treatment.
There is still much to learn about the most effective methods for providing high-quality health care in rural communities. Many health questions that patients, families, and clinicians face have not been addressed through reliable research, and we’re eager to help close these information gaps.
To be effective, our research portfolio must incorporate the distinct perspectives of rural patients and clinicians to ensure it is responsive to their needs. We look forward to receiving more input from the rural community, and we encourage rural residents to visit our Get Involved page for opportunities to guide our work.
Luce served as PCORI’s Chief Science Officer from May 2013 – September 2015
Hasnain-Wynia is Director of PCORI’s Addressing Disparities program