- Note from the HRSA Guest Editors
The Federal Office of Rural Health Policy (FORHP) within the Health Resources and Services Administration (HRSA) and the Journal of Health Care for the Poor and Underserved (JHCPU) are pleased to present this special themed issue entitled Forging New Frontiers: Translating theory to practical health solutions in rural communities as a supplement to the November 2016 issue of the Journal of Health Care for the Poor and Underserved. The goal of this issue is to highlight promising practices and evidence-based solutions to longstanding rural health care quality and delivery challenges. These solutions may be replicable in other rural communities, and may help to inform a broad audience of the remarkable innovation occurring in rural communities to address these challenges.
The variety of topic areas and geographic regions represented by the manuscripts received for consideration reflects the heterogeneity of rural communities as well as a desire to build an evidence base around rural health and a need to share best practices and lessons learned. We are thankful to all those who submitted a manuscript and for the essential work they do.
Given recent health and mortality trends in rural communities, this special issue is timely. Recent studies point to a widening rural-urban disparity in life expectancy. In 1969–1971, people living in urban areas were living 0.4 years longer than their rural counterparts (70.9 vs. 70.5 years); by 2005–2009, they were living on average a full two years longer than people living in rural areas (78.8 vs. 76.8 years).1 Similarly, rural counties have consistently reported higher—and in recent years, increasing—rates of premature death than urban counties. In the last 20 years, the difference in all-age, all-cause mortality between rural and urban individuals has increased from 2% in 1990–92 to 13% in 2005–2009.1 Singh and Siahpush suggested that unintentional injuries, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer accounted for 70% of the overall rural-urban gap in life expectancy, highlighting the increasingly important role chronic disease plays in determining excess mortality in rural areas.1 [End Page xiii] Rural-urban disparities are also evident among other key health care concerns such as the opioid epidemic currently sweeping the country. According to the Centers for Disease Control and Prevention, the rate of opioid-related overdose deaths among people in rural counties is 45% higher than in urban counties.2
These worsening health disparities in our rural communities compel us to examine strategies and solutions spanning many approaches from clinical care to social determinants of health. The Federal Office of Rural Health Policy is the primary entity within the U.S. Department of Health and Human Services that collaborates with rural communities and partners to support programs and shape policy to improve health in rural America. This supplement highlights promising practices and innovative solutions rural communities have developed for successful advances among rural populations in health care including topics such as health care delivery redesign, workforce retention and recruitment, care coordination, health information technology, population health, and health care financing models for rural populations.
We rely upon evidence to inform our programs and our policy initiatives. Accordingly, this special issue showcases a diverse selection of papers that employ both quantitative and qualitative methods to respond to the following questions:
• What evidence-based or innovative strategies have improved access, quality, efficiency, or patient outcomes in the rural setting?
• What effect has health care redesign and reform had on access, quality, efficiency, or patient outcomes within rural communities? What are the challenges, and innovative strategies to address those challenges, to improving and sustaining high-quality health care delivery and health outcomes in rural communities?
The articles in this supplement highlight a number of promising and innovative approaches that have the potential to combat challenges facing rural health systems. For example, Lee et al. and Gross et al. describe efforts to bolster the recruitment and retention of physicians working in rural communities, while Zurawski et al. discuss how...