Improving Health Care Access and Quality in Rural America

More than 65 million Americans call rural areas home, and they are more likely than their urban counterparts to be older, uninsured, living in poverty, disabled, or managing chronic health conditions. At the same time, rural communities face unique barriers to accessing care because of clinician shortages and hospital closures.

Since 2005, nearly 200 rural hospitals have shut down or dropped inpatient services, reducing access to emergency care, maternity services, chemotherapy, and other care. Today, between 400 and 700 more rural hospitals are at risk of closure. With fewer care options close to home, people may delay treatment, need to travel long distances to get care, or go without care altogether.

Addressing these challenges requires more than funding—it takes research, innovation, and collaboration across the health system.
 

AIR works with hospitals, clinicians, state and federal agencies, and rural residents to support practical solutions that expand access and improve care in rural communities. Our work combines research, evaluation, technical assistance, and collaboration with frontline providers.

Key efforts include:

• Designing and testing clinical training programs – The opioid epidemic has hit rural America especially hard, but access to treatment is difficult in rural communities. To expand access to care, AIR partnered with Oklahoma to design, implement, and evaluate training for rural primary care clinicians to prescribe medications for opioid use disorder, an evidence-based intervention that combines behavioral therapy and medication to treat substance use disorders.
   
• Developing practical resources for quality improvement – Rural hospitals face limited budgets and staff often wear multiple hats, leaving little time to focus on quality improvement and patient safety. AIR listened carefully to hospital concerns and found new ways to offer training and tools so hospital staff could learn at their own pace and take small steps to change, resulting in higher quality and safer hospital care close to home in rural communities.
   
• Evaluating Medicare payment policies for rural hospitals – Through the Rural Community Hospital Demonstration (RCHD), AIR conducts a long-running, congressionally mandated evaluation to examine whether cost-based Medicare payment can help rural hospitals remain financially viable and avoid closure. Since 2004, the RCHD has worked with hospitals across the country, including hospitals in Colorado, Iowa, Kansas, Maine, Mississippi, Nebraska, Oklahoma, South Dakota, and Wyoming.
   
• Examining efforts to recruit and retain the rural health workforce – An AIR study found that a federal program providing incentives to practice in designated Health Professional Shortage Areas was associated with an increase in the supply of primary care physicians in rural communities.
   

By identifying and implementing real-world solutions based on rigorous research and evaluation and cutting-edge methods, AIR’s work is making a difference to individuals, families, and rural communities across the country, including:

• Identifying effective ways to help rural hospitals stay open – Our work helps hospital leaders and policymakers make informed decisions to improve financial sustainability and prevent more hospital closures in rural communities.
   
• Expanding access to treatment – AIR-supported training helped increase the number of clinicians qualified to provide evidenced-based care for opioid use disorder care in rural communities.
   
• Improving care quality and patient safety – AIR-developed tools helped rural hospitals make real improvements in care, despite tight budgets and staffing constraints.
   
• Generating evidence to strengthen the rural health workforce – AIR’s research helps identify effective ways to attract and retain primary care providers in underserved rural areas.

As hospital closures and clinician shortages continue to threaten access to high-quality care for millions of Americans living in rural communities, AIR’s evidence-based work supports practical solutions that help ensure care remains accessible, safe, and affordable.

Related Work

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Improving Health Care Access and Quality in Rural America

Rural residents often face difficulty accessing health care because of clinician shortages and hospital closures. AIR leverages expertise in data analysis, technical assistance, human-centered design, and stakeholder engagement to understand and help solve the health care challenges facing rural communities.