Journal of Rural Health最新文献_第3页

Financial status, fatalism, and self-care of cardiovascular disease risk factors among rural adults living in socioeconomically distressed areas 生活在社会经济困难地区的农村成年人的经济状况、宿命论和心血管疾病危险因素的自我保健

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-30 DOI: 10.1111/jrh.70107

Ashmita Thapa PhD, RN, Geunyeong Cha PhD, RN, Dustin Hodges BSc Psychology, Jia-Rong Wu PhD, RN, FAHA, FAAN, Misook L. Chung PhD, RN, Martha J. Biddle PhD, RN, APRN, CCNS, FAHA, Jennifer L. Smith PhD, RN, Debra K. Moser PhD, RN, FAHA, FAAN

Purpose

Adults with fewer financial resources often have poor self-care. Rural dwellers commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about health. We examined whether fatalism mediates the association of financial status with cardiovascular disease (CVD) self-care in rural adults in economically distressed areas. We hypothesized that those with fewer financial resources would have poorer self-care, and fatalism would mediate this relationship.

Methods

We enrolled 1,122 adults (53 ± 15 years) at risk for CVD. Financial status was reflected by individuals’ perceptions of how well they made “ends meet” with their financial resources, fatalism by the CVD-Fatalism Instrument, and self-care of CVD risk factors by the Medical Outcomes Study-Specific Adherence Scale. We used conditional process analysis with the PROCESS macro.

Findings

Financial status was directly associated with self-care. Those with enough (C'1 = −1.57, P = .016) and those with not enough to make ends meet (C'2 = −3.51, P = .003) compared to those with more than enough had worse self-care. Those with higher levels of fatalism had worse self-care (b = −1.78, P = .001). Financial status was indirectly associated with self-care through fatalism. Compared to those with more than enough, those with not enough (indirect effect = −.269, 95% confidence interval = −.609, −.021) and enough (indirect effect = −.182, 95% confidence interval =−.376, −.041) had higher fatalism levels and thus worse self-care.

Conclusions

Poor financial status drives fatalism in rural dwellers, which in turn results in poor self-care.

目的：经济资源较少的成年人往往自我照顾能力较差。农村居民通常比城市居民拥有更少的财政资源，而且往往被定型为对健康持宿命论态度。我们研究了宿命论是否在经济困难地区的农村成年人的财务状况与心血管疾病（CVD）自我保健之间起中介作用。我们假设那些经济资源较少的人会有较差的自我照顾，而宿命论会调解这种关系。方法：我们招募了1122名有心血管疾病风险的成年人（53±15岁）。财务状况反映在个人对其财务资源的“收支平衡”程度的看法，CVD宿命论工具的宿命论，以及医疗结果研究特定依从性量表对CVD风险因素的自我护理。我们对process宏使用了条件过程分析。研究发现：经济状况与自我保健直接相关。与生活富足的人相比，生活富足的人（C′1 = -1.57,P = .016）和生活拮据的人（C′2 = -3.51,P = .003）的自我照顾能力更差。宿命论水平较高的人自我保健水平较差（b = -1.78, P = .001）。经济状况通过宿命论与自我保健间接相关。与足够者相比，不够者（间接效应=- 0.269,95%可信区间=- 0.609,- 0.021）和足够者（间接效应=- 0.182,95%可信区间=- 0.376,- 0.041）的宿命论水平较高，因此自我保健较差。结论：贫困的经济状况导致农村居民的宿命论，进而导致较差的自我保健。

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引用次数: 0

Changes in telehealth usage among Medicaid beneficiaries with mental illnesses in a rural state: An analysis of Kentucky Medicaid dataset over 5 years (2018–2022) 农村州精神疾病医疗补助受益人远程医疗使用的变化：对肯塔基州医疗补助数据集5年（2018-2022）的分析

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-30 DOI: 10.1111/jrh.70108

Chizimuzo T. C. Okoli PhD, MPH, MSN, APRN, FAAN, Tianyi Wang PhD candidate, MS, Bassema Abufarsakh PhD, MSN, RN, Sarret Seng PhD candidate, BSN, BS, RN, Zainab S. Almogheer PhD, MSN, Jarrah Al-Kayed PhD candidate, BSN, RN, Pooja Bhattarai MSN, RN, Holly Stith DNP, APRN, Andrew Makowski DNP, APRN

Introduction

Accessing mental health care remains challenging for Medicaid beneficiaries with mental illnesses (MI) in rural settings. The COVID-19 pandemic prompted telehealth service expansion through temporary policy changes and shifts in health care delivery. Despite the increased availability of telehealth as a modality to address disparities in health care access, telehealth adoption and associated use are inadequately explored among Medicaid beneficiaries with MI in Kentucky.

Objective

To examine trends and factors associated with telehealth use by residence status among Kentucky Medicaid beneficiaries with MI.

Design

A retrospective analysis of Kentucky Medicaid claims data obtained from 174,354 beneficiaries aged 18 years or older and diagnosed with MI. Chi-square tests and logistic regression analyses were performed to examine telehealth use over time and factors associated with its use.

Results

Telehealth use increased significantly from 0.3% in 2018 to 1.0% in 2022. Telehealth use was higher among urban residents (from 0.5% in 2018 to 1.4% in 2022) versus rural residents (from 0.2% in 2018 to 0.6% in 2022). Factors associated with increased telehealth use were being female, younger age, White non-Hispanic, having serious MI (SMI) or concurrent SMI and substance use disorders, and having a fee-for-service payor type. Rural residents were less likely than urban residents to use telehealth despite a similar trend of year-to-year increase.

Conclusion

Although telehealth use remains low, its utilization has increased among Medicaid beneficiaries with MI in Kentucky. Demographic characteristics, MI status, and payor type were associated with telehealth use, with notable disparities between urban and rural populations. These results highlight the need to further examine barriers that deter or promote telehealth use in rural states.

引言：获得精神卫生保健仍然具有挑战性的医疗补助受益人与精神疾病（MI）在农村设置。COVID-19大流行通过临时政策变化和卫生保健服务的转变推动了远程医疗服务的扩展。尽管远程医疗作为解决医疗保健获取差异的一种方式的可用性有所增加，但在肯塔基州患有心肌梗死的医疗补助受益人中，远程医疗的采用和相关使用尚未得到充分探讨。设计：对174,354名18岁及以上诊断为心肌梗死的肯塔基州医疗补助受益人的索赔数据进行回顾性分析。采用卡方检验和logistic回归分析来检验远程医疗的使用情况及其相关因素。结果：远程医疗使用率从2018年的0.3%显著上升至2022年的1.0%。城市居民的远程医疗使用率（从2018年的0.5%上升到2022年的1.4%）高于农村居民（从2018年的0.2%上升到2022年的0.6%）。与远程医疗使用增加相关的因素是女性、年龄较小、非西班牙裔白人、患有严重的重度精神分裂症（SMI）或同时患有重度精神分裂症和药物使用障碍，以及属于按服务付费的付费类型。农村居民使用远程医疗的可能性低于城市居民，尽管这种趋势逐年增加。结论：尽管远程医疗的使用仍然很低，但其使用率在肯塔基州的医疗补助受益人中有所增加。人口特征、心肌梗死状况和付款人类型与远程医疗使用相关，城乡人口之间存在显著差异。这些结果突出表明，有必要进一步审查阻碍或促进农村各州使用远程医疗的障碍。

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引用次数: 0

The interaction of tobacco retailer density and rurality with tobacco use prevalence in Kentucky 肯塔基州烟草零售商密度和乡村性与烟草使用流行的相互作用。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-26 DOI: 10.1111/jrh.70106

Shyanika W. Rose PhD. MA, W. Jay Christian PhD, Judy van de Venne PhD, Delvon Mattingly PhD, Bethany Shorey Fennell PhD, Saber Feizy PhD, Mary Kay Rayens PhD

Purpose

Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population.

Methods

We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor's access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance System data. We modeled county-level frequency of each outcome among adults as a function of tobacco retailer density and the Index of Relative Rurality, and interactions using ANCOVA, controlling for county percent of adult population and percent with an advanced degree.

Findings

We observed significant interactions between retailer density and rurality for both cigarette and smokeless tobacco use. Post-hoc protected pairwise comparisons demonstrated that within the 40 most urban counties, cigarette and smokeless tobacco use were significantly higher among counties with the highest retailer density, compared to low-density counties. Retailer density was not associated with the prevalence of cigarette and smokeless tobacco use within the 2 more rural tertiles of counties.

Conclusions

Consistent with prior research, policies limiting tobacco retailer density could be most beneficial in urban and urban-adjacent areas, while other policies may need to be considered for rural areas, even within a relatively rural state such as Kentucky.

目的：烟草零售商密度是美国烟草使用流行率的关键相关因素，但这种关系通常在城市地区进行研究。我们调查了肯塔基州各县的零售商密度与烟草使用之间的关系，肯塔基州吸烟率高，农村人口众多。方法：我们从2021年肯塔基州Synar项目中获得烟草零售商名单，用于未成年人的准入检查。我们将这些数据与肯塔基州每个县的卷烟和无烟烟草使用的县级流行率估计值合并，使用肯塔基州行为风险因素监测系统数据的汇总3年估计值（2017-2019）进行计算。我们将每个结果的县级频率建模为烟草零售商密度和相对乡村性指数的函数，并使用ANCOVA进行交互，控制县成人人口百分比和高等学历百分比。研究结果：我们观察到零售商密度与卷烟和无烟烟草使用的乡村性之间存在显著的相互作用。事后保护两两比较表明，在40个最城市化的县中，零售商密度最高的县的卷烟和无烟烟草使用明显高于零售商密度低的县。在另外两个县的农村地区，零售商密度与卷烟和无烟烟草使用的流行程度无关。结论：与先前的研究一致，限制烟草零售商密度的政策可能在城市和城市邻近地区最有利，而其他政策可能需要考虑在农村地区，甚至在肯塔基州这样一个相对农村的州。

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引用次数: 0

Prevalence of meeting youth physical activity guidelines across income, sex, urbanicity, and sport participation: 2022–2023 National Survey of Children's Health (NSCH) 在收入、性别、城市化和体育参与方面满足青少年体育活动指南的流行程度：2022-2023年全国儿童健康调查（NSCH）

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-26 DOI: 10.1111/jrh.70105

Ashleigh Johnson DrPH

Purpose

This cross-sectional study used data from the 2022–2023 National Survey of Children's Health to examine the prevalence of American youth meeting physical activity (PA) guidelines by sociodemographic subgroups defined by income, sex, urbanicity, and sports participation.

Methods

Weighted prevalence statistics were computed for meeting PA guidelines (≥60 min/day) for groups defined by income (0%–199% or ≥200% of Federal Poverty Level), sex (male, female), urbanicity (urban, rural), and past year sports participation (yes, no). Equity plots were generated to visualize the prevalence of meeting guidelines across subgroups (ref: high socioeconomic status (SES), urban male sports participants).

Findings

The final analytic sample included 61,740 youth (M_age = 11.6 years [SD = 3.2], 51.2% male). About 45% were sports participants, 88% were urban-dwelling, and <20% met PA guidelines. Meeting guidelines prevalences ranged from 13.2% (95% CI: 11.6%–15.0%) among high SES, urban female non-sport participants to 31.1% (95% CI: 25.5%–37.4%) among low SES, rural male non-sport participants. All comparisons were significantly different (versus reference group) except low SES, urban male sport participants; high SES, rural male non-sport participants; and low SES, rural females.

Conclusions

Most American youth fail to meet guidelines, with lowest prevalences among female non-sport participants, regardless of SES and urbanicity status. Sports may be more important for PA among urban versus rural youth. The findings, which show a complex interplay between sociodemographic factors, PA, and sport, can be used to identify populations needing targeted PA promotion programs.

目的：本横断面研究使用了2022-2023年全国儿童健康调查的数据，通过收入、性别、城市化和体育参与定义的社会人口亚组来检查美国青少年符合体育活动（PA）指南的流行程度。方法：根据收入（联邦贫困水平的0%-199%或≥200%）、性别（男性、女性）、城市化程度（城市、农村）和过去一年的体育参与（是、否）定义的人群，计算符合PA指南（≥60分钟/天）的加权患病率统计。生成公平图，以可视化各亚组（参考：高社会经济地位（SES），城市男性体育参与者）的会议指南的流行程度。结果：最终分析样本包括61,740名青年（年龄= 11.6岁[SD = 3.2]， 51.2%为男性）。结论：大多数美国年轻人不符合指南，女性非运动参与者的患病率最低，无论社会经济地位和城市地位如何。体育运动对城市青年和农村青年的PA可能更重要。研究结果表明，社会人口因素、体育运动和体育运动之间存在复杂的相互作用，可以用来确定需要有针对性的体育运动推广计划的人群。

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引用次数: 0

“Sacred ground for kids”: Institutional perspectives on rural school-based health centers as patient-centered medical homes “儿童的圣地”：从制度角度看农村校本保健中心作为以病人为中心的医疗之家。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-20 DOI: 10.1111/jrh.70098

Xue Zhang PhD, Mildred E. Warner PhD

Background

School-based health centers (SBHCs) can function as patient-centered medical homes (PCMHs), but few studies examine how SBHCs fit the PCMH definition and address the challenges of rural health disparities among children and adolescents.

Methods

Note that 12 semi-structured interviews were conducted in four rural counties in New York State with school superintendents, SBHCs medical providers, and health care network administrators and between January 2024 and April 2024. Participants were identified using snowball sampling. Interviews were transcribed. Framework analysis was applied with thematic coding based on the PCMH framework. NVivo 14 was used to generate the final set of themes.

Findings

Our analysis confirms SBHCs fit the PCMH model—accessibility, comprehensive, family-centered, coordinated, continuous, and compassionate care—to improve health care access for rural children and empower children to advocate for their own health. We identify privacy and confidentiality as additional important elements in the PCMH model, which ensure children's empowerment. However, they present special challenges for rural SBHCs. Addressing these challenges requires attention to information sharing between SBHCs and schools and the need for trust and communication to empower children, while not alienating school partners and parents. This may explain why so few rural SBHCs are PCMH.

Conclusions

This qualitative thematic analysis shows SBHCs can serve as PCMHs in rural communities. It also highlights the importance of privacy, confidentiality, trust, and communication between SBHCs, schools, parents, and children.

背景：校本卫生中心（shbhcs）可以作为以患者为中心的医疗之家（PCMH），但很少有研究考察校本卫生中心如何符合PCMH的定义，并解决农村儿童和青少年健康差距的挑战。方法：在2024年1月至2024年4月期间，在纽约州4个农村县对学校负责人、shbhcs医疗服务提供者和医疗保健网络管理人员进行了12次半结构化访谈。参与者是通过滚雪球抽样确定的。采访被记录下来。在PCMH框架的基础上，采用主题编码进行框架分析。使用NVivo 14生成最后一组主题。研究结果：我们的分析证实，农村儿童健康中心符合PCMH模式——可及性、全面、以家庭为中心、协调、持续和富有同情心的护理——以改善农村儿童获得卫生保健的机会，并赋予儿童倡导自身健康的权力。我们认为隐私和保密是PCMH模式的另一个重要因素，它确保了儿童的权力。然而，它们对农村小卫生保健公司提出了特殊的挑战。要解决这些挑战，需要关注小健康中心与学校之间的信息共享，以及需要建立信任和沟通，以增强儿童的权能，同时不疏远学校合作伙伴和家长。这也许可以解释为什么农村shbhc很少是PCMH。结论：本定性专题分析表明，农村小卫生保健中心可作为农村社区医疗保健中心。它还强调了儿童健康中心、学校、家长和孩子之间隐私、保密、信任和沟通的重要性。

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引用次数: 0

Innovating for success: Strengthening rural maternity care and delivery programs 创新促成功：加强农村孕产妇保健和分娩项目。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-12 DOI: 10.1111/jrh.70099

Erin E. Sullivan PhD, Mary Louise Gilburg MS, Morgan McDonald MD, Mark Deutchman MD

Purpose

To identify and analyze facility-level strategies that support the sustainability of rural maternity and delivery care programs in the United States.

Methods

This qualitative, cross-case study draws from data collected during the March 2024 Rural Maternity Innovation Summit in Clifton, Texas. Six rural health care organizations from diverse geographic regions shared their approaches to sustaining maternity and delivery services. Data include transcripts and presentation materials from summit sessions involving clinical, financial, and operational representatives of 6 rural hospitals. Thematic analysis was applied to identify cross-site strategies.

Findings

Three core themes emerged: financial sustainability, workforce development, and community engagement. Strategies included maximizing payment mechanisms, forming partnerships with Federally Qualified Health Centers, employing family physicians with obstetric training, establishing rural residency pipelines, and implementing culturally responsive community outreach. These practices were adapted to local contexts but shared a focus on aligning maternity and delivery services with broader organizational and community goals.

Conclusion

Sustaining rural maternity and delivery care requires an integrated approach that combines financial acumen, strategic workforce development, and strong patient and community engagement. Facility-level innovations offer replicable strategies for improving maternal health access and outcomes in rural settings.

目的：确定和分析支持美国农村产妇和分娩护理项目可持续性的设施级战略。方法：这项定性的跨案例研究借鉴了2024年3月在德克萨斯州克利夫顿举行的农村产妇创新峰会上收集的数据。来自不同地理区域的六个农村保健组织分享了它们维持产妇和分娩服务的方法。数据包括6家农村医院的临床、财务和业务代表参加的首脑会议的笔录和演示材料。专题分析用于确定跨站点战略。研究结果：出现了三个核心主题：财务可持续性、劳动力发展和社区参与。战略包括最大限度地提高支付机制，与联邦合格保健中心结成伙伴关系，雇用接受过产科培训的家庭医生，建立农村居民管道，以及开展响应文化的社区外联活动。这些做法根据当地情况进行了调整，但都注重使产妇和分娩服务与更广泛的组织和社区目标保持一致。结论：维持农村孕产妇和分娩护理需要一种综合方法，将财务敏锐性、战略性劳动力发展以及强有力的患者和社区参与结合起来。设施一级的创新提供了可复制的战略，以改善农村环境中的孕产妇保健机会和成果。

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引用次数: 0

Impact of Ostomy Self-Management Telehealth training for rural cancer survivors on health care utilization and economic outcomes in the United States 美国农村癌症幸存者造口自我管理远程医疗培训对医疗保健利用和经济结果的影响

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-11 DOI: 10.1111/jrh.70096

Daniel Maeng PhD, Virginia Sun PhD, RN, Matthew E. Nielsen MD, MS, Rebecca L. Hoffman MD, MSCE, Tullika Garg MD, MPH, Sarah M. Popek MD, Robert P. Sticca MD, Allison A. Aka MD, Walid M. Hesham MD, Marcia Grant PhD, RN, Michael Holcomb BS, Robert S. Krouse MD

Purpose

To assess the impact of a structured educational curriculum Ostomy Self-Management Telehealth (OSMT) treatment among cancer survivors residing in rural areas of the United States on selected measures of health care utilization, cost, and employment status.

Methods

This was a multi-site randomized controlled trial comparing OSMT treatment group against a control group receiving usual care (UC) in rural populations. OSMT treatment consisted of virtual group sessions led by trained peer ostomates delivered once a week over a 5-week period via video conferencing platforms. Surveys related to health care utilization were administered up to four times: baseline, post-session, 3-month and 6-month follow-up.

Results

Compared to the UC group, the OSMT group was associated with lower frequencies of in-person nurse (–57.2%; p = 0.015) and physician (–76.1%; p = 0.024) visits in the post-session follow-up survey; no significant differences were observed in the subsequent follow-up surveys. Moreover, the OSMT treatment group was also associated with lower ostomy-related emergency department visits (–88.3%; p = 0.119), lower direct out-of-pocket health care (–25.8%; p = 0.405) and travel costs (–47.7%; p = 0.105), as well as higher probability of full-time employment (18.9% vs. 12.3%; p = 0.179) and lower probability of claiming disability (14.3% vs. 18.9%; p = 0.459) in the 6-month follow-up; these differences, however, were not statistically significant.

Conclusion

While not all statistically significant, the OSMT treatment was associated with some notable changes in the patterns of health care utilization and selected economic outcomes among ostomates residing in rural communities. This suggests that the OSMT treatment likely contributes to more efficient and cost-effective care in the target population.

Synopsis

Ostomy Self-Management Telehealth (OSMT) program seeks to reduce barriers to care and improve self-management skills especially among ostomates residing in rural communities. This study reports that OSMT was associated with lower in-person health care provider visits, suggesting OSMT may lead to more efficient and cost-effective care.

目的：评估结构化教育课程对居住在美国农村地区的癌症幸存者的造口自我管理远程医疗（OSMT）治疗对医疗保健利用、成本和就业状况的影响。方法：这是一项多地点随机对照试验，比较OSMT治疗组和接受常规护理（UC）的农村人群的对照组。OSMT治疗包括通过视频会议平台每周进行一次的虚拟小组会议，由训练有素的同伴主持，为期5周。与卫生保健利用有关的调查进行了多达四次：基线、会后、3个月和6个月的随访。结果：与UC组相比，OSMT组在治疗后随访调查中有较低的护士（-57.2%,p = 0.015）和医生（-76.1%,p = 0.024）就诊频率；在随后的随访调查中未观察到显著差异。此外，在6个月的随访中，OSMT治疗组还与较低的造口相关急诊就诊（-88.3%,p = 0.119），较低的直接自付医疗费用（-25.8%,p = 0.405）和旅行费用（-47.7%,p = 0.105）以及较高的全职就业概率（18.9%比12.3%,p = 0.179）和较低的声称残疾的概率（14.3%比18.9%,p = 0.459）相关；然而，这些差异在统计学上并不显著。结论：OSMT治疗与居住在农村社区的患者在医疗保健利用模式和选择的经济结果方面的一些显著变化有关，尽管并非全部具有统计学意义。这表明OSMT治疗可能有助于在目标人群中提供更有效和更具成本效益的护理。摘要：造口自我管理远程医疗（OSMT）计划旨在减少护理障碍，提高自我管理技能，特别是居住在农村社区的造口者。本研究报告OSMT与较低的亲自医疗保健提供者访问相关，表明OSMT可能导致更有效和更具成本效益的护理。

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引用次数: 0

Revisiting the rural and urban divide in hospital health information technology adoption: Evidence from 2023 重新审视医院卫生信息技术采用的城乡差异：来自2023年的证据。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-10 DOI: 10.1111/jrh.70100

Alice S. Yan MAcc, Teagan K. Maguire MA, Jie Chen PhD

Purpose

We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals.

Methods

We used the linked 2023 American Hospital Association Annual Survey and Information Technology Survey data. We examined average adoption rates of eight telehealth, eight PE, and three HIE functionalities across metropolitan, micropolitan, and rural acute care hospitals. Multivariate regression models were used to assess differences in adoption, adjusting for hospital characteristics.

Findings

Rural and urban disparities in hospital health information technology (HIT) adoption persist in 2023. After adjusting for hospital characteristics, rural and urban differences in the likelihood of adopting any treatment-stage (e.g., psychiatric treatment and stroke care) or post-discharge (e.g., remote patient monitoring for chronic care) telehealth were not significant. However, overall, rural hospitals adopted an average of 0.24 fewer telehealth services (p < 0.05) and 0.25 fewer PE capabilities (p < 0.05). They were also less likely to have any HIE capabilities, relative to their urban peers.

Conclusions

Although overall adoption of hospital HIT has increased since 2018 and some rural and urban gaps have narrowed, disparities remain in 2023. Rural hospitals continue to lag behind in the adoption of telehealth, PE, and HIE functionalities. Future research should explore barriers to adoption among under-resourced hospitals. Policy efforts must prioritize tailored strategies to support rural hospitals and promote broader access to HIT adoption nationwide.

目的：我们评估了2023年医院对远程医疗、患者参与（PE）和健康信息交换（HIE）功能的采用情况，并比较了农村和城市医院的采用率。方法：我们使用链接的2023年美国医院协会年度调查和信息技术调查数据。我们检查了8个远程医疗、8个PE和3个HIE功能在大都市、小城市和农村急症护理医院的平均采用率。多变量回归模型用于评估采用的差异，调整医院的特点。研究结果：2023年，城乡在医院卫生信息技术（HIT）采用方面的差异将持续存在。在对医院特点进行调整后，农村和城市在采用任何治疗阶段（如精神科治疗和中风护理）或出院后（如慢性护理的远程患者监测）远程保健的可能性方面的差异并不显著。然而，总体而言，农村医院采用的远程医疗服务平均少0.24个（p < 0.05）， PE能力平均少0.25个（p < 0.05）。与城市同龄人相比，他们也不太可能有任何HIE能力。结论：尽管自2018年以来，医院医疗卫生技术的总体采用率有所提高，部分城乡差距有所缩小，但到2023年，差距仍然存在。农村医院在采用远程保健、体育和健康信息系统功能方面仍然落后。未来的研究应探讨在资源不足的医院中采用这种方法的障碍。政策努力必须优先考虑有针对性的战略，以支持农村医院并促进在全国范围内更广泛地采用医疗卫生技术。

{"title":"Revisiting the rural and urban divide in hospital health information technology adoption: Evidence from 2023","authors":"Alice S. Yan MAcc, Teagan K. Maguire MA, Jie Chen PhD","doi":"10.1111/jrh.70100","DOIUrl":"10.1111/jrh.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the linked 2023 American Hospital Association Annual Survey and Information Technology Survey data. We examined average adoption rates of eight telehealth, eight PE, and three HIE functionalities across metropolitan, micropolitan, and rural acute care hospitals. Multivariate regression models were used to assess differences in adoption, adjusting for hospital characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural and urban disparities in hospital health information technology (HIT) adoption persist in 2023. After adjusting for hospital characteristics, rural and urban differences in the likelihood of adopting any treatment-stage (e.g., psychiatric treatment and stroke care) or post-discharge (e.g., remote patient monitoring for chronic care) telehealth were not significant. However, overall, rural hospitals adopted an average of 0.24 fewer telehealth services (<i>p</i> < 0.05) and 0.25 fewer PE capabilities (<i>p</i> < 0.05). They were also less likely to have any HIE capabilities, relative to their urban peers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although overall adoption of hospital HIT has increased since 2018 and some rural and urban gaps have narrowed, disparities remain in 2023. Rural hospitals continue to lag behind in the adoption of telehealth, PE, and HIE functionalities. Future research should explore barriers to adoption among under-resourced hospitals. Policy efforts must prioritize tailored strategies to support rural hospitals and promote broader access to HIT adoption nationwide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726622","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}

引用次数: 0

Changing rural-urban and racial patterns in VA tele-mental health use among women Veterans, 2019–2022 2019-2022年女性退伍军人远程心理健康使用的城乡和种族模式变化

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-10 DOI: 10.1111/jrh.70097

Michelle A. Mengeling PhD, MS, Adam Batten MS, M. Bryant Howren PhD, MPH, B. Josea Kramer PhD, Kelly R. Miell PhD, Heather Davila PhD, Anne G. Sadler PhD, MS, RN

Purpose

To assess whether women veterans accessed synchronous video telehealth for mental health (SVT-MH) similarly by (1) rurality, (2) race, and (3) race within rural and urban settings.

Methods

This retrospective cohort study used VA administrative data to examine temporal trends in outpatient VA mental health use from January 1, 2019, through December 31, 2022—a period spanning the pre- and post-COVID-19 pandemic. The cohort included VA-enrolled women veterans ages 18–60 years with at least one outpatient mental health visit delivered by a VA provider in-person (VA-MH) or via SVT-MH. Outcomes included (1) any SVT-MH use and (2) annual SVT-MH visit counts. Models adjusted for demographics and used Bayesian logistic and Poisson regression to estimate effects and interactions over time.

Findings

SVT-MH use increased from 7% in 2019 to 32% in 2022. Rural women Veterans initially had higher SVT-MH use, but by 2022, urban women had higher use and visit counts. Black and Hispanic women Veterans showed the largest increases, especially in urban areas. American Indian and Alaska Native (AIAN) women Veterans were the only group without significant rural-urban differences in 2022, though they had lower overall visit counts.

Conclusions

SVT-MH use among women veterans increased substantially during the study period, with rural-urban gaps narrowing over time. These findings suggest SVT-MH differences may shift rapidly based on infrastructure, outreach, and policy implementation. Ongoing monitoring and tailored strategies are needed to ensure fair access to SVT-MH for all veterans, especially for AIAN and rural women veterans.

目的：评估女性退伍军人是否通过(1)农村地区、(2)种族和(3)种族在农村和城市环境中获得同步视频远程医疗心理健康（SVT-MH）。方法：这项回顾性队列研究使用VA管理数据来检查2019年1月1日至2022年12月31日期间VA门诊心理健康使用的时间趋势，这段时间跨越了covid -19大流行之前和之后。该队列包括VA登记的年龄在18-60岁的女性退伍军人，至少有一次由VA提供者亲自（VA- mh）或通过SVT-MH进行的门诊心理健康访问。结果包括(1)任何SVT-MH使用和(2)每年SVT-MH就诊计数。模型根据人口统计调整，并使用贝叶斯逻辑和泊松回归来估计随时间的影响和相互作用。研究结果：SVT-MH的使用从2019年的7%增加到2022年的32%。农村妇女退伍军人最初有更高的SVT-MH使用率，但到2022年，城市妇女的使用率和就诊次数更高。黑人和西班牙裔女性退伍军人人数增幅最大，尤其是在城市地区。美国印第安人和阿拉斯加原住民（AIAN）女性退伍军人是2022年唯一没有明显城乡差异的群体，尽管她们的总体访问次数较低。结论：在研究期间，女性退伍军人使用SVT-MH的人数大幅增加，城乡差距随着时间的推移而缩小。这些发现表明，SVT-MH差异可能会根据基础设施、外联和政策实施而迅速变化。需要进行持续监测并制定有针对性的战略，以确保所有退伍军人，特别是AIAN和农村妇女退伍军人公平获得SVT-MH服务。

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引用次数: 0

Effectiveness of a self-care intervention addressing social determinants of health in reducing cardiovascular disease risk in rural populations 针对健康的社会决定因素的自我保健干预措施在降低农村人口心血管疾病风险方面的有效性。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-12-04 DOI: 10.1111/jrh.70101

Jennifer L. Smith PhD, RN, Ashmita Thapa PhD, RN, Misook L. Chung PhD, RN, FAHA, FAAN, Terry A. Lennie PhD, RN, FAHA, FAAN, Martha Biddle PhD, RN, APRN, CCNS, FAHA, Mary Kay Rayens PhD, Debra K. Moser PhD, RN, FAHA, FAAN

Purpose

HeartHealth is a multi-component cardiovascular disease (CVD) risk reduction intervention developed for rural Appalachia participants. Its effectiveness in reducing CVD risk factors has been demonstrated, and although HeartHealth was developed to address the negative impact of social determinants of health (SDOH), it remains unclear whether its impact is modified by key SDOH. The aims of the study were to evaluate whether the intervention effect on the Framingham CVD Risk Score (FRS) differs by financial status, education level, sex, depressive symptoms, and health literacy.

Methods

A secondary analysis was conducted using data from a randomized controlled trial involving 349 participants (mean age: 43 ± 13, female 78%) from rural Appalachian Kentucky. Financial status, education level, and sex were measured using standard questionnaires, depressive symptoms were measured using the Patient Health Questionnaire-9, and health literacy was measured using the Newest Vital Sign. Repeated measures mixed modeling was employed to assess the impact of each SDOH while simultaneously evaluating the effects of time, intervention, and their interaction on FRS.

Findings

The interaction between time and intervention was significant, indicating a sustained reduction in FRS among intervention participants. None of the SDOH had moderating effects on the intervention's impact on reducing CVD risk factors. This demonstrates that the HeartHealth intervention remains effective despite the impact of selected SDOH.

Conclusions

The HeartHealth intervention effectively reduces CVD risk factors in rural Appalachia populations. This remains true regardless of SDOH that are commonly seen in rural areas.

目的：HeartHealth是一项针对阿巴拉契亚农村参与者的多成分心血管疾病（CVD）风险降低干预措施。它在减少心血管疾病风险因素方面的有效性已被证明，尽管HeartHealth是为了解决健康社会决定因素（SDOH）的负面影响而开发的，但目前尚不清楚其影响是否会因关键的SDOH而改变。本研究的目的是评估干预对Framingham CVD风险评分（FRS）的影响是否因经济状况、教育水平、性别、抑郁症状和健康素养而异。方法：对来自肯塔基州阿巴拉契亚农村地区的349名参与者（平均年龄：43±13岁，女性78%）的随机对照试验数据进行二次分析。使用标准问卷测量经济状况、教育水平和性别，使用患者健康问卷-9测量抑郁症状，使用最新生命体征测量健康素养。采用重复测量混合模型来评估每种SDOH的影响，同时评估时间、干预及其相互作用对FRS的影响。结果：时间和干预之间的相互作用显著，表明干预参与者的FRS持续降低。所有的SDOH对降低心血管疾病危险因素的干预都没有调节作用。这表明，尽管选定的SDOH有影响，但心脏健康干预仍然有效。结论：心脏健康干预可有效降低阿巴拉契亚农村人群心血管疾病的危险因素。无论在农村地区常见的SDOH如何，这仍然是正确的。

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引用次数: 0