The Agency for Healthcare Research and Quality (AHRQ) invests and prioritizes research to improve health outcomes for rural patients. The Agency recognizes rural Americans as a priority population, and directs evidence generation, dissemination, implementation efforts to identify the unique health and access concerns these populations have. With the recently announced reorganization of the Department of Health and Human Services (HHS) , it is important to understand the key role AHRQ plays improving health for rural Americans.
The growing problem of rural hospital closures
According to Census Bureau data, about 20 percent of the population lives in rural or nonmetropolitan areas. Rural communities face unique health challenges due to complex cultural, social, economic and geographic factors, and access to health services has become increasingly challenging in these communities due to the closures of health care facilities. Since 2010, 194 rural hospitals throughout the U.S. closed, resulting in an increase of 20 to 40 miles in the distance that individuals in rural areas must travel to receive health care. Such increases in travel distance can lead to delays in receiving adequate care or to forgoing care altogether due to the increase in travel time required to access health services, which can have significant impacts on health outcomes. For example, age-adjusted death rates have consistently been higher in rural areas than urban areas, and this difference has increased over time. In 2019, the age-adjusted death rate was 20 percent higher in rural areas compared to urban. Rural patients are living shorter lives due to insufficient health care access, a trend that AHRQ is working to turn around.
AHRQ’s role in supporting rural health
AHRQ prioritizes the health of rural Americans, funding research and programs aimed at uncovering barriers to health care and improving access to quality care by addressing the unique needs of rural communities. The Agency publishes an annual report that highlights health care quality and gaps in care, including that of rural communities, which can inform funding priorities, policy, and practice. AHRQ-funded initiatives focus on developing, testing, implementing, and disseminating evidence-based resources and programs to overcome barriers and address gaps in rural health systems, and improve health for rural Americans. For example, AHRQ-funded Project ECHO, a collaborative medical education and care management program, increases access to specialty treatment in rural areas. Evidence suggests Project ECHO’s model of telementoring results in health outcomes similar to patients who receive care in academic medical centers, and the model has been adapted and implemented with success in rural areas across the U.S.
How AHRQ ensures continued access
AHRQ’s investment in rural health infrastructure and education and training for rural health care providers ensures improvements in care quality and access continue beyond the lifespan of the projects they fund. In 2004, AHRQ earmarked $139 million for advancing rural health IT, funding 40 projects focused on improving electronic health record (EHR) use, telemedicine, and mobile health technologies, and helping rural communities overcome barriers to care including distance and personnel shortages. AHRQ-funded training and education initiatives build capacity in rural health facilities, equipping providers with knowledge, tools, and resources to implement evidence-based treatments and practices, ensuring access to quality care for rural patients. For example, AHRQ developed the Medication-Assisted Treatment (MAT) for Opioid Use Disorder Playbook to equip providers in rural primary care settings with practical guidance for implementing MAT in their settings.
AHRQ initiatives improve rural access to the latest evidence-based opioid treatments
While opioid use disorder (OUD) has become widespread across the U.S., rural communities have been hit especially hard by the opioid epidemic. Data from AHRQ's Healthcare Cost and Utilization Project show that from 1993 to 2012, the rate of hospitalizations related to OUD among adults increased by more than 150 percent, and the annual growth rate in opioid-related hospitalizations was greater for patients in rural areas (8.6 percent) than urban (4.9 percent).
In 2016, AHRQ awarded approximately $12 million in funding over three years for four research demonstration projects to support the implementation of MAT, an evidence-based treatment approach that combines medication and talk therapy, for OUD in rural primary care settings. Given the lack of addiction and mental health experts in rural areas, OUD treatment often falls on rural primary care providers, many of whom lack access to new medication recover options. Additionally, long distances to access care and negative attitudes and beliefs about MAT prevent rural Americans from adequate access to treatment. The AHRQ initiative provides education and training on MAT to rural providers, improves access to medications, and implements models of care that address other barriers to MAT in rural settings, improving both health outcomes for patients with OUD and rural providers’ confidence in treating patients.
Learn more about AHRQ’s research and programs that support rural health at ahrq.gov. Read our previous blogs on why AHRQ is a smart investment and the Agency’s essential role in the delivery of high value, quality care. Learn how to stand with AHRQ using our toolkit.