Beyond Geography: Using a Cluster-Based Analysis to Conceptualize the Rurality of Veterans Health Administration...

Area of Science:

• Health Services Research
• Rural Health
• Veterans Affairs Healthcare

Background:

• Rural veterans face unique challenges and strengths tied to military service and rural living.
• Accurate classification of healthcare facilities' rurality is crucial for resource allocation, assessing rural health initiatives, and evaluating veteran access and outcomes.
• Current geographical definitions of rurality may not fully capture the complexities of rural healthcare access.

Purpose of the Study:

• To develop an empirically informed taxonomy of Veterans Health Administration (VHA) acute care hospitals beyond simple geography-based classifications.
• To propose facility-level variables for measuring rural veterans' access to hospital-based care.

Main Methods:

• A k-means cluster analysis was performed on 110 VHA acute care hospitals.
• Variables included enrollee numbers, rural/highly rural enrollee percentages, VHA hospital complexity, and mean drive times for veterans to access care.

Main Results:

• Three distinct clusters of VHA hospitals were identified: Low Rural Serving (LRS), Medium Rural Serving (MRS), and High Rural Serving (HRS).
• The HRS cluster served the highest percentage of rural and highly rural veterans (61.9% rural, 9.7% highly rural) and had longer average drive times.
• Hospital complexity varied across clusters, with the HRS cluster including low, medium, and high complexity facilities.

Conclusions:

• A novel classification system using nine hospital-level factors effectively differentiates VHA hospitals based on their service to rural populations.
• This taxonomy provides a more nuanced understanding of rurality in healthcare settings and can inform strategies to improve rural veteran healthcare access.