QUERI – Quality Enhancement Research Initiative

Go to the HSRD website

Partnered Evaluation of the Social Determinants of Health and Healthcare Resource Needs of Rural Veterans

North Little Rock, AR and Seattle, WA


Recent transformative efforts within VA, as outlined in the VHA Blueprint for Excellence, offer unprecedented opportunity for the Office of Rural Health (ORH) to further develop and expand strategic partnerships to improve health and healthcare for more than five million Veterans who reside in rural areas. To effectively respond to this mandate, it is essential to conduct a needs assessment that will accurately gauge where gaps in care for this Veteran population exist, gain a better understanding of the reasons for those gaps, and identify opportunities for innovative partnerships between ORH and other governmental and non-governmental entities. An assembled multi-site (Little Rock, Seattle, and San Antonio) team of experts in health services research, epidemiology, implementation science, demography, and clinical care is well prepared to conduct the proposed work - and to quickly respond to additional project requests by ORH. This work will be guided by the SOTA access model developed by co-investigator, Dr. Fortney. The Healthy People 2020 Framework will be used to operationalize social determinants of health, referred to in the SOTA model as "community attributes."


The overarching goal of this work is to provide ORH with data, including recommendations from Veterans and community stakeholders, to inform strategic planning for policies and programs that will improve the health of Veterans living in rural areas. Specific aims include:

  • Characterize geographic variation in access, utilization, quality, satisfaction, and outcomes using existing data sources and GIS (geographic information system) mapping;
  • Identify the specific socioeconomic, cultural, and environmental factors associated with geographic variation in access, utilization, quality, satisfaction and outcomes;
  • Describe perceived access and need, and identify preferences for - and barriers and facilitators to - healthcare and achieving optimal health and well-being by meaningfully engaging with and listening to Veterans; and
  • Identify strategies and opportunities to support innovative partnerships with community, state, and federal organizations to optimize the health and well-being of Veterans residing in rural areas through interviews with stakeholders.


Investigators will create the Veterans Rural Health Atlas and chart book (VeRHA) patterned after the Dartmouth Atlas of Health Care, which has conducted ground-breaking research on geographic variation in the distribution and use of medical resources, and has helped policymakers and others improve their understanding of our healthcare system. The VeHRA will provide an interactive map and chart book that ORH and others can use to efficiently examine a wide range of factors related to health and healthcare of Veterans in rural residence. The analyses will assess the relationships between socioeconomic, cultural, and environmental factors - and geographical variation in access, utilization, quality, satisfaction and outcomes. It also will identify community, state, and federal entities with which ORH could form strategic partnerships to improve health and healthcare for Veterans in rural residence.

Operations Partner(s)

The partner for this project is VA's Office of Rural Health (ORH), which works to optimize the use of available and emerging technologies, establish new access points to care, and employ strategies to increase healthcare options for all Veterans living in rural areas.

Principal Investigator: Teresa J. Hudson, PhD, is part of HSR&D's Center for Mental Healthcare and Outcomes Research (CeMHOR); contact at Teresa.Hudson@va.gov or HudsonTeresaJ@uams.edu .