VA Health Care: Office of Rural Health Would Benefit from Improved Communication and Developing Performance Goals

What GAO Found

The Veterans Health Administration's (VHA) Office of Rural Health provides funding to support (1) initiatives that expand existing services for rural veterans, and (2) research on interventions intended to address disparities in health care for rural veterans. In fiscal year 2022, the office allocated approximately $245 million for 35 separate initiatives, such as transportation for veterans to Department of Veterans Affairs (VA) facilities. (See figure.) In the same year, the office allocated about $56 million to its resource centers, and funded 120 research projects through them. For example, researchers funded by the Office of Rural Health developed and tested telehealth interventions, such as telehealth knee rehabilitation and smoking cessation programs.

The Office of Rural Health's Allocation of Funding, Fiscal Year 2022

To receive research funding, researchers apply through a standardized application and review process. However, the Office of Rural Health does not communicate its research funding opportunities across VA. Instead, the office's resource centers informally communicate research opportunities, such as through word-of-mouth and existing relationships, to identify projects to fund. Officials from one VHA health care delivery system GAO interviewed were unaware of the Office of Rural Health's research funding, and stated they could benefit from additional funding from the office. Without communicating these opportunities across VA, the office may be missing opportunities to fund research at VA facilities serving rural veterans with unique access issues.

The Office of Rural Health identified the outcomes it hopes to achieve through its strategic goals and objectives, and collects data on its progress using performance measures. However, the office has not established performance goals that define expected levels of performance each year. For example, the office wants to reduce rural health care workforce disparities and collects data on the number of clinicians trained; however, it has not defined how many clinicians should be trained each year to achieve the intended outcome. Developing performance goals that incorporate leading practices identified in prior GAO work, such as being measurable, could help the Office of Rural Health better understand to what extent its funded initiatives and research projects demonstrate progress in achieving its mission.

Why GAO Did This Study

Access to health care is a critical issue for the 2.7 million veterans enrolled in VHA and living in rural areas. A variety of factors may affect rural veterans' access, such as distances to health care facilities and staffing shortages. The Office of Rural Health's mission is to improve the health and well-being of rural veterans. It is one of the main offices responsible for addressing the health care needs of rural veterans.

GAO was asked to review how the Office of Rural Health carries out its responsibilities. Among other objectives, this report examines the initiatives and research projects the office funded in fiscal year 2022. It also examines how the office communicates funding opportunities, and examines the office's efforts to assess its progress towards achieving its mission.

GAO reviewed Office of Rural Health documentation, such as its fiscal year 2022 budget data (the most recent data at the time of GAO's review), research agenda, and its strategic plan. GAO also interviewed Office of Rural Health officials and officials from four selected VHA health care delivery systems selected for variation by geography, rurality, funding, and partnerships.