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

GAO-23-105855 Published: May 04, 2023. Publicly Released: May 04, 2023.
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Fast Facts

Access to health care is critical for veterans, particularly those living in rural areas. The Veterans Health Administration's Office of Rural Health funds research and initiatives aimed at improving the health of veterans living in rural areas.

In 2022, ORH supported 120 research projects. But it informs researchers of funding opportunities via word-of-mouth and existing relationships, leaving some researchers potentially unaware.

Also, ORH knows what steps it wants to take to improve rural veterans' health, but hasn't established how it will annually assess whether it's making progress or not.

We recommended that ORH address these issues.

A stethoscope, military uniform, identification tags, and an American flag.

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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

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.


GAO is making two recommendations for the Office of Rural Health to 1) require resource centers to communicate research funding opportunities across VA and 2) develop performance goals that reflect leading practices. VA concurred with the recommendations and identified steps to implement them.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Director of the Office of Rural Health should develop a policy requiring resource centers to communicate their available research funding opportunities across VA. (Recommendation 1)
VA concurred with the recommendation. As of March 2024, the Office of Rural Health (ORH) has identified key steps necessary to develop a communication plan that will outline standardized processes to communicate available research funding opportunities throughout VA. ORH identified these key steps with the assistance of its veterans rural health resource centers. As of March 2024, ORH is developing a communication plan and accompanying standard operating procedures and anticipates implementing them in September 2024.
Department of Veterans Affairs The Director of the Office of Rural Health should develop performance goals that reflect leading practices, such as being objective, measurable, quantifiable, and linked to other strategic plan components. (Recommendation 2)
VA concurred with the recommendation. As of March 2024, ORH started the process of drafting its upcoming fiscal years 2025 through 2029 strategic plan. According to officials, the plan will include performance goals and activities necessary to achieve them. In March 2024, ORH started holding listening sessions with stakeholders, such as rural health resource center staff, to develop the plan, including identifying performance goals and performance measures. ORH officials plan to use the feedback from stakeholders to finalize the strategic plan in May 2024.

Full Report

Office of Public Affairs


Access to health careBest practicesHealth careHealth care administrationHealth care systemsPerformance goalsRural healthStrategic goalsStrategic planVeteransVeterans affairsVeterans health careCommunication