{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:01:55Z","timestamp":1789995715475,"version":"4.0.1"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":70,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Rural veterans experience challenges and strengths related to military service and rural residence. Defining rurality for healthcare facilities is vital for allocating resources, estimating impacts of rural health initiatives, and evaluating rural veteran access and outcomes. While geolocation is one way of conceptualizing rural healthcare facilities, rurality exists on a continuum and is influenced by many factors. The purpose of this work was to create an empirically informed taxonomy of VHA acute care hospitals that moves beyond a geography\u2010based classification alone and to propose facility\u2010level variables that can be used to measure rural veterans\u2019 access to hospital\u2010based care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cluster analysis of 110 Veterans Health Administration (VHA) acute care hospitals using k\u2010means clustering. Hospital\u2010level variables included number of enrollees, number and percentage of rural and highly rural enrollees, VHA hospital complexity classification level (low, medium, high), and mean drive times for veterans to access VHA care (primary, secondary, tertiary).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Three clusters emerged. The Low Rural Serving (LRS) Cluster (\n                      <jats:italic>N<\/jats:italic>\n                      = 40) comprised 39 high complexity hospitals, with an average of 16.5% of veteran enrollees residing in rural areas. The Medium Rural Serving (MRS) Cluster (\n                      <jats:italic>N<\/jats:italic>\n                      = 26) contained all high complexity hospitals, with an average of 32.8% of veteran enrollees residing in rural areas. The High Rural Serving (HRS) Cluster (\n                      <jats:italic>N<\/jats:italic>\n                      = 44) comprised 10 low, 12 medium, and 22 high complexity hospitals, with an average of 61.9% of veteran enrollees residing in rural areas. The average percentage of highly rural veteran enrollees was 1.0% for LRS, 1.6% for MRS, and 9.7% for HRS. Average drive times to primary, secondary, and tertiary care increased incrementally across clusters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using 9 hospital\u2010level factors that may characterize degree of hospital rurality, we identified 3 clusters that differentiate VHA hospitals and the rural populations they serve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70195","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T07:16:44Z","timestamp":1786346204000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Geography: Using a Cluster\u2010Based Analysis to Conceptualize the Rurality of Veterans Health Administration Hospitals"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9695-1369","authenticated-orcid":false,"given":"Alexandra B.","family":"Caloudas","sequence":"first","affiliation":[{"name":"Department of Veterans Affairs (VA) Veterans Health Administration (VHA), Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2014Salt Lake City (VRHRC\u2010SLC), VA Salt Lake City Healthcare System  Salt Lake City Utah USA"},{"name":"VHA Health Systems Research, Center for Innovations in Quality Effectiveness, and Safety, Michael E. DeBakey VA Medical Center Houston Texas USA"},{"name":"South Central VA Health Care Network, South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center  Houston Texas USA"},{"name":"Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine, One Baylor Plaza\u2009  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6612-5613","authenticated-orcid":false,"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center\u2014Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Health Systems Research, Center for Access &amp; Delivery Research and Evaluation, VA Iowa City Healthcare System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa, Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5863-3420","authenticated-orcid":false,"given":"M. Bryant","family":"Howren","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center\u2014Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Health Systems Research, Center for Access &amp; Delivery Research and Evaluation, VA Iowa City Healthcare System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa, Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9545-6817","authenticated-orcid":false,"given":"Zachary","family":"Burningham","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA) Veterans Health Administration (VHA), Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2014Salt Lake City (VRHRC\u2010SLC), VA Salt Lake City Healthcare System  Salt Lake City Utah USA"},{"name":"VHA Health Systems Research, Informatics, Decision\u2010Enhancement and Analytic Sciences Center, Salt Lake City Veterans Affairs Medical Center  Salt Lake City Utah USA"},{"name":"Department of Internal Medicine, Division of Epidemiology University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-3540","authenticated-orcid":false,"given":"Diana J.","family":"Govier","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center\u2014Portland, VA Portland Health Care System  Portland Oregon USA"},{"name":"VHA Health Systems Research, Center to Improve Veteran Involvement in Care, VA Portland Health Care System  Portland Oregon USA"},{"name":"Department of Psychiatry School of Medicine Oregon Health &amp; Science University  Portland Oregon USA"},{"name":"School of Public Health Oregon Health &amp; Science University\u2013Portland State University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7298-6567","authenticated-orcid":false,"given":"Travis I.","family":"Lovejoy","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center\u2014Portland, VA Portland Health Care System  Portland Oregon USA"},{"name":"VHA Health Systems Research, Center to Improve Veteran Involvement in Care, VA Portland Health Care System  Portland Oregon USA"},{"name":"Department of Psychiatry School of Medicine Oregon Health &amp; Science University  Portland Oregon USA"},{"name":"School of Public Health Oregon Health &amp; Science University\u2013Portland State University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2331-3065","authenticated-orcid":false,"given":"Eric R.","family":"Litt","sequence":"additional","affiliation":[{"name":"North Florida\u2013South Georgia Veterans Health Care System  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-9530","authenticated-orcid":false,"given":"James W.","family":"Watts","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2857-1668","authenticated-orcid":false,"given":"Sarah S.","family":"Ono","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center\u2014Portland, VA Portland Health Care System  Portland Oregon USA"},{"name":"VHA Health Systems Research, Center to Improve Veteran Involvement in Care, VA Portland Health Care System  Portland Oregon USA"},{"name":"Department of Psychiatry School of Medicine Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6594-3996","authenticated-orcid":false,"given":"Kristen","family":"Wing","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0993-0952","authenticated-orcid":false,"given":"Peter J.","family":"Kaboli","sequence":"additional","affiliation":[{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center\u2014Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Health Systems Research, Center for Access &amp; Delivery Research and Evaluation, VA Iowa City Healthcare System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa, Carver College of Medicine  Iowa City Iowa USA"},{"name":"VHA Office of Rural Health  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Who Are the Recruits? 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