{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:02:16Z","timestamp":1789995736123,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":94,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"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"}],"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>The Veterans Health Administration (VHA) reports provider shortages in up to 86% of their hospitals, with rural VHA Medical Centers (VAMCs) disproportionately affected. To address this, the VHA's Office of Rural Health launched the Telehospital Medicine Program to provide hospitalist coverage in understaffed facilities. This evaluation describes adoption and expansion of this program across six rural VHA hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a mixed\u2010methods approach guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, we evaluated implementation across six VHA facilities. Reach was assessed by measuring the number of inpatient bed days of care at rural facilities served by the Telehospital Medicine Program. Costs were evaluated through a budget impact analysis, while adoption, implementation, and maintenance were examined using facility\u2010, provider\u2010, and individual\u2010level metrics, and staff and Veteran interviews and surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>On average, the Telehospital Medicine Program covered an average of 87 beds per day, with a range of 50\u2212395 beds per day across the six facilities analyzed. Estimated savings for the facilities served range from $72K to $1.05M per year, equivalent to a reduction on average of \u223c1.5 full\u2010time equivalents of on\u2010site providers, with the largest hospitals perceiving the largest savings. Additionally, no increases in length of stay, hospital readmissions, or mortality rates were observed following implementation. Factors influencing adoption include \u201chesitancy among newer nurses,\u201d \u201ctraining components for residents and advanced practice providers,\u201d and \u201ctechnology logistics.\u201d Staff found the program easy to integrate and effective in filling care gaps. Maintenance remained robust 6 months after implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The VHA's rural Telehospital Medicine Program demonstrated scalability, adaptability, and sustainability across a variety of practice settings\u2014highlighting the program's ability to meet varying staffing needs across rural VHA facilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70214","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:29:00Z","timestamp":1788420540000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Descriptive Analysis of a Rural Telehospital Medicine Program in the Veterans Health Administration: A Multi\u2010Facility, Mixed\u2010Methods Evaluation"],"prefix":"10.1111","volume":"42","author":[{"given":"Octavia K.","family":"Goodman","sequence":"first","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline A.","family":"Benson","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Burke","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center  Philadelphia Pennsylvania USA"},{"name":"Divisions of General Internal Medicine and Hospital Medicine, Perelman School of Medicine, University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Hospital Medicine Analytics Team (HMAT)  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Lestina","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center \u2013 Iowa City, Iowa City VA Healthcare System  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Vinzant","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center \u2013 Iowa City, Iowa City VA Healthcare System  Iowa City Iowa USA"},{"name":"Specialty Care, Iowa City VA Healthcare System  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Bailey","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center \u2013 Iowa City, Iowa City VA Healthcare System  Iowa City Iowa USA"},{"name":"Center for Access and Development Research Excellence (CADRE)  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiwei","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeydith","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center \u2013 Iowa City, Iowa City VA Healthcare System  Iowa City Iowa USA"},{"name":"Specialty Care, Iowa City VA Healthcare System  Iowa City Iowa USA"},{"name":"Division of Hospital Medicine, Department of Internal Medicine University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie M.","family":"Wray","sequence":"additional","affiliation":[{"name":"Hospital Medicine Analytics Team (HMAT)  San Francisco California USA"},{"name":"Department of Medicine University of California, San Francisco  San Francisco California USA"},{"name":"Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center  San Francisco California USA"},{"name":"Center for Data to Discovery and Delivery Innovation (3DI)  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Nearly One\u2010Quarter of Veterans Live in Rural Areas Census Bureau Reports (U.S. Census Bureau) Updated May 1 2024. Accessed September 29 2025.https:\/\/www.census.gov\/newsroom\/press\u2010releases\/2017\/cb17\u201015.html."},{"key":"e_1_2_9_3_1","unstructured":"2020 Census Urban Areas Facts (U.S. Census Bureau) Updated June 29 2023. Accessed September 29 2025.https:\/\/www.census.gov\/programs\u2010surveys\/geography\/guidance\/geo\u2010areas\/urban\u2010rural\/2020\u2010ua\u2010facts.html#:~:text=Table_title:%202020%20Census%20Urban%20Areas%20by%20the States:%2020.0%25%20%7C%20Island%20Areas:%2012.9%25%20%7C."},{"key":"e_1_2_9_4_1","unstructured":"OIG Determination of Veterans Health Administration's Occupational Staffing Shortages(Department of Veterans Affairs Office of Inspector General 2019). Accessed September 22 2025.https:\/\/www.vaoig.gov\/sites\/default\/files\/reports\/2019\u201009\/VAOIG\u201019\u201000346\u2010241.pdf."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12403"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.3570"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2020.0018"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X241311957"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.3061"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.89.9.1322"},{"key":"e_1_2_9_11_1","unstructured":"U.S. Department of Veterans Affairs Veterans Health Administration Office of Rural Health How to Define Rurality Fact Sheet Accessed March 24 2026.https:\/\/www.ruralhealth.va.gov\/docs\/ORH_RuralityFactSheet_508.pdf."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.112516"},{"key":"e_1_2_9_13_1","volume-title":"Qualitative Methods in Rapid Turn\u2010Around Health Services Research","author":"Hamilton A. 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