{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:49:10Z","timestamp":1791614950451,"version":"4.3.4"},"reference-count":72,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":38,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007181","name":"Quality Enhancement Research Initiative","doi-asserted-by":"publisher","award":["QUE HX0003205\u201001"],"award-info":[{"award-number":["QUE HX0003205\u201001"]}],"id":[{"id":"10.13039\/100007181","id-type":"DOI","asserted-by":"publisher"}]},{"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Rural patients face an increased risk of 30\u2010day mortality after hospitalization, compared to their urban counterparts. The Department of Veterans Affairs (VA) Geriatric Learning Health System's operational partners sought to identify care\u2010related and contextual factors associated with mortality among rural patients being discharged from hospital to home.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We examined clinical notes from medical records of 200 (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0100 rural;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0100 urban) Veterans \u226565 years\u2010old who were discharged alive to home after a medical or neurological index admission but who died within 30 days of discharge. Text related to the post\u2010discharge course was abstracted verbatim for qualitative analysis. Inductive and deductive codes were used to generate themes describing features of patients\u2019 experiences from hospital discharge to death. Cases exemplifying qualitative themes were identified to represent findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Three themes described key elements of patients\u2019 journeys from discharge to end of life that distinguished rural patients\u2019 experiences from urban patients: geographic distance barriers to accessing care settings (i.e., lengthy drive times), declining the offer of home health services, and high caregiver burden. These experiences negatively impacted patients\u2014contributing to moments of discordance and uncertainty among the patients, care team, and caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural patients faced unique challenges during their transitional journeys. These findings provide targets for future studies seeking to reduce rural\u2013urban disparities mortality for community\u2010dwelling older patients transitioning from hospital to home.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70225","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:12:35Z","timestamp":1791612755000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rural Patients\u2019 Transitional Care Experiences: A Qualitative Analysis of Provider Notes"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6265-8698","authenticated-orcid":false,"given":"Samantha B.","family":"Randolph","sequence":"first","affiliation":[{"name":"VA HSR Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9683-889X","authenticated-orcid":false,"given":"Nicholas A.","family":"Rattray","sequence":"additional","affiliation":[{"name":"VA HSR Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"},{"name":"Department of Veterans Affairs (VA), Health Systems Research (HSR), Expanding Expertise Through E\u2010health Network Development (EXTEND), Quality Enhancement Research Initiative (QUERI)  Indianapolis Indiana USA"},{"name":"Division of General Internal Medicine and Geriatrics, Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"William M. Tierney Center for Health Services Research Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4063-4219","authenticated-orcid":false,"given":"Claire E.","family":"Donnelly","sequence":"additional","affiliation":[{"name":"VA HSR Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"},{"name":"Department of Veterans Affairs (VA), Health Systems Research (HSR), Expanding Expertise Through E\u2010health Network Development (EXTEND), Quality Enhancement Research Initiative (QUERI)  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3309-526X","authenticated-orcid":false,"given":"Mindy E.","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA), Health Systems Research (HSR), Expanding Expertise Through E\u2010health Network Development (EXTEND), Quality Enhancement Research Initiative (QUERI)  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8262-8007","authenticated-orcid":false,"given":"Laura J.","family":"Myers","sequence":"additional","affiliation":[{"name":"VA HSR Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"},{"name":"Department of Veterans Affairs (VA), Health Systems Research (HSR), Expanding Expertise Through E\u2010health Network Development (EXTEND), Quality Enhancement Research Initiative (QUERI)  Indianapolis Indiana USA"},{"name":"Division of General Internal Medicine and Geriatrics, Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"William M. Tierney Center for Health Services Research Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0815-1746","authenticated-orcid":false,"given":"Joanne","family":"Daggy","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9341-1340","authenticated-orcid":false,"given":"Cathy C.","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs (VA), Health Systems Research (HSR), Expanding Expertise Through E\u2010health Network Development (EXTEND), Quality Enhancement Research Initiative (QUERI)  Indianapolis Indiana USA"},{"name":"Division of General Internal Medicine and Geriatrics, Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Community, Home, and Geriatrics Service, Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-6872","authenticated-orcid":false,"given":"Scotte R.","family":"Hartronft","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs Office of Geriatrics &amp; Extended Care, Veterans Health Administration  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0993-0952","authenticated-orcid":false,"given":"Peter","family":"Kaboli","sequence":"additional","affiliation":[{"name":"Veterans Rural Health Resource Center\u2014Iowa City, VA Office of Rural Health, Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System  Iowa City Iowa USA"},{"name":"Division of General Internal Medicine Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3048-2536","authenticated-orcid":false,"given":"Dawn M.","family":"Bravata","sequence":"additional","affiliation":[{"name":"VA HSR Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"},{"name":"Department of Veterans Affairs (VA), Health Systems Research (HSR), Expanding Expertise Through E\u2010health Network Development (EXTEND), Quality Enhancement Research Initiative (QUERI)  Indianapolis Indiana USA"},{"name":"Division of General Internal Medicine and Geriatrics, Department of Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"William M. 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