A new report from Texas A&M's Rural and Community Health Institute provides analysis of -- and proposed solutions for -- the health care challenges faced by rural Texas communities.

The institute, which is part of the Texas A&M University Health Science Center, released the report this week. It outlines ways forward for rural Texas communities that face, or are in the midst of, hospital closures.

Most of the 75-page report centers around focus group research and other data analysis done in three rural Texas communities. It calls for rural health care providers to ramp up communication and engagement with local residents, to look more fully into telemedicine options, and for community leaders to think creatively about needs based on demographic data and trends.

"Texas has had an unprecedented number of rural hospital closures, and those that remain open are facing increasing legislative, regulatory, and fiscal challenges," reads the report's summary. "Focus groups in several Texas communities share the belief that all rural hospitals need to be saved, especially their own." The report goes on to encourage a broader view of possible solutions.

More than 80 hospitals nationwide have closed their doors since January 2010, according to the report. According to the American Hospital Association, there are 1,825 rural hospitals in the United States. Several of the remaining rural facilities are vulnerable, and many are on the precipice of closure. Michael Topchik's "Rural Relevance: Vulnerability to Value" study found that 41 percent of rural hospitals operate at a negative fiscal margin, the report relayed.

Nancy Dickey, executive director of the A&M Rural and Community Health Institute and the report's lead author, said the report found both commonalities and distinct traits in the three communities researchers analyzed.

"If it's possible to put this report into thumbnail form, I'd say, 'It's important to know your numbers.' " Dickey urged health care providers and community officials alike to look into population trends and other specific data about their community. 

The first community in the report was an East Texas city that had a population of around 6,500 people in 2017, a number that had fallen since the 2010 census. The second community had about 2,700 residents, and more 33,000 residents lived in the third community.

"The challenge is to help communities to understand the complexities of health care today and which parts of that can safely and efficiently be delivered locally versus which things would need to go to a more intensive setting that can support increasingly sophisticated care," Dickey said.

Dickey, who is also head of the Department of Primary Care at the A&M College of Medicine, also urged communities to not look for ready-made solutions, but to think about what's best for them. "Perhaps there are no right or wrong answers at all, but instead steps tailored to and supported by each community to ensure access to care," she said.

In one community, the hospital had closed and was in the process of reopening. The outline plan for that community involved ways to make the reopening successful and involve the community in the process, something the report stressed repeatedly.

Another community did not have plans to reopen its hospital. The report's blueprint suggested ways to prioritize mental health and sports medicine, along with other needed work, to advance the health of the community even without the inpatient beds that had been in the hospital.

Dickey and the report said solutions for providers who want to further engage with residents can include offering up space in the building for other events, and shifting hours to nights and weekend days. Dickey said a shift in hours from regular care facilities can help relieve burdens on emergency rooms and urgent care facilities. 

The report stated that rural hospitals around the country "are looking for alternatives when it comes to specialized care options." Telemedicine can provide hospitals with providers they might not have locally, and hospitals using telemedicine often fill provider gaps and cut down on travel the community's members do for health care services.

"Telemedicine should be seen as an innovative way hospitals can provide services that are not available in their communities," the report argues.

The report acknowledged that web connection challenges can be a barrier to these services in rural areas.

The report was sponsored by the Episcopal Health Foundation, Robert Wood Johnson Foundation and the T.L.L. Temple Foundation.

"The goal is 'right-sizing' health care delivery in rural communities in a way that provides quality services for families living there," Elena Marks, EHF's president and CEO, said in a statement. "In some areas that includes a hospital, but these blueprints show that communities may be able to find new and sometimes more effective ways of offering affordable access to the services families need the most."

Dickey pointed to the report and two recent moves -- Blue Cross and Blue Shield of Texas' Nov. 13 announcement of a $10 million commitment to the A&M Health Science Center, and a $4 million grant for A&M to create the Center for Optimizing Rural Health -- as signs of a large-scale commitment to helping rural Texas communities' health care needs.

"These are all working in the direction of creating a toolbox to help a community and its health care facilities to evaluate their capacity and think creatively," Dickey said.

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