Beyond Geography: Using a Cluster-Based Analysis to Conceptualize the Rurality of Veterans Health Administration Hospitals.

PURPOSE: 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-based classification alone and to propose facility-level variables that can be used to measure rural veterans' access to hospital-based care. METHODS: We conducted a cluster analysis of 110 Veterans Health Administration (VHA) acute care hospitals using k-means clustering. Hospital-level 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). FINDINGS: Three clusters emerged. The Low Rural Serving (LRS) Cluster (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 = 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 = 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. CONCLUSIONS: Using 9 hospital-level factors that may characterize degree of hospital rurality, we identified 3 clusters that differentiate VHA hospitals and the rural populations they serve.