Background: The research history of rural hospitals from 1980 forward is reviewed. This summary, in turn, becomes a foundation for proposing an updated applied research agenda; one focused on ensuring health services for rural America. Research history: From 1980 to 1997 rural hospitals closed at a disproportionally higher rate than non-rural facilities. This trend prompted an academic search (Phase I) for the factors associated with the closure-conversion threat to hospitals. The public policy response was the Balanced Budget Act of 1997 and the creation of the Critical Access Hospital (CAH). Once the closure-conversion threat diminished as a result, the research focus (Phase II) shifted from survival to financial performance monitoring, economic efficiency, quality of care, and patient safety of CAHs. Phase II research demonstrates that CAHs can sustain themselves and are not necessarily victims of adverse rural circumstances. Today, CAHs, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) exist as an established rural health safety net. Also, the 1332 CAHs are considered the hub of health services for rural communities. Significance: The rural environment remains a changing, challenging arena in which to ensure care for it residents. As such, the expanded Internal Revenue Service (IRS) definition of Community Benefit, specifically the periodic Community Health Needs Assessment (CHNA), provides a template for assessing the rural health safety net’s capacity to meet local health needs and improve the health status of its communities. This rubric also balances fiscal stewardship with positive health service outcomes. It is argued that the CHNA expansion of Community Benefit is an ideal research template and performance standard for all rural hospitals. It enables one to offer researched answers to the enduring question, “What is the best way to ensure health services for rural America?”
From surviving to community benefit: A proposed rural health services research agenda