Developing a Research Agenda to Improve Rural Health Access and Quality in West Virginia

West Virginia faces significant rural health access and quality challenges, including provider workforce shortages, limited infrastructure, high prevalence of chronic diseases (e.g., opioid use disorder, diabetes, cardiovascular disease), and long-standing barriers to care (e.g., transportation and broadband limitations). Several health indicators—such as life expectancy, rates of preventable hospitalization, and maternal and child health outcomes—highlight urgent, unmet needs in the state's rural communities. Improving rural health access and service quality in West Virginia represents a critical opportunity for high-impact, evidence-based action and policy innovation that requires a comprehensive, tailored research agenda to inform evidence-based policy and programmatic decisions.

This study presents West Virginia's strengths and challenges in rural health access and quality and describes a preliminary research agenda to guide evidence-based improvements in access and care delivery across the state.

Key Takeaways

• West Virginia's healthcare system uses a hub-and-spoke model in which major academic health networks anchor a system of rural Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), school-based health centers, and telemedicine initiatives.
• Despite a strong system and collaboration across these institutions, there is financial instability and risks of closures.
• West Virginia's rural communities have urgent, unmet health needs as measured by life expectancy, rates of preventable hospitalization, and maternal and child health outcomes.
• The state faces severe and widespread shortages of healthcare professionals, including physicians, nurses, laboratory technicians (lab techs), and Emergency Medical Service (EMS) professionals.
• The state's mountainous terrain and challenging road network significantly increase travel times and hinder access to care.
• High rates of poverty, low educational attainment, food insecurity, and lack of stable housing are primary drivers of poor health outcomes.
• Based on a literature scan and key informant interviews, this study describes principles towards research in West Virginia as well as pressing research areas.
• Key principles for more engaged research processes in West Virginia include recognizing the spirit of innovation and collaboration in the state, being attentive to cultural norms and phenomena that may be driving specific health behaviors in rural communities, considering systemic challenges for the state, such as the rugged terrain or poor broadband infrastructure, and prioritizing effective and understandable communication of findings.
• The most pressing research areas include identifying promising or evidence-based practices to address social and economic health drivers, identifying approaches to improve uneven service delivery for acute health care needs, and assessing the impact of state and federal policies on rural communities in West Virginia.