title: Delivering Rural Health in a Changing Health Model: A Qualitative Study Involving Four Hospitals.
abstract: OBJECTIVE
  An exploratory examination of rural hospital staff experiences to determine whether the physical state of rural healthcare facilities influence the healthcare experience and perception of care quality.
  
  
  BACKGROUND
  Rural hospitals have served as the backbone of rural communities in the United States. Over time, these facilities have witnessed enhanced expectations, expanding their scope of operations from acute care to diversified services through linked provider networks and disaster management. Simultaneously, financial challenges, increasing emphasis on safety and quality, and the Affordable Care Act have introduced new challenges for rural hospitals. Currently, there is little empirical knowledge in this domain from a facility perspective.
  
  
  METHODS
  An exploratory qualitative study was conducted, involving semistructured interviews of upper and mid-level administrators in four rural hospitals located in West Texas. All questions attempted to obtain the subject's knowledge, ideas, and opinions concerning the physical design of the hospitals and the hospital experience.
  
  
  RESULTS
  According to data on staff experiences, two classes of factors surfaced as potential influencers of hospital experience and care quality: (1) care configuration and (2) outdated building. Care configuration pertains to positioning facilities designed with inpatient care focus to a market expanding in outpatient services. Outdated buildings affect several issue including perceived provider quality and spatial accommodations for safe/efficient care and thereby also affecting the healthcare experience.
  
  
  CONCLUSIONS
  Physical infrastructure of rural hospitals may have important and meaningful implications for population health performance in rural America.
authors.affiliation: Department of Design, College of Human Sciences, Texas Tech University, Lubbock, TX, USA d.pati@ttu.edu.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Pati
authors.affiliation: Department of Design, College of Human Sciences, Texas Tech University, Lubbock, TX, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Gaines
authors.affiliation: Department of Design, College of Human Sciences, Texas Tech University, Lubbock, TX, USA.
authors.forename: Shabboo
authors.initials: S
authors.lastname: Valipoor
mesh_terms: D000288:Administrative Personnel; D006272:Health Facility Environment; D006749:Hospital Design and Construction; D006780:Hospitals, Rural; D006801:Humans; D010044:Outpatient Clinics, Hospital; D058991:Patient Protection and Affordable Care Act; D036301:Qualitative Research; D012423:Rural Health; D013781:Texas
keywords: Affordable Care Act; environmental design; healthcare facilities; rural hospitals