Faculty studies address health care challenges for rural Veterans
Several department faculty members are leading research projects to improve care and health outcomes for rural Veterans. These studies examine topics ranging from telemedicine access and dementia care to food insecurity, with the goal of identifying practical solutions to challenges that Veterans face in rural communities. Below, we cover three of our faculty-led projects.
Heather Davila, PhD, MPA, Research Assistant Professor in General Internal Medicine, is leading two projects funded by the Veterans Health Administration Office of Rural Health (ORH) to understand how the VA can better support Veterans as they navigate complex care needs. One study examines access to post-acute and long-term care services, while the other explores barriers to dementia specialty care.
Davila’s post-acute and long-term care project grew out of earlier research showing that rural Veterans often receive fewer home-based services than urban Veterans, even when their needs are similar. The study examines data from VA, VA-purchased care, and Medicare to understand how Veterans access home health care and nursing home care.
“Most Veterans want to stay in their homes and communities as they age, and I’m really interested in the services that make that possible,” Davila said. “Earlier work from our team showed that rural Veterans often receive fewer home-based services, even when they have similar or greater needs. That finding pushed me to look more broadly across all sources of care to see where gaps might exist and why.”
The project is supported through a two-year VHA Office of Rural Health award running from October 2025 through September 2027.
On her second project, examining barriers to dementia specialty care, Davila is collaborating with Guneet Jasuja, PhD, a behavioral epidemiologist at the VA Bedford Healthcare System and an associate professor of internal medicine at the Chobanian and Avedisian School of Medicine.
Jasuja leads the quantitative analysis of national VA and VA Community Care data, and Davila oversees the qualitative aspect by conducting interviews with dementia specialists, rural primary care clinicians, and family caregivers.
Davila and Jasuja’s research is funded through a three-year VHA ORH award running from October 2024 through September 2027. As they near the end of the study’s second year the team has already identified important differences between rural and urban Veterans’ care. Their early findings show that rural Veterans are slightly but consistently less likely to receive dementia specialist visits and neuropsychological testing. Interviews have also revealed difficulties beyond diagnosis, including long travel distances, staff shortages, and telehealth barriers.
By combining the national data with firsthand accounts, the researchers hope to develop recommendations that are both evidence-based and practical.
“We are working to integrate what we see in the data with what we hear directly from the people providing and receiving care,” Davila said. “Our goal is to identify strategies that improve access and coordination so rural Veterans with dementia can receive the care and support they need while remaining in their homes and communities whenever possible.”
For many rural Veterans, telemedicine can make it easier to access both primary and specialty care without the burden of long travel distances or arranging assistance from family members. But those benefits depend entirely on reliable internet access, which remains out of reach in some of Iowa’s more rural communities. Research Associate Professor in General Internal Medicine Amy M.J. O’Shea, PhD, is leading a project to better understand how those connectivity challenges affect Veterans’ ability to use virtual care.
The Veterans Rural Health Resource Center-Iowa City, an ORH-funded center, funded this project, which was designed as a needs assessment rather than a technology pilot.
Through qualitative interviews, O’Shea’s team has been studying the experiences of Veterans living in areas without adequate broadband services, exploring telemedicine use and perceptions of low-earth orbit (LEO) satellite technology.
“Veterans implement workarounds, such as cellular hotspots or traveling to alternative Wi-Fi-connected locations, when their connection is insufficient to reliably facilitate telemedicine visits,” O’Shea said. “While a small proportion of Veterans might benefit from LEO satellite assistance, our findings suggest there are additional opportunities to better support rural Veterans.”
One of those opportunities emerged directly from conversations with study participants. Veterans frequently recommended additional training on using digital tools like video visit platforms and the My HealtheVet patient portal. O’Shea said these suggestions broadened the project’s focus and emphasized the importance of Veterans’ comfort using resources already available to them.
The project entered its third and final year of funding on October 1, 2026. During this phase, the research team is partnering with the Iowa City VA’s Virtual Health Resource Center to engage rural Veterans who could benefit from virtual care technology training, including those receiving care at the Waterloo Community-Based Outpatient Clinic.
O’Shea hopes the effort will help the VA better understand how to connect rural Veterans with the right support so they can get care in the setting that works best for them.
Honor Harvest, a pilot Food is Medicine initiative led by Taylor Cox, MD, Clinical Assistant Professor in Hospital Medicine, was developed by the ORH and the Iowa Department of Agriculture and Land Stewardship. The program aims to improve access to healthy, locally grown foods for rural Iowa Veterans living with diet-related chronic health conditions, including hypertension, hyperlipidemia, type 2 diabetes, and obesity.
Implemented through the White Team Primary Care Clinic at the Iowa City VA Medical Center, the pilot provided 40 eligible Veterans with weekly boxes of Iowa-grown produce, meat, and dairy products over seven weeks. The food is sourced through Field to Family Food Hub and supplied by Choose Iowa members. These partnerships that make the program possible are its defining strength.
“This has created a unique ‘win-win’ for all parties involved, which we hope will create sustainability going forward,” Cox said.
That shared investment is part of what made the project so salient for Cox. He was impressed by the level of commitment from organizers across the project—Field to Family, local Veteran farmers, the Iowa Department of Agriculture and Land Stewardship, the ORH, and Iowa City VA primary care staff.
While reflecting on a recent program event, Cox captured this collaborative spirit. “[It] was probably best exemplified by our end-of-program event that took place on September 22, where representatives from all parties were present during our produce pickup window to meet with Veterans, share a meal, and show commitment to the program,” he said.
Looking ahead, Cox hopes Honor Harvest can expand to additional locations within the Iowa City VA catchment area in eastern Iowa. The pilot has already benefited from guidance provided by other VA sites running similar Food is Medicine programs. He hopes this same learning model can continue, helping successful programs spread to new communities.
