Rural Patients' Transitional Care Experiences: A Qualitative Analysis of Provider Notes

Samantha B Randolph; Nicholas A Rattray; Claire E Donnelly; Mindy E Flanagan; Laura J Myers; Joanne Daggy; Cathy C Schubert; Scotte R Hartronft; Peter Kaboli; Dawn M Bravata

doi:10.1111/jrh.70225

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Rural Patients' Transitional Care Experiences: A Qualitative Analysis of Provider Notes

Journal article

Open access

Peer reviewed

Rural Patients' Transitional Care Experiences: A Qualitative Analysis of Provider Notes

Samantha B Randolph, Nicholas A Rattray, Claire E Donnelly, Mindy E Flanagan, Laura J Myers, Joanne Daggy, Cathy C Schubert, Scotte R Hartronft, Peter Kaboli and Dawn M Bravata

The Journal of rural health, Vol.42(4), e70225

10/09/2026

DOI: 10.1111/jrh.70225

PMID: 42855931

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Abstract

Rural patients face an increased risk of 30-day mortality after hospitalization, compared to their urban counterparts. The Department of Veterans Affairs (VA) Geriatric Learning Health System's operational partners sought to identify care-related and contextual factors associated with mortality among rural patients being discharged from hospital to home. We examined clinical notes from medical records of 200 (N = 100 rural; N = 100 urban) Veterans ≥65 years-old who were discharged alive to home after a medical or neurological index admission but who died within 30 days of discharge. Text related to the post-discharge course was abstracted verbatim for qualitative analysis. Inductive and deductive codes were used to generate themes describing features of patients' experiences from hospital discharge to death. Cases exemplifying qualitative themes were identified to represent findings. Three themes described key elements of patients' journeys from discharge to end of life that distinguished rural patients' experiences from urban patients: geographic distance barriers to accessing care settings (i.e., lengthy drive times), declining the offer of home health services, and high caregiver burden. These experiences negatively impacted patients-contributing to moments of discordance and uncertainty among the patients, care team, and caregivers. Rural patients faced unique challenges during their transitional journeys. These findings provide targets for future studies seeking to reduce rural-urban disparities mortality for community-dwelling older patients transitioning from hospital to home.

United States

Aged

Aged, 80 and over

Female

Humans

Male

Patient Discharge - statistics & numerical data

Qualitative Research

Rural Population - statistics & numerical data

Transitional Care - standards

Transitional Care - statistics & numerical data

United States Department of Veterans Affairs - organization & administration

United States Department of Veterans Affairs - statistics & numerical data

Details

Title: Subtitle: Rural Patients' Transitional Care Experiences: A Qualitative Analysis of Provider Notes
Creators: Samantha B Randolph - Richard L. Roudebush VA Medical Center
Nicholas A Rattray - Regenstrief Institute
Claire E Donnelly - Richard L. Roudebush VA Medical Center
Mindy E Flanagan - Quality Enhancement Research Initiative
Laura J Myers - Regenstrief Institute
Joanne Daggy - Indiana University Indianapolis
Cathy C Schubert - Richard L. Roudebush VA Medical Center
Scotte R Hartronft - United States Department of Veterans Affairs
Peter Kaboli - University of Iowa
Dawn M Bravata - Regenstrief Institute
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.42(4), e70225
DOI: 10.1111/jrh.70225
PMID: 42855931
ISSN: 1748-0361
eISSN: 1748-0361
Publisher: Wiley
Grant note: U.S. Department of Veterans Affairs QUE HX0003205-01 / QUERI Health Systems Research (HSR)
Language: English
Date published: 10/09/2026
Academic Unit: Internal Medicine
Record Identifier: 9985242768202771

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