What Rural Communities Stand to Lose From AHRQ Grant Cancellations

As policymakers debate how to strengthen rural health care, researchers whose AHRQ grants were canceled are describing what rural communities stand to lose when studies aimed at improving care delivery are interrupted. Beginning on July 15, AHRQ issued termination notices for at least 150 active research and training grants, ending support for projects focused on issues ranging from cancer care and vaccination to telehealth, patient safety, and health care quality improvement. These cancellations are part of a broader disruption at AHRQ that has included halted grantmaking, staffing reductions, and the continued withholding of congressionally appropriated research funding.

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The timing is significant. Last week, new research found that rural patients continue to use telehealth at lower rates than urban patients despite facing greater barriers to care and higher burdens of chronic disease. At the same time, policymakers are investing billions through the Rural Health Transformation Program to address workforce shortages, hospital closures, and persistent access challenges across rural America. The program was created through H.R. 1, which paired a $50 billion investment in rural health transformation with far larger reductions to Medicaid and other health programs. Researchers have warned that those cuts could reduce the capacity of rural hospitals, community health centers, and other providers to deliver care, making it even more important to understand which interventions are most effective in strengthening rural health systems.

Many of the canceled AHRQ-funded projects were designed to tackle those same problems.

Maternal Health and Rural Emergency Preparedness

As rural hospitals continue to close labor and delivery units, researchers have warned that pregnant patients are increasingly likely to receive care from clinicians without specialized obstetric training. Andrea Shields, M.D., M.S. at the University of Connecticut School of Medicine, was leading two AHRQ-funded projects designed to address this gap by training paramedics, first responders, and non-obstetric clinicians to recognize and manage life-threatening emergencies during pregnancy, childbirth, and the postpartum period.

The training had already led to tangible changes in practice. Ambulance protocols in Arizona were updated to include medications used to treat severe maternal bleeding, a maternal transport team serving six states adopted new equipment to manage postpartum hemorrhage, and the Indian Health Service in Arizona embraced the curriculum as part of its training efforts. Planned trainings for the Navajo Nation and other underserved communities were also in development. Shields reported that care teams who completed the training have already used the skills they learned to help save the lives of pregnant patients experiencing cardiac arrest. The grant cancellations also halted data collection, disrupted research staff positions and clinical partnerships, and stopped efforts to adapt the curriculum for low-resource communities disproportionately affected by rising maternal mortality. As a result, work that was already expanding into rural and remote areas is now indefinitely delayed.

Telehealth and Rural Care Delivery

Just days after a new study reported that telehealth utilization continues to lag in rural areas despite ongoing provider shortages and access challenges, the cancellation of Annie Larson Ph.D, M.P.H.’s research highlights how many questions remain unanswered. At OCHIN, a national network of safety-net clinics, Larson was studying how telehealth affected preventive care use and quality of care among rural, low-income populations, with a particular focus on how rurality and the COVID-19 pandemic shaped access patterns.

The project never moved forward after a promised Notice of Award was not issued. Early findings suggested that telehealth use in safety-net settings was driven primarily by audio-only visits, not video visits, for both rural and urban patients. For many low-income and rural patients, audio-only telehealth can be the only practical option, particularly when broadband access, cellular coverage, digital literacy, or access to video-enabled devices is limited. Those findings raise important questions as policymakers invest heavily in rural digital health infrastructure and debate the future of telehealth reimbursement and regulation. Without studies like Larson’s, health systems and policymakers may have less evidence to guide decisions about which telehealth strategies are most effective for patients facing broadband, transportation, and access barriers.

Beyond telehealth, other canceled projects examined broader changes in rural health care delivery. At Northeastern University, Brady Post, Ph.D., was studying how hospital-physician integration affects access to care, care coordination, and health outcomes in rural and urban communities. The project comes as policymakers and health system leaders grapple with ongoing consolidation across the health care sector. According to Bipartisan Policy Center, only 32 percent of hospitals now operate independently, down from about 90 percent in 1970, and researchers continue to debate whether consolidation improves care coordination and helps struggling rural providers survive or instead leads to higher costs and reduced access to care.

Post’s research was designed to help answer those questions. The findings could have informed policies aimed at ensuring rural patients benefit from changes in the health care marketplace while avoiding unintended consequences. With the project canceled, policymakers lose an opportunity to better understand how one of the most significant trends in health care delivery is affecting rural communities.

Rural Health Research and Prevention

At Vanderbilt University Medical Center in Tennessee, Tom Reese PharmD, Ph.D. was leading an early-career research project focused on improving patient-centered decision-making for opioid use disorder treatment. The cancellation of Dr. Reese’s project comes as lawmakers from both parties are seeking to strengthen rural responses to the opioid crisis. This week, Senators Shelley Moore Capito (R-WV) and Peter Welch (D-VT) introduced legislation to preserve the Rural Communities Opioid Response Program (RCORP), which supports prevention, treatment, and recovery services in rural communities. Reese’s project focused on helping patients become active partners in decisions about opioid use disorder treatment, with the goal of improving engagement and long-term retention in care. As policymakers look for ways to expand access to treatment in rural areas, the loss of research on what helps patients stay connected to care weakens the evidence available to guide those efforts.

The cancellations also extended to research designed to address longstanding health disparities in rural communities. At the University of North Carolina at Chapel Hill, Nadja Vielot, Ph.D., was developing and testing strategies to increase HPV vaccination among rural adolescents. The project examined whether recommending the HPV vaccine at age 9, rather than waiting until ages 11 or 12, could improve vaccine completion rates and help reduce urban-rural disparities in HPV-related cancers. The research comes at a time when new studies continue to document significant geographic variation in HPV vaccination rates and highlight the need for targeted strategies to improve uptake, particularly in states and regions that continue to lag behind national goals. By identifying effective approaches to increase vaccination in rural communities, the project aimed to reduce disparities in preventive care and lower the long-term burden of HPV-related cancers. At a time when policymakers, health systems, and public health officials continue searching for ways to improve preventive care in underserved communities, the loss of research focused specifically on rural cancer prevention leaves important questions unanswered.

These stories highlight a growing disconnect between national conversations about strengthening rural health care and the loss of research designed to inform those efforts. From maternal emergency preparedness and telehealth access to substance use disorder treatment, these projects were generating evidence about how to solve some of rural America’s most pressing health challenges. Now that those studies have abruptly ended, communities lose more than research dollars and the time and money already invested. They lose opportunities to learn what works, improve care, and support better outcomes for the patients who need it most.

This post was written by AcademyHealth Communications Fellow, Karina Collins.