Addressing the need for health equity reform in rural community hospitals: Centering the voices of local health care stakeholders.

Rural hospitals are closing rapidly across the US, causing a decline in access to health care for rural populations. Tennessee has the highest rate of rural hospital closures per capita; however, some rural hospitals have managed to survive. To better understand protective strategies against rural hospital closures in Tennessee, fourteen interviews were conducted with hospital stakeholders in five racially and geographically diverse rural communities. Interviewees shared perspectives on strategies that have supported their hospital's continued operations. Interviews were recorded and transcribed. Transcripts were analyzed using rapid qualitative analysis. Analysis of participants' interviews resulted in the emergence of six major themes to reduce hospitals' risk for closure: government policy; commercial factors; business-internal strategies; community-engagement strategies; ongoing challenges, and behavioral health and substance abuse. Within these major themes, subthemes were elucidated. Amplifying the concerns and successful strategies of rural hospital stakeholders may provide solutions to address the health crisis affecting rural communities throughout the US and advance rural health equity.