STEPHENVILLE, Texas — A new five-year research project funded by the National Institutes of Health (NIH) will examine the causes and consequences of rural hospital closures, with the goal of identifying strategies to strengthen healthcare access and improve health outcomes in rural communities nationwide.
Tarleton State University is contributing to the multi-institutional study through its first subaward under an NIH R01 research grant, one of the agency’s primary funding mechanisms for supporting major research projects. The milestone reflects the university’s expanding research capacity and growing role in national research collaborations addressing critical healthcare challenges.
The project is led by Dr. Hossein Zare of the Johns Hopkins Bloomberg School of Public Health, with collaborators at Harvard University and Tarleton State.
The study will take a comprehensive approach to understanding and addressing rural hospital closures by developing a national early-warning model to identify hospitals at greatest risk of closure, measuring the effects of closures on healthcare access and chronic disease outcomes, and evaluating Maryland’s global budgeting model as a potential strategy to strengthen rural hospital sustainability.
Building on these findings, researchers will estimate whether more flexible global budget approaches could help prevent future closures while preserving access to essential healthcare services for rural populations.
“This award reflects the growing national reach of Tarleton State’s health sciences research,” said Dr. Elizabeth Palmarozzi, Vice President for the Division of Health Sciences and Executive Dean of the proposed College of Osteopathic Medicine (applicant status – seeking accreditation). “Dr. Gandhi’s work shows how research rooted in rural communities can shape policy for communities across the country.”
Dr. Subi Gandhi, Professor of Public Health and Co-director of Tarleton State’s Center for Rural Resilience in the Division of Health Sciences, will serve as a co-investigator on the project, bringing expertise in epidemiology and rural population health.
“When a rural hospital closes, the effects can extend well beyond the hospital itself, potentially influencing chronic disease management, access to timely care and emergency response,” said Dr. Gandhi. “Through this study, we hope to better understand and measure those impacts while exploring approaches that can help keep care accessible and close to home. More broadly, this work reflects Tarleton State’s collaborative commitment to advancing rural health research and contributing to the national conversation on the health and resilience of rural communities.”
Predicting rural hospital closures and understanding their downstream health impacts require not only financial analysis but also rigorous epidemiological methods that link hospital operations and access to care to population health outcomes.
As the study’s epidemiologist, Dr. Gandhi will help define and examine the causal pathways linking the loss of local healthcare services to nonmedical drivers of health and subsequent health outcomes. She will also provide epidemiological and data-analytic expertise, co-author study publications and mentor trainees involved in the project.
“Having worked with Dr. Gandhi for 11 years, I have witnessed her dedication to advancing rural health through research and community engagement,” said Dr. Myong-Gwi Ryou, Dean of the College of Health and Clinical Professions. “This NIH R01 award is a well-deserved recognition of her contributions and a significant milestone for our college and Tarleton State University.”
Dr. Gandhi joined Tarleton State in 2014 as a founding public health faculty member and launched the university’s public health program that same year. She holds a Ph.D. and MPH in epidemiology from the University of North Texas Health Science Center.
For more than a decade, her work has focused on improving health outcomes in underserved areas of Texas. She partners with rural hospitals, health departments, libraries, faith communities and local organizations to expand access to care, strengthen behavioral health services and prevent chronic disease. Her community-engaged research turns local needs into practical solutions, and she continues to build the rural public health workforce by training the next generation of practitioners and researchers.
Dr. Gandhi is a Fellow of the Texas Public Health Association (TPHA) and serves on its Executive Board and Governing Council. She is also a board member of Healthier Texas and received TPHA’s 2024 James E. Peavy Memorial Award.
A founding member of The Texas A&M System, Tarleton State University is breaking records — in enrollment, research, scholarship, athletics, philanthropy and engagement — while transforming the lives of more than 28,000 students in Stephenville, Fort Worth, Waco, Bryan and online. For 127 years, Tarleton State has been committed to accessible higher education opportunities for all while helping students grow academically, socially and professionally through programs that emphasize real-world learning and address regional, state and national needs.