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To assess telehealth adoption among hospitals located in rural and urban areas, and identify barriers related to enhanced telehealth capabilities in the areas of patient engagement and health information exchange (HIE) capacity with external providers and community partners. Methods:We used the 2018 American Hospital Association (AHA) Annual Survey and IT Supplement Survey. We applied state fixed effects multivariate analyses and Oaxaca decomposition to estimate the variation of outcomes of interest by hospital geographies.Findings: Our research showed substantial differences in telehealth adoption among hospitals located in rural, micropolitan, and metropolitan areas, where adoption rates increase with urbanicity. Rural hospitals were least likely to have telehealth systems with patient engagement capabilities such as the ability to view their health information online and electronically transmit medical information to a third party. They were also the least likely to report that clinical information was available electronically from outside providers. Our model explained 65% of the rural/urban difference in telehealth adoption, 55% of the number of telehealth services adopted, and 43%-49% of the rural/urban difference in telehealth barriers. Conclusion:Findings demonstrated significant barriers to telehealth use among hospitals located in rural and urban areas. For rural hospitals, barriers include lack of HIE capacity among health care providers in the community, and lack of patient engagement capability.

Our results suggest that LHDs in Maryland that engage in mental health prevention, promotion, and coordination activities are associated with benefits for residents and for the health care system at large. Additional research is needed to evaluate LHD activities in other states to determine if these results are generalizable.

Retirement indicates the end of people's participation in the labour force due to age, disease and other reasons. It is one of the major transitions of an individual's life and can have a significant impact on health outcomes (Apouey, Guven, & Senik, 2019). Retirement can lead to social isolation, a lack of physical and intellectual exercise and deterioration in mental and physical health (Rohwedder & Willis, 2010). On the other hand, retirement may reduce physical and mental stress and lead to a healthier lifestyle (Eibich, 2015; Shai, 2018). Increasing sleep duration is a key mechanism through which retirement affects health. Time spent on sleeping and working is often traded-off due to time constraints. However, people's sleep habits may be less constrained after retirement. Previous stud

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