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Rural Health
Research Gateway

ETSU/NORC Rural Health Research Center

Current Projects

  • A Closer Examination of Rural Hospital Bypass
    This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.
    Topics: Critical Access Hospitals (CAHs), Health reform, Health services, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Private health insurance, Uninsured and underinsured
  • Building the Rural Evidence Base: Examining the Feasibility of Implementing Pilot Programs and Demonstrations in Rural Communities
    Evidence-based interventions are commonly developed in populated, urban centers and then adapted for rural communities. This project will investigate the benefits of piloting and evaluating interventions in rural areas to build the rural evidence base as a step in addressing rural health disparities and improving health conditions in rural communities.
    Topics: Health promotion and disease prevention, Health services
  • Comparing Across Health Indices: Differences by Rurality, Missingness, and Associations With Health Outcomes
    The purpose of this study is to describe and compare existing area-level indices of vulnerability by rurality and to examine associations between indices and health outcomes of interest by area-level measures of rurality.
    Topics: Healthcare access, Poverty, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  • Considerations for the Use of Area-Level Vulnerability and Resilience Indices and Rurality in Funding Formulas
    The purpose of this study is to model potential funding formulas within states to understand how structural elements in formulas (i.e., inclusion of the Social Vulnerability Index, use of rural carve-outs or floor amounts, and other factors) affect county-level allocations compared to simple, population-based formulas.
    Topics: Healthcare financing, Public health, Social determinants of health
  • Examining Post-Acute Care Utilization and Outcomes for Rural Medicare FFS and Medicare Advantage Beneficiaries
    This study will describe differences in post-acute care utilization and post-discharge outcomes between rural Medicare Fee-for-Service beneficiaries and rural Medicare Advantage beneficiaries overall, by region of the country, and levels of rurality.
    Topics: Care management, Critical Access Hospitals (CAHs), Healthcare access, Home health, Medicare, Medicare Advantage (MA), Post-acute care
  • Examining Rural Population Characteristics and Access to Care: A Study of Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs)
    This project examined Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs), analyzing geographic disparities in provider shortages across rural and urban settings. Findings highlight variations in access to primary care, mental health, and dental services, informing federal programs that allocate resources to improve health care access.
    Topics: Healthcare access, Mental and behavioral health, Oral health, Workforce
  • Going Beyond Hospital Closures: Estimating Rural and Urban Changes in Access to Hospital Service Lines
    Rural hospital closures have been prominent in the last decade and are an important reflection of decreases in access to essential healthcare services. However, hospital closures alone may overlook other decreases to access through service line closures. This study estimates hospital service line closures over time and by rurality.
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare access, Hospitals and clinics
  • Rural and Urban Sepsis Outcomes as a Measure of Health Care Quality: A Nationwide Comparative Analysis Using HCUP Data
    This study examines differences in sepsis prevalence, outcomes, costs, and treatment between rural and urban hospitals using the HCUP Nationwide Readmissions Database. It aims to inform policies related to access to timely, high-quality sepsis care and identify strategies to enhance healthcare outcomes across diverse hospital settings.
    Topics: Care management, Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Private health insurance, Quality, Social determinants of health
  • Rural/Urban Differences in Forgoing Health Care during the COVID-19 Pandemic
    Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
    Topics: Aging, Care management, Chronic diseases and conditions, Coronavirus Disease 2019 (COVID-19), Diabetes, Health promotion and disease prevention, Health services, Medicare, Mental and behavioral health, Telehealth
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
    This study will include an analysis of 2018/2019 Medicare, Medicaid and Commercial claims to compare the penetration of Screening, Brief Intervention and Referral to Treatment (SBIRT) and its different components in rural compared to urban healthcare settings. Within the overarching analysis, the study team will examine the type of interventions conducted within the SBIRT framework stratified by provider type, healthcare setting, and rural and urban provider ZIP codes. Findings will be analyzed within the context of county-level substance use rates, historical enactment of state SBIRT billing codes, overdoses, and alcohol poisoning-based hospital admissions contrasting trends in SBIRT administration with a proxy for community need.
    Topics: Chronic diseases and conditions, Health promotion and disease prevention, Medicaid and CHIP, Medicare, Mental and behavioral health, Private health insurance, Public health, Substance use and treatment
  • Suicide Mortality: A Comparison of Urban and Rural Rates
    Suicide contributes to significant mortality in the United States. This project will examine the differences in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. The research design of this study will adopt a cross-sectional, retrospective approach, using secondary data.
    Topics: Healthcare access, Mental and behavioral health, Public health, Rural statistics and demographics, Uninsured and underinsured
  • Understanding Rural Health Data Challenges through Analysis of Peer-Reviewed Publication Limitations
    This project will quantify and characterize health data-related limitations commonly identified in published studies on rural health and ways in which researchers overcome these challenges. Findings will provide a rigorous description of rural health data challenges, which may be used by researchers, policymakers, and rural health data collectors to improve rural data and research using rural data.
    Topic: Rural statistics and demographics