Rural Health
Research Gateway

Maine Rural Health Research Center

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2024

  • How are Rural Health Clinics Serving Pediatric and Obstetrical Medicaid Populations?
    This project examined the roles of independent and provider-based Rural Health Clinics in serving pediatric and obstetrical patients covered by state Medicaid programs.
    Topics: Children and adolescents, Health services, Healthcare financing, Maternal health, Medicaid and CHIP, Rural Health Clinics (RHCs), Women
  • Understanding Rural Non-Emergent Emergency Department Use
    Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study used the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.
    Topics: Emergency medical services (EMS) and trauma, Health services, Healthcare access, Hospitals and clinics

2023

  • Ambulance Deserts: Addressing Geographic Disparities in the Provision of Ambulance Services
    This two-year study aimed to identify geographic disparities in accessing ambulance services by building a database of ambulance service locations in year one and identifying and creating maps of ambulance deserts within each of the states in year two.
    Topics: Emergency medical services (EMS) and trauma, Healthcare access, Rural statistics and demographics, Transportation
  • Excess Deaths Associated with COVID-19 in Rural Communities
    Quantifying excess deaths associated with the COVID-19 pandemic can provide a more complete measure of the total burden of the pandemic on mortality. While the National Center for Health Statistics maintains an online dashboard of U.S. excess deaths associated with the COVID-19 pandemic overall and by race/ethnicity and age, excess deaths by rurality of residence are not tabulated and this project aims to fill that gap.
    Topics: Coronavirus Disease 2019 (COVID-19), Rural statistics and demographics
  • Rural Health Access: Affordability and Barriers to Care
    Rural-urban comparisons of healthcare access and affordability predate many policy reform efforts aimed at increasing access and decreasing costs—ongoing concerns of rural families. This study used national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
    Topics: Health disparities and health equity, Health reform, Health services, Healthcare access, Healthcare financing, Private health insurance, Public health, Social determinants of health

2022

  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • Northern Border Regional Commission State and Region Chartbooks: A Health-Focused Landscape Analysis
    The aim of this study was to compile the most recent publicly available data related to health and healthcare access at the county-level and state-level for the Norther Border Region and the individual states: ME, NH, VT, and NY. We highlighted counties with worse health outcomes, as compared to the rest of the counties in the region.
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Rural statistics and demographics, Social determinants of health, Substance use and treatment, Telehealth, Uninsured and underinsured, Workforce
  • Rural Health Clinics Chartbook
    This project produced a comprehensive, descriptive chartbook detailing the characteristics and status of rural health clinics (RHCs) nationally. It also assessed the use of secondary data to construct a national set of indicators for RHCs and identify gaps in our knowledge that cannot be addressed using secondary data.
    Topic: Rural Health Clinics (RHCs)

2021

  • A Current Examination of HIV and Hepatitis C in Rural Counties
    Using data from federal and state sources, we produced a chartbook on county-level data on human immunodeficiency virus (HIV) prevalence and acute hepatitis C virus (HCV) incidence, examined the availability of Ryan White HIV/AIDS medical providers and other HIV and HCV treatment/testing services across the rural-urban continuum, and estimated county-level prevalence of maternal HCV infection.
    Topics: Maternal health, Mental and behavioral health, Substance use and treatment
  • Capacity of Rural Counties to Respond to an HIV or Hepatitis C Outbreak
    Rural counties may be potentially vulnerable to an HIV or Hepatitis C outbreak among persons who inject drugs. Using mixed methods, we provided an understanding of the rural areas at risk of an outbreak based on their state and county characteristics and an assessment of their public health infrastructure.
    Topics: Healthcare access, Public health, Substance use and treatment
  • Impact of the Opioid Crisis on Rural Emergency Departments
    This study used data from the Nationwide Emergency Department Sample and information from a panel of rural emergency care experts to assess the impact of the opioid crisis on rural emergency departments. Findings informed policies designed to help rural healthcare systems and communities address the growing problem of opioid abuse.
    Topics: Emergency medical services (EMS) and trauma, Mental and behavioral health, Substance use and treatment
  • Tobacco Treatment in Rural Primary Care
    This study used the National Ambulatory Medical Care Survey to compare rural and urban rates and predictors of tobacco counseling and tobacco treatment medication prescribing by primary care providers to their smoking patients.
    Topics: Physicians, Substance use and treatment

2020

  • Acuity Differences Among Newly Admitted Rural and Urban Nursing Home Residents
    This study used nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persisted among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics were associated with differences in resident acuity.
    Topics: Aging, Long-term care
  • Healthcare Use and Access Among Rural & Urban Non-elderly Disabled Medicare Beneficiaries
    This project explored healthcare use and barriers to healthcare access among disabled Medicare beneficiaries under 65 in rural and urban areas. The study was based on quantitative analyses of the 2009-2013 Medicare Current Beneficiary Survey.
    Topics: Disabilities, Health disparities and health equity, Medicare
  • Understanding Rural-Urban Mortality Differences
    This study will address rural-urban mortality gaps in our understanding of rural mortality disparities using the 1985-2009 National Health Interview Survey (NHIS), linked to national death certificate data, to explore the individual-level characteristics and health behaviors of rural and urban adults and their association with mortality.
    Topic: Health disparities and health equity

2019

  • Preventive Health Service Use Among Rural Residents
    Examining differences in rural-urban preventive health service use is critical to assessing the impact of health benefit design changes on access to preventive services and their use among rural and urban populations. We used National Health Institute Survey data to compare receipt of preventive health services among rural and urban adults.
    Topics: Health promotion and disease prevention, Health services, Women
  • Rural Health Clinic Financial Performance and Productivity
    This study used Medicare cost reports for independent and provider-based clinics to provide a detailed national picture of the financial and operational performance of RHCs and describe variations in performance related to revenue, costs, staffing, payer mix, productivity levels, and hours of operation across independent and provider-based clinics. The project also developed measures that can be used to benchmark RHC performance over time.
    Topics: Medicare, Rural Health Clinics (RHCs)
  • Understanding Differences in Rural and Urban Adolescent and Young Adult Substance Use
    Using National Survey of Drug Use and Health data, we'll examine rural-urban adolescent/young adult substance use differences. While substance use has declined among all adolescents in recent years, it's unclear whether the trends apply to rural adolescents/young adults who have historically higher substance use rates than their urban counterparts.
    Topic: Substance use and treatment

2018

2017

2016

  • Access To and Use of Home and Community-Based Services in Rural Areas
    This study will use data from the 2010 Medicaid Analytic eXtract (MAX) file and in-depth policy reviews and interviews in four states to examine differences in the use of institutional and home and community-based service (HCBS) use by older adults across urban and rural areas, and the policy and community factors that contribute to differences or comparability in use.
    Topics: Aging, Home health, Long-term care
  • Adverse Childhood Experiences and the Health Status of Rural Residents
    The proposed project will (1) assess the prevalence of adverse childhood experiences (ACEs) in rural populations and (2) examine associations of ACEs with health outcomes in rural versus urban settings.
    Topic: Children and adolescents
  • Role and Early Impact of CO-OPs in the Rural Health Insurance Marketplace
    This study will combine quantitative analysis with administrative health plan practice data with targeted case studies to examine the rural availability and pricing of CO-OP plans, and the early experiences of these plans.
    Topic: Private health insurance

2015

  • Assessing Health Information Technology (HIT) Strategies to Improve Access for Rural Veterans
    Rural veterans face unique barriers to care including insufficient communication and coordination of care provided across multiple settings—both within and outside of the Veteran's Administration. To help reduce these barriers, multiple agencies within the federal government have promoted technology as an opportunity to improve access and care coordination to veterans living in remote areas. Most recently, programs in Maine, Montana and Alaska have received grants to use health information technology (HIT) to expand and integrate services—including mental health services—for rural Veterans. However, little is known about the challenges these programs face on the ground, or what conditions and program strategies may facilitate success. This study will consist of case studies of these programs in each of the three states, and will identify best practices and barriers for implementing rural HIT initiatives that could inform future strategies in this area.
    Topic: Veterans
  • Expanded Look at Rural Access to Care
    This study will use newly available national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
    Topics: Health disparities and health equity, Uninsured and underinsured
  • Out-of-Pocket Costs Among Rural Medicare Beneficiaries
    The purpose of this project is to examine out-of-pocket spending among Medicare beneficiaries, to identify whether there are rural-urban differences in out-of-pocket costs, and to explore what factors account for these differences. Should Medicare redesign occur, this study will provide important information against which to assess the possible impact of different design options on rural Medicare beneficiaries.
    Topics: Disabilities, Medicare
  • Rural Maternal Smoking Behaviors
    In this project, we will develop a chart book documenting the prevalence of mental health/substance abuse conditions and describing the utilization of mental health services in rural and urban settings.
    Topics: Health disparities and health equity, Mental and behavioral health, Substance use and treatment
  • Rural Mental Health First Aid Evaluation
    This project is a mixed-methods case study that focuses on the Mental Health First Aid training program, with a view toward clarifying the rural reach, feasibility, impact, and appropriateness of the program for rural communities.
    Topic: Mental and behavioral health
  • Transformation of Rural Health Clinics: Are They Ready to Serve as Patient-Centered Medical Homes?
    Rural Health Clinics (RHCs) face pressure to transform their practices by becoming patient-centered medical homes (PCMHs). This study will document the readiness of RHCs to serve as PCMHs and provide information to assist policymakers in developing technical assistance and other policy resources to support RHCs in doing so.
    Topics: Care management, Rural Health Clinics (RHCs)
  • Year 2 of the Sentinel Cohort of Rural Health Clinics: Testing, Evaluating and Refining a Set of Rural Health Clinic Quality Measures
    This project implements the set of core consensus quality measures identified during Year One of the Rural Health Clinic (RHC) Sentinel Cohort project among a group of approximately 130 RHCs in 13 states.
    Topics: Quality, Rural Health Clinics (RHCs)

2014

  • Assessing HIT Readiness of Rural Health Clinics: A National Survey
    We will design and conduct a national survey of rural health clinics, both independent and provider-based, to determine the current level of health information technology adoption and readiness in these clinics
    Topics: Health information technology, Rural Health Clinics (RHCs)
  • Developing a Sentinel Cohort of Rural Health Clinics for Use in Developing Relevant Quality Measures and Monitoring Program Performance
    This two year project will assemble a cohort of Rural Health Clinics (RHCs) from ten to thirteen states to participate in a sentinel quality measurement process. During the first year of the project, the cohort of RHCs will participate in the identification, development, and refinement of a discrete set RHC quality measures in conjunction with the project team and an expert panel of RHC and quality measurement experts. During the second year, the cohort will be asked to implement, report, and evaluate the measures.
    Topics: Quality, Rural Health Clinics (RHCs)
  • Health Insurance Stability Among Rural Children Following Public Coverage Expansions
    While estimates indicate that the uninsured rate among rural children has dramatically decreased since the 1997 passage of the State Children's Health Insurance Program (CHIP), it is not clear whether or not coverage has become more stable and uninsured spells shorter. The purpose of this study is to investigate changes in insurance stability among rural and urban children following CHIP, and whether this is affected by specific state eligibility and enrollment policies or clusters of policies. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we will measure rural-urban differences in uninsured spell length and frequency, sources of coverage before and after uninsured spells, movement between sources of coverage, how these measures of stability have changed over time, and the factors that relate to greater continuity of coverage among rural children.
    Topics: Children and adolescents, Medicaid and CHIP, Uninsured and underinsured
  • Implications of Mental Health Comorbidity and Rural Residence for Health Care Use Patterns of Individuals with Chronic Disease
    This study will use the 2005-2010 panels of the Medical Expenditure Panel Survey to compare the prevalence of concurrent mental health and chronic illnesses across rural and urban populations and to describe relationships among comorbidity, residence, and healthcare use. Findings will inform public and private decisions on how best to allocate new resources available for mental health/primary care integration efforts.
    Topics: Chronic diseases and conditions, Mental and behavioral health
  • Prevalence and Impact of High Deductible Health Insurance Plans in Rural Areas
    This study will use national health survey data to examine whether privately insured rural residents are more likely than their urban counterparts to have plans with high deductibles. It will also assess whether high deductible health plans create health care barriers for rural residents, and if these differ from the barriers experienced by those in urban areas.
    Topics: Health disparities and health equity, Private health insurance
  • Rural Residential Care: The Implications of Federal and State Policy Changes
    This project will assess the impact on Medicaid-funded rural residential care options of new and proposed federal policy guiding state compliance with the Americans with Disabilities Act (ADA). The extent to which rural facilities are able to comply with the proposed guidelines may affect their eligibility for funding through Home and Community-Based Services waiver programs.
    Topics: Aging, Disabilities, Medicaid and CHIP

2013

  • Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act
    This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
    Topics: Aging, Care management, Long-term care
  • Patterns of Care for Rural and Urban Children with Mental Health Problems
    This study will assess whether use of office-based care and psychotropic medicine by children differs between rural and urban areas, as well as the role of insurance coverage and availability of mental health providers on use of these services.
    Topics: Children and adolescents, Health disparities and health equity, Mental and behavioral health
  • Rural E-Mental Health: Models That Enhance Access, Service Delivery, and Integration of Care
    E-mental health programs have been developed in rural areas as a promising approach to address the chronic challenges of low availability of mental health clinicians, long travel distances, and stigma surrounding mental health care. The literature has established the technical feasibility of these programs and interest remains strong in developing and implementing them more broadly. However, we lack a clear understanding of the viability of current rural e-mental health programs - both the business case for starting and sustaining them and the clinical case for what services and functions may be provided _ and what impact they have had. The current rural health environment is changing significantly and it is important to understand where and how e-mental health programs have been established and sustained, what impact they have had, and what value they may add to other initiatives. To address this gap we will conduct interviews with between 24-30 current rural e-mental health programs.
    Topics: Mental and behavioral health, Telehealth

2012

  • Adolescent Alcohol Use in Rural Areas: What Are the Issues?
    This study will use the National Survey on Drug Use and Health (NSDUH) to examine the effect of developmental, individual, and environmental factors on adolescent alcohol use across the urban-rural continuum.
    Topic: Substance use and treatment

2011

  • Consequences of Rural Uninsurance
    This study will assess whether uninsured rural residents have different levels of access to care than their urban counterparts, and the factors associated with any differences (including sub-analyses for individuals with identified chronic conditions). In doing so, it will provide policymakers with critical information for improving rural health systems.
    Topics: Diabetes, Uninsured and underinsured
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    This project aims to examine rural-urban differences in the proportion of employed adults with private health insurance who experience an employment transition (defined as a change in jobs or hours worked, or no job) and the impact of that change on health insurance status.
    Topic: Private health insurance

2010

  • Access to Mental Health Services and Family Burden of Rural Children with Significant Mental Health Problems
    The needs of rural children with serious emotional disturbance and the burden these needs place on their families are intertwined and may place these rural children and their families at "double jeopardy" of having their mental health and other needs go unmet. Using the National Survey of Children with Special Health Care Needs and information on community characteristics from the Area Resource File we will examine the factors associated with whether children and their families have their needs meet across the rural continuum.
    Topics: Children and adolescents, Mental and behavioral health
  • Health Reform-Rapid Response
    This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health.
    Topics: Health services, Healthcare financing, Mental and behavioral health
  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.
    Topic: Critical Access Hospitals (CAHs)
  • Provision of Specialty Mental Health Services by Rural Health Clinics
    This project will document the extent to which Rural Health Clinics (RHCs) are employing mental health staff nationally, understand why more RHCs are not employing specialty mental health staff, and analyze the barriers to and opportunities for the delivery of mental health services by RHCs. The results will identify opportunities and interventions to encourage RHCs to offer this important service.
    Topics: Health services, Mental and behavioral health, Rural Health Clinics (RHCs), Substance use and treatment
  • Safety Net Activities of Independent Rural Health Clinics
    This national study will investigate and describe the safety net role of independent Rural Health Clinics (RHC). It will further examine the market effect of Federally Qualified Health Centers (FQHC) on the safety net role of independent RHCs at the county level.
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs)

2009

  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    This project will produce a comprehensive description of the distribution and characteristics of detoxification (detox) services across rural areas including a discussion of access issues, the role of detox services within local systems of care, barriers to the delivery of detox services by rural providers, and policy and regulatory incentives needed to encourage the development of rural detox services. Products will include a working paper and related journal articles addressing these topics.
    Topic: Substance use and treatment
  • Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
    This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
    Topics: Health reform, Private health insurance, Uninsured and underinsured
  • Mental Health Services in Rural Jails
    This project will investigate how rural jails manage the mental health and substance abuse problems of their inmates. Through analysis of the National Survey of Jails and semi-structured interviews with state-level and county-level/local officials, barriers to providing such services will be assessed and promising practices will be documented.
    Topic: Mental and behavioral health

2008

  • Financial Impact of Mental Health Services on Rural Individuals and Families
    This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed.
    Topics: Healthcare financing, Mental and behavioral health, Private health insurance
  • Impact of Mental and Emotional Stress on Rural Employment Patterns
    This study will use the National Longitudinal Survey of Youth to investigate how mental health symptoms affect employment patterns, and the extent to which these effects differ by rural and urban residence.
    Topic: Mental and behavioral health
  • National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas
    This project will research the prevalence of the abuse of legal and illegal substances across rural populations and geographic areas, including the extent to which rural individuals are receiving treatment for their substance abuse and barriers to the receipt of treatment.
    Topics: Health disparities and health equity, Health services, Rural statistics and demographics, Substance use and treatment
  • Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008
    Under contract with the federal Office of Rural Health Policy, the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project will assess the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development.
    Topics: Critical Access Hospitals (CAHs), Rural Hospital Flexibility Program
  • Rural-Urban Differences in Access to Children's Mental Health Services
    This study uses data from the Urban Institute's National Survey of America's Families to examine and compare the use of mental health services by rural and urban children, age 6 to 17, relative to their need for mental health care, family income, and insurance status.
    Topics: Children and adolescents, Health services, Mental and behavioral health
  • Using Program Logic Models to Monitor the Performance of State Flex Programs
    This project will use a program logic model approach to track state program activities and develop tools that allow states to systematically monitor and manage their accomplishments in the context of Flex Program goals.
    Topic: Rural Hospital Flexibility Program

2007

  • Role of Inpatient Psychiatric Units in Small Rural Hospitals and Rural Mental Health Systems
    This is a descriptive, exploratory study which will investigate the role of the small rural hospital Inpatient Psychiatric Units from the perspectives of both the rural hospital, in terms of scope of services and revenue enhancement, and the regional mental health system, meeting the needs of outpatient mental health and primary care providers, law enforcement, and human services.
    Topics: Health services, Hospitals and clinics, Mental and behavioral health

2006

  • Community Impact Assessment
    This project will evaluate the impact of the Flex program on local communities. Activities will focus on identifying the ways in which the program could have a measurable effect, as well as the ways in which Flex program coordinators intended to affect community health. A briefing paper that integrates information on scope of services, networking, and quality will be produced. Additionally, case studies will be conducted in six CAH communities.
    Topics: Critical Access Hospitals (CAHs), Networking and collaboration, Rural Hospital Flexibility Program
  • Database for Rural Health Research in Progress
    This searchable database of current rural health services research and policy analysis includes all ORHP-funded studies as well as research funded by other federal agencies, major private foundations and other sources.
    Topic: Health services
  • Development of State Flex Program Logic Models and Related Toolkit
    Topic: Rural Hospital Flexibility Program
  • State Flex Program Quality Improvement Activities
    Topics: Quality, Rural Hospital Flexibility Program

2005

  • Analysis of 2004-2005 State Flex Grant Plans
    This project will analyze state Flex grant applications and related budget and work plan revisions focusing on state activities in the core Flex program areas of networks, quality improvement, and EMS.
    Topics: Emergency medical services (EMS) and trauma, Networking and collaboration, Quality, Rural Hospital Flexibility Program
  • Health Insurance Dynamics of Uninsured Rural Families
    To better understand the dynamics of insurance coverage among rural and urban families, this study will use the Medical Expenditure Panel Survey (MEPS) to compare family health insurance coverage among non-elderly rural and urban families.
    Topic: Uninsured and underinsured
  • Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
    This project will survey Emergency Room (ER) managers in a nationally representative sample of Critical Access Hospitals (CAHs) to determine the proportion of ER encounters involving mental health pathology, types of mental health problems most commonly seen in these encounters, and resources available to CAHs to address the problems encountered.
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Mental and behavioral health
  • Special Study of EMS Issues
    This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Networking and collaboration

2003

2002

2001

2000

1999