Upper Midwest Rural Health Research Center: Rural Health Research Products & Journal Articles

2012

Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures
Policy Brief
Date: 07/2012
As a part of a larger project that examined alternative ways of identifying high quality rural hospitals, this report assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals.
The Use of Hospitalists in Small Rural Hospitals
Date: 04/2012
This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants, or nurse practitioners who assume responsibility for patient care during inpatient hospital stays.
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
Policy Brief
Date: 03/2012
This brief explores the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban patients, and time to follow-up care. These factors were examined in a large population of Medicare patients with hospital stays for congestive heart failure or bacterial pneumonia.
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
Date: 03/2012
This study explored the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban residence of the patient, and time to follow-up care.

2011

Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Policy Brief
Date: 09/2011
This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues.
Care Transitions: "Time to Come Home"
Policy Brief
Date: 03/2011
This policy brief examines care coordination, with a focus on the transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.
Care Transitions: "Time to Come Home" (Full Report)
Date: 03/2011
This report looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.

2010

Nurse Staffing and Rural Hospital Performance
Policy Brief
Date: 12/2010
This policy brief examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
Date: 11/2010
Potentially preventable readmissions (PPRs) among Medicare patients are examples of inefficiencies in the healthcare system. This study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS), rural PPS, and Critical Access Hospitals.
The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006
Policy Brief
Date: 10/2010
This policy brief uses a retrospective analysis of data on rural hospital, ambulatory surgery center (ASC), and market characteristics for the years 1997 through 2006 to assess the impact of freestanding ASCs on rural hospital performance.
The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
Date: 10/2010
This policy brief describes the impact of ambulatory surgery centers on rural hospital markets.
Patient Assessments and Quality of Care in Rural Hospitals
Policy Brief
Date: 06/2010
This policy brief analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
Date: 06/2010
This report analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences. It assesses whether rural patients' perspectives of quality of care are related to quality measures focused on the provision of recommended care for medical conditions.

2009

Potentially Preventable Readmissions in Rural Hospitals
Policy Brief
Date: 08/2009
Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals and discusses the rural implications of policy initiatives to reduce readmission rates.
Health Information Technology Policy and Rural Hospitals
Policy Brief
Date: 06/2009
This brief summarizes the implementation status of key health information technology (HIT) applications in critical access hospitals and other rural hospitals and discusses policies for encouraging HIT adoption in rural hospitals.
Rural Issues Related to Bundled Payments for Acute Care Episodes
Policy Brief
Date: 06/2009
Bundling Medicare payments has been proposed as a way of encouraging providers to find innovative, cost-reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address the challenges.
Rural Issues Related to Comparative Effectiveness Research and Dissemination
Policy Brief
Date: 06/2009
This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
Policy Brief
Date: 03/2009
This policy brief describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.

2008

Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
Date: 12/2008
Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.
Far From the City: Community Orientation and Responsiveness of Rural Hospitals
Date: 05/2008
This policy brief reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts.

2007

Health Insurance Coverage and Access to Health Care for American Indian and Alaska Native Elders
Date: 10/2007
This policy brief reports findings from a study assessing health insurance coverage and access to healthcare among American Indian and Alaska Native elders using data from a national survey that included more than 8,300 Native elders.
The Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural Native American Elders
Date: 10/2007
This study examines health insurance coverage and access to healthcare among American Indian and Alaska Native elders, defined as 55 years or older. The authors conclude it is essential to develop policies that address the financial, geographical, and cultural aspects that negatively impact access to culturally appropriate healthcare.
Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
Date: 08/2007
The Tennessee Rural Hospital Patient Safety Demonstration project included the implementation of three patient-safety initiatives in eight rural Tennessee hospitals using a collaborative model and an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Brief)
Date: 08/2007
This policy brief reports the results of a study of rural emergency department staffing and discusses potential implications of staffing for the quality of emergency care provided in rural areas.
Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children (Brief)
Date: 06/2007
This brief reports results from a study examining children's inpatient hospitalizations for ambulatory care sensitive conditions, rural residence, poverty, health insurance, and physician supply. Admission rates were examined for asthma, diabetes short-term complications, gastroenteritis, urinary tract infection, and perforated appendix.
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
Date: 06/2007
The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas.
Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
Date: 05/2007
This policy brief discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.
Hospital Size, Uncertainty and Pay-for-Performance
Date: 02/2007
This report examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings.
North Dakota Health Care Workforce: Planning Together to Meet Future Health Care Needs
Date: 01/2007
This policy brief details strategies for addressing health workforce needs in North Dakota. It includes examples of state health workforce pipeline strategies used in other states.

2006

Prioritizing Patient Safety Interventions in Small Rural Hospitals
Journal Article
Date: 12/2006
Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project
Policy Brief
Date: 11/2006
This paper provides an overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration project.
Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
Date: 10/2006
This report analyzes critical access hospital inpatient hospitalizations and transfers and assesses the implications for national quality measurement and reporting.
Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project (Full Report)
Date: 09/2006
This report shares the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
A Rural Healthcare Quality Agenda
Journal Article
Date: 09/2006
An editorial that highlights aspects of the Institute of Medicines' report "Quality Through Collaboration: The Future of Rural Health," known as the "rural report." The editorial serves as an introduction to the journal's special issue on healthcare quality in rural health.
Defining the Term "Frontier Area" for Programs Implemented Through the Office for the Advancement of Telehealth
Date: 05/2006
This report provides an overview of current frontier definitions and describes the process used to develop a new frontier area definition that could be applied to telehealth programs.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
Policy Brief
Date: 01/2006
This study's results indicate that many small rural hospitals have limited hours of onsite pharmacist coverage and many either don't have a pharmacy computer or don't use it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Health Risks Factors Among American Indians and Alaska Native Elders
Journal Article
Date: 2006
Chronic disease rates are higher among American Indian and Alaska Native elders although they exercise more and have higher rates of participation in multiple exercise activities. Research concerning the relationship between chronic disease and health risk factors is limited for American Indian and Alaska Native elder populations. This paper indicated results of an analysis of the effect of risk factors on chronic disease from a survey of 9,296 Native elders, representing 171 tribes from 88 sites. The sampling design employed systematic random sampling for larger tribes, with smaller tribes (fewer than 200) interviewing all or the majority of their elders. The data suggest that smokers, drinkers, and non-exercisers are at increase risk for chronic disease.
Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
Journal Article
Date: 2006
Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.

2005

Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Date: 12/2005
This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
Date: 10/2005
This report examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, healthcare access, and health behaviors. It includes policy recommendations.
Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries
Policy Brief
Date: 10/2005
This brief looks at three broad areas in addressing suicide: 1) an understanding of factors associated with suicide; 2) information about specific trends, such as race, gender, location, and costs; and 3) an awareness of suicide prevention strategies that address these factors through public policy and community action.
More Culturally Sensitive Neuropsychological Tests (and Normative Data) Needed
Journal Article
Date: 04/2005
Discusses the need for culturally sensitive tests and normative data regarding the Native elder population.
Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders
Journal Article
Date: 2005
Reports the results of an analysis of chronic disease's effect on functional limitation from a survey of 7,107 Native elders representing 143 tribes from 77 sites.
Chronic Disease in American Indian/Alaska Native Elders
Journal Article
Date: 2005
This journal article describes the prevalence of chronic diseases among Native American elders.
Comparing Patient Safety in Rural Hospitals by Bed Count
Date: 2005
This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.
Factors Associated With Incidence of Inappropriate Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children
Journal Article
Date: 2005
An analysis was conducted to identify a set of significant predictors of cases of inappropriate deliveries to acute care facilities with no trauma-center designation of any level. Greater distance to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving corresponded to higher probabilities of mistriage.
Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
Journal Article
Date: 2005
The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.

2004

Indian Health Care Improvement Act: Implications for North Dakota Tribes
Date: 11/2004
This policy brief provides an overview of healthcare issues facing American Indians in North Dakota, with discussion of the impact of the Indian Health Care Improvement Act.
North Dakota's Uninsured and Uncompensated Care: Costs and Coverage Options
Policy Brief
Date: 11/2004
This policy brief on health insurance coverage and the uninsured in North Dakota discusses the financial impact of uncompensated care on the healthcare system and describes several methods for expanding health insurance coverage.
Do Rural Elders Have Limited Access to Medicare Hospice Services?
Journal Article
Date: 05/2004
Examines whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.

1997

Access to Maternity Care in Rural Washington: Its Effect on Neonatal Outcomes and Resource Use
Journal Article
Date: 01/1997
Compares birth outcomes for areas with poor healthcare access to those with adequate healthcare access in rural Washington state.