Rural Health
Research Gateway

University of Minnesota Rural Health Research Center

Completed Projects

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

2024

  • Housing as a Social Determinant of Rural Health
    The purpose of this project was to identify rural/urban and within-rural differences in housing quality and its relationship to health and disability status, especially for individuals living in poverty. We also identified rural-specific housing issues and innovative policy solutions to address housing challenges in order to improve rural health.
    Topics: Disabilities, Environmental and agricultural health, Health disparities and health equity, Poverty, Public health, Rural statistics and demographics, Social determinants of health
  • Ransomware Attacks on Rural Hospitals
    The rise in hospital ransomware attacks threatens to harm patients, especially in rural areas. This project used a novel dataset to analyze rural/urban differences in how ransomware attacks affect patients and hospitals.
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Health information technology, Hospitals and clinics
  • Rural Obstetric Unit Closures
    The goal of this project was to update prior research to include the latest information on the loss of hospital-based obstetric services in rural U.S. counties. This project is important because ensuring obstetric care access and reducing maternal mortality in rural and underserved areas is a key focus of national, state, and local policies.
    Topics: Critical Access Hospitals (CAHs), Healthcare access, Hospitals and clinics, Maternal health, Women, Workforce
  • Rural-Urban Differences in Domestic Violence as a Contributor to Maternal Morbidity and Mortality
    Using 2016-2020 data from the CDC's Pregnancy Risk Assessment Monitoring System, this project assessed the prevalence of domestic violence among rural and urban residents who give birth. We also analyzed how screening and support services could be improved to support rural families that experience domestic violence, including during pregnancy and the postpartum period.
    Topics: Maternal health, Social determinants of health, Violence and abuse, Women

2023

  • Improving Racial Equity for Rural Mothers and Infants
    The purpose of this project was to assess differences in maternal and infant health outcomes and access to perinatal care, among urban and rural counties. We also compared health outcomes and availability of services, including evidence-based services and supports, between rural counties that are majority Black, Indigenous, and People of Color with those that are majority white.
    Topics: American Indians and Alaska Natives, Critical Access Hospitals (CAHs), Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Minority health, Rural statistics and demographics, Social determinants of health, Women
  • Rural/Urban Differences in Health and Health Care Access for LGBT Adults
    The purpose of this project was to identify rural/urban differences in health and health care access for lesbian, gay, bisexual, and transgender (LGBT) adults. We also identified within-rural differences among LGBT adults by race, ethnicity, age, disability status, and socio-economic status. Finally, we identified examples of best practices supporting LGBT health and wellness in rural areas.
    Topics: Aging, Cancer, Disabilities, Health disparities and health equity, Healthcare access, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), Mental and behavioral health, Minority health, Poverty, Rural statistics and demographics, Social determinants of health
  • Rural/Urban Differences in Postpartum Health Insurance, Healthcare Use, and Health Outcomes
    The purpose of this project was to identify rural/urban differences in health insurance, healthcare use, and health outcomes among postpartum individuals, and to describe policy-relevant implications or strategies to improve insurance coverage, receipt of recommended healthcare, and, ultimately, health outcomes among rural residents who give birth. With a lens towards health equity, all analyses were stratified by race/ethnicity and income.
    Topics: American Indians and Alaska Natives, Health disparities and health equity, Healthcare access, Healthcare financing, Hispanics, Hospitals and clinics, Legislation and regulation, Maternal health, Medicaid and CHIP, Minority health, Private health insurance, Women
  • The Direct Care Workforce in Rural Areas
    In this study, we measured the supply of long-term care services and supports (LTSS) direct care workers relative to older adult populations in rural and urban areas and measure employer and industry turnover among LTSS direct care workers. We also explored how compensation levels – including wages and employer-based health insurance – are related to and predict worker turnover in the LTSS direct care workforce in rural and urban areas.
    Topics: Aging, Allied health professionals, Health services, Home health, Long-term care, Post-acute care, Poverty, Rural statistics and demographics, Social determinants of health, Workforce

2022

  • Aging in Place in Rural America: What Does It Look Like and How Can It Be Supported?
    In general, people want to age in place. This project looked at the structures in place to help them do so and how those structures vary by rurality. Federal, state, and local policy implications for improving health outcomes and quality of life for rural older adults aging in place were also be identified.
    Topics: Aging, Disabilities, Health disparities and health equity, Healthcare access, Home health, Long-term care, Social determinants of health
  • Evaluating the Rural HIV/AIDS Planning Grant Program
    The Rural HIV/AIDS Planning Grant program is administered by the Federal Office of Rural Health Policy to plan and develop healthcare networks designed to address HIV/AIDS prevention and treatment in states disproportionately impacted by the virus. This project identified factors that facilitate and impede success of such planning efforts.
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Healthcare access, Minority health, Networking and collaboration
  • Living Alone: Rural-Urban Differences in Prevalence, Socio-Demographic Correlates, and Health Needs Across the Lifespan
    This project's purpose was to document rural-urban differences in the prevalence of living alone across different age groups, describe rural-urban differences in the socio-demographic correlates and health needs of individuals living alone, and identify rural-relevant policies and programs to support rural residents living alone across the lifespan.
    Topics: Health disparities and health equity, Social determinants of health
  • Safe Obstetric Care Access for All Rural Residents: Minimum Standards for Clinical, Workforce, and Financial Viability of Rural Obstetric Units
    The goal of this project was to analyze data from rural hospitals to understand the criteria by which hospitals and communities assess their need and capacity for obstetric care access in rural counties and to describe effective ways to operationalize minimum standards for clinical safety and financial viability for rural obstetric units.
    Topics: Critical Access Hospitals (CAHs), Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Women, Workforce

2021

  • Evaluating the Rural Health Network Development Planning Grant Program
    This project identified factors that facilitate and impede success of Rural Health Network Development grantees, based on discussions with grantees from the 2019 cohort and surveys of prior grantees dating back more than 10 years, as well as with technical assistance providers.
    Topics: Health services, Healthcare access, Healthcare financing, Networking and collaboration, Public health, Quality

2020

  • Community Context and Rural Strategies to Support the Oldest Old
    This project developed a chartbook profiling older adults (65 and older) in rural areas and assessed where rural residents ages 85 and older were most likely to live, what rural counties had experienced the fastest growth of those 85 and older, and what strategies were in place or were possible for supporting this population in aging in place.
    Topics: Aging, Hospice and palliative care, Long-term care, Rural statistics and demographics
  • Disparities in Preventive Care by Race and Ethnicity Among Rural Adults
    The purpose of this project is to identify differences in access to and use of preventive care by race and ethnicity among rural residents. Results from this project will identify racial/ethnic disparities that exist within rural communities and may guide targeted interventions to improve equity and increase access to high-quality healthcare for all rural residents.
    Topics: Health disparities and health equity, Healthcare access, Hispanics, Minority health, Rural statistics and demographics
  • Emergency Obstetrics in Communities Without Hospital-Based Maternity Care
    The purpose of this project was to describe rural hospitals that do not provide obstetric services and to survey a sample of these hospitals regarding their capacity for emergency obstetrics locally in order to inform policy to support access to high-quality maternity care for all pregnant rural residents.
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Making It Work: Models of Success in Rural Maternity Care
    The purpose of this project was to update information on access to obstetric services in rural counties, to identify common factors across rural communities that have maintained local hospital-based obstetric services, and to describe best practices associated with successfully supporting birth locally in rural communities.
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Maternal health, Quality, Women
  • Team-Based Primary Care in Rural Communities
    This project will describe primary care practice structure in rural communities and quantify characteristics of primary care teams associated with high-quality care.
    Topics: Allied health professionals, Healthcare access, Nurses and nurse practitioners, Physicians, Quality, Rural statistics and demographics, Workforce

2019

  • Access and Quality of Care for Rural Patients with Chronic Obstructive Pulmonary Disease
    Although rates of chronic obstructive pulmonary disease (COPD) are substantially higher in rural areas, there has been limited research on healthcare access and quality issues for individuals with COPD who live in rural communities. This project aimed to improve the accessibility and quality of care for rural COPD patients.
    Topics: Cancer, Chronic diseases and conditions, Quality
  • Access to Care for Rural Medicare Beneficiaries
    This project examined multiple dimensions of access to care, with a focus on rural Medicare beneficiaries, including rural-urban differences in access to care, and within-rural differences in access to care by region, coverage type (traditional fee-for-service vs. supplemental Medigap coverage), and socio-demographic characteristics.
    Topics: Aging, Healthcare access, Medicare, Medicare Advantage (MA)
  • Developing Rural-Relevant Strategies to Reduce Maternal Morbidity
    The purpose of this project was to distinguish and analyze predictors of maternal morbidity during childbirth hospitalization by geography and to develop recommendations to improve the safety of childbirth for rural residents. It also assessed the degree of rural focus and representation in current policy efforts to address this crisis.
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Legislation and regulation, Maternal health, Quality, Women

2018

  • Addressing Rural Social Isolation as a Health and Mortality Risk Factor
    This project aimed to describe rural/urban differences in the prevalence of social isolation, as well as to identify challenges and strategies related to addressing rural social isolation in order to inform policy-making.
    Topics: Aging, Health promotion and disease prevention
  • Caring for Caregivers: Available Support for Unpaid Caregivers in Rural Areas
    This project describes rural-urban differences in the prevalence and intensity of informal caregiving for older adults and associated socio-demographic correlates and as well as identifies potential policy interventions to improve the quality of life and health outcomes of rural caregivers.
    Topics: Aging, Home health, Long-term care
  • Measuring the Quality of Swing Bed Care in Critical Access Hospitals
    This project identified quality measures to be used by Critical Access Hospitals to assess the quality of care provided to their swing bed patients, and recommend appropriate uses of the measures.
    Topics: Hospitals and clinics, Post-acute care, Quality
  • Rural-Urban Differences in Opioid-Affected Pregnancies and Births
    This analysis aimed to combat the opioid epidemic in rural communities by describing the rates and predictors of non-medical opioid use prior to and during pregnancy and maternal diagnosis of opioid use disorder at birth, based on rural or urban maternal residence and rural or urban hospital location.
    Topics: Maternal health, Substance use and treatment, Women

2017

  • Identifying Adverse Drug Events and Improving Patient Safety in Rural Hospitals
    This study identifies rates of adverse drug events (ADEs) and opportunities to improve patient safety in Critical Access Hospitals (CAHs) and non‐CAH rural hospitals.
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • Obstetric Unit and Hospital Closures and Maternal and Infant Health in Rural Communities
    This project will examine the relationship between closure of an obstetric unit or hospital and maternity care and outcomes of childbirth in rural US counties including prenatal care, distance to delivery hospital, out-of-hospital birth, and infant health outcomes.
    Topics: Children and adolescents, Health services, Hospitals and clinics, Women
  • Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
    This project will use a mixed-methods design to examine ways in which transportation operates as a social determinant of health for vulnerable rural residents, and to identify exemplar transportation programs that are successfully improving health and well-being of those residents.
    Topics: Aging, Health services, Networking and collaboration, Transportation
  • Rural Implications of Quality-Based Physician Payment Reform
    The purpose of this project is to assess existing national data about the quality of care provided by rural physicians, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.
    Topics: Physicians, Quality
  • Skilled Nursing Facility Care for Rural Residents with Complex Care Needs
    This project will examine barriers to skilled nursing facility placement for rural residents with complex care needs, including obesity, dementia, and behavioral health problems, and explore potential implications for access to and quality of care.
    Topics: Health services, Hospitals and clinics, Long-term care
  • What Constitutes An Adequate Provider Network For Rural Health Populations?
    The purpose of this study is to develop norms/standards for provider network adequacy for rural populations (which may vary across different rural environments) that will be useful to consumers, providers, and policymakers in the decisions they face with respect to health plan choices, participation, and policies.
    Topic: Private health insurance

2016

  • Quality Measures and Sociodemographic Risk Factors: The Rural Environmental Context
    For three acute care conditions/diagnoses (potential examples include diabetes, congestive heart failure, COPD), this study will (1) identify the key socio-demographic variables that may affect quality adjustment for rural populations/providers; (2) identify data sources/strategies available for the above variables; and (3) identify the quality measures (e.g. readmission rates) that should be adjusted for socio-demographic variables for rural populations/providers and estimate the potential impact of those adjustments on quality measurement.
    Topics: Diabetes, Quality, Rural statistics and demographics
  • Relationship Between Service Utilization and Costs for High Cost Rural Medicare Patients
    This project will 1) assess the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum, and 2) examine the relationships between rural beneficiaries' service utilization and market structure.
    Topic: Medicare
  • Rural Hospital Obstetric Workforce, Procedure Utilization, and Quality of Care
    This study examines the relationships between key aspects of the obstetric workforce in rural hospitals and procedure intensity and quality of maternity care in those hospitals.
    Topics: Maternal health, Quality, Women, Workforce
  • Rural-Urban Differences in Insurer Participation, Premiums, Health Plan Provider Networks in Federal and State Marketplaces
    This two-year project will: 1) measure rural-urban differences in the size, scope, and composition of provider networks affiliated with Marketplace plans; 2) analyze the relationships between provider network size and composition, other benefit design attributes, geographic rating area designations, and premiums; and 3) examine how rural and urban Marketplace-based plan enrollment is affected by plan availability and provider network size and scope.
    Topic: Private health insurance

2015

2014

  • High Quality Rural Hospitals and Post-Acute Care Providers
    This project will use several large longitudinal national databases to model alternative ways of identifying high quality rural hospitals, analyze factors related to quality in rural hospitals, and examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.
    Topics: Hospitals and clinics, Post-acute care, Quality
  • Observation Care Services in Rural Hospitals: Reimbursement and Quality Implications
    This project will describe the nature and scope of observation care services provided by rural hospitals and discuss policy relevant issues for Medicare beneficiaries and providers. Study findings will provide the first assessment of rural observation care services and identify policy options to minimize the potential for unintended consequences of Medicare policies related to observation care services.
    Topics: Hospitals and clinics, Medicare, Quality
  • Obstetric Care Practice Models and Quality in Rural Hospitals
    The project will examine current obstetric practice models in rural hospitals and assess the prospects for implementation of new policy recommendations for reducing primary cesarean rates and non-medically indicated inductions of labor in rural hospitals.
    Topics: Maternal health, Quality
  • Quality Implications of Transferring Emergency Department Patients from Rural Hospitals
    This project will use Medicare inpatient and Emergency Department claims data to 1.) compare patients who are transferred directly from rural hospital Emergency Departments to larger hospitals with those who are admitted as inpatients to rural hospitals in terms of diagnoses, comorbidities, demographics, and the care received and 2.) analyze how the inclusion or exclusion of transferred emergency patients affects risk-adjusted mortality rates for transferring and receiving hospitals.
    Topics: Emergency medical services (EMS) and trauma, Quality

2013

  • Has the Medicare Part D Program Improved Medication Access and the Health Status of Rural Beneficiaries?
    This project will use Medicare Current Beneficiary Survey data to assess the impact of the Medicare Part D Program on medication access and the health status of rural Medicare beneficiaries.
    Topics: Medicare Advantage (MA), Medicare Part D, Pharmacy and prescription drugs
  • Progress Toward Meaningful Use of Health Information Technology Among Rural Physician Practices
    This project will assess progress toward the meaningful use of health information technology among rural physician practices, using several sources of data. This empirical analysis will be supplemented by a qualitative assessment of rural physician practices' experiences with the meaningful use of health IT, working with two quality improvement organizations (QIOs)/Regional Extension Centers (RECs).
    Topics: Health information technology, Physicians
  • Quality of Obstetric Care and Perinatal Safety in Rural Hospitals
    The project will use both national and state-level hospital discharge data to examine obstetric care quality and perinatal safety in rural U.S. hospitals, with an in-depth focus on rural hospitals in a nationally representative group of eight states across all four U.S. Census regions.
    Topics: Critical Access Hospitals (CAHs), Maternal health, Women

2009

  • Measuring Quality Performance in CAHs
    The purpose of the project is to update our previous analyses of Critical Access Hospital (CAH) participation in Hospital Compare, analyze trends over time, and explore additional sources of quality data for CAHs.
    Topics: Critical Access Hospitals (CAHs), Quality

2008

  • Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
    The purpose of this project is to continue to investigate the relationship between Critical Access Hospital financial performance and quality of care. The University of Minnesota and the University of North Carolina will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Quality, Rural Hospital Flexibility Program
  • 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

2006

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

2004

  • Critical Access Hospital Access To and Use of Capital
    This project will describe the capital needs of CAHs and their experiences in accessing and using capital, based on data from an e-mail survey of State Flex Coordinators, the TASC listserve, telephone contacts with Flex Coordinators in key states, and Medicare Cost Reports.
    Topics: Critical Access Hospitals (CAHs), Rural Hospital Flexibility Program
  • Evaluating the Financial Impact of Critical Access Hospital Conversion Over Time
    Using Medicare cost report data, this project will analyze changes in several key financial and organizational indicators that may be affected by CAH conversion, and produce annual reports describing the financial status of CAHs.
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Rural Hospital Flexibility Program

2003

2002

2001

2000

1999