North Carolina Rural Health Research and Policy Analysis Center
Research Products & Journal Articles
Browse the full list of research publications from this Rural Health Research Center.
Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.
Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.
2024
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An Updated Model of Rural Hospital Financial Distress
Journal Article
Date: 10/2024
In fall 2024, the North Carolina Rural Health Research Program completed a study modeling financial distress among rural hospitals, "An Updated Model of Rural Hospital Financial Distress." The model updates a 2016 version, by adding recent changes in the operating environment.
2023
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Rural Emergency Hospital Map and Data
Date: 10/2023
This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023. -
Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
2022
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Predictors of Hospital Bypass for Rural Residents Seeking Common Elective Surgery
Journal Article
Date: 08/2022
This article used Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates and predictors for patients bypassing rural hospitals for common procedures. -
The Economic Effects of Rural Hospital Closures
Journal Article
Date: 03/2022
This study updates previous research (Holmes, et al. 2006) on the economic effects of rural hospital closures by measuring the economic changes over time among U.S. rural counties that had a hospital closure from 2001-2018.
2020
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Decline in Inpatient Volume at Rural Hospitals
Journal Article
Date: 12/2020
This study examined inpatient volume in rural hospitals between 2011 and 2017. Patient population and the organizational and geographic characteristics of hospitals that were significant predictors of inpatient volume included census region, Medicare payment type, ownership type, total margin, and percent of the population in poverty.
2017
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A Positive Association Between Hospice Profit Margin and the Rate at Which Patients Are Discharged Before Death
Journal Article
Date: 07/2017
The links between the increasing live discharge rate from hospice and the quality of care is examined. -
Predicting Financial Distress and Closure in Rural Hospitals
Journal Article
Date: 06/2017
Examines the financial distress of rural hospitals to better predict closures within two years.
2016
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How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act's Medicare Low-Volume Hospital Adjustment?
Journal Article
Date: 11/2016
Using data from the Hospital Market Service Area File, the Hospital Cost Report Information System, and Nielsen-Claritas Pop-Facts, this study examined the effect the low-volume hospital payment adjustment has on a hospital's finances. It also looked at the effects of losing the payment adjustment. -
To What Extent Do Community Characteristics Explain Differences in Closure Among Financially Distressed Rural Hospitals?
Journal Article
Date: 11/2016
This study examined the differences between rural hospitals at high risk of financial distress that stayed open and those that closed.
2015
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Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?
Journal Article
Date: 11/2015
Examines characteristics of rural hospitals that have merged or were acquired during 2005 and 2012. Also compares the change is rural hospital finances, staffing, or services after the merger or acquisition. -
Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
Journal Article
Date: 10/2015
Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013. -
Rural Medicare Beneficiaries Have Fewer Follow-Up Visits and Greater Emergency Department Use Post-Discharge
Journal Article
Date: 09/2015
Compares rates of post hospital discharge care among Medicare beneficiaries in rural and urban settings. Discusses the effect on policies for follow-up care and readmission penalties. -
The Rising Rate of Rural Hospital Closures
Journal Article
Date: 07/2015
Discusses the increase in rural hospital closure rates, including the causes of closures and its impact on rural communities. -
Financially Fragile Hospitals: Mergers and Closures
Journal Article
Date: 01/2015
Evaluates the causes of financial stress in rural hospitals, and describes the impact rural hospitals have on their communities. Also discusses the ways in which rural hospitals and communities have responded to this financial stress. -
The Effect of Surgery on the Profitability of Rural Hospitals
Journal Article
Date: 2015
Presents research on the effect of providing surgery in rural hospitals. Examines the availability of surgery's effect on trauma outcomes and economies in rural communities.
2007
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The Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
Journal Article
Date: 2007
Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation. -
Intensive Care in Critical Access Hospitals
Journal Article
Date: 2007
Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community. -
Rural/Urban Differences in Barriers to and Burden of Care for Children With Special Health Care Needs
Journal Article
Date: 2007
Examines the barriers and difficulties experienced by rural families of children with special healthcare needs in caring for their children. Covers rural-urban differences in types of providers used, reasons for unmet healthcare needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care. -
Urban-Rural Flows of Physicians
Journal Article
Date: 2007
Reports findings from a study to determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs. -
Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
Journal Article
Date: 2007
Reports findings from a study that investigated whether indicators of financial performance and condition systematically vary among peer groups of Critical Access Hospitals (CAHs).
2006
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The Effect of Rural Hospital Closures on Community Economic Health
Journal Article
Date: 04/2006
This article describes the effect of hospital closures on the local economies based on a study of county-level economic data for 1990-2000 in rural counties experiencing hospital closures. -
The Effect of Rural Residence On Dental Unmet Need for Children With Special Health Care Needs
Journal Article
Date: 2006
Unmet need for dental care is the most prevalent unmet healthcare need among children with special healthcare needs (CSHCN). The combination of rural residence and special healthcare needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. -
Emergency Medical Services and the Federal Government's Evolving Role: What Rural and Frontier Emergency Medical Services Advocates Should Know
Journal Article
Date: 2006
Examines the debate around recent recommendations for an expanded federal role in supporting Emergency Medical Services (EMS). If federal expansion were to occur, the author recommends that responsibility for EMS be placed in the Department of Health and Human Services.
2005
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The Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
Journal Article
Date: 2005
Are self-reports of unmet need a biased measure of access to healthcare? We examined the relationship between rural residence and perceived need for physician services and the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. -
How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Preimplementation Prescription Volume and Payment Sources in Rural and Urban Areas
Journal Article
Date: 2005
Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the Medicare Prescription Drug, Improvement, and Modernization Act may affect the financial viability of rural independent pharmacies.
2004
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Comparative Performance Data for Critical Access Hospitals
Journal Article
Date: 2004
Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
2002
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Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
Journal Article
Date: 08/2002
This article updates a 1997 study examining implementation of rural Medicaid-managed care programs.