Rural Health
Research Gateway

Current Research Projects

Browse all of the research projects still underway. Learn more about the research questions guiding each study, the lead researcher for each, and when the Research Center anticipates releasing completed product(s) under each project. Current projects are listed by the date they were funded by the Federal Office of Rural Healthy Policy. You can also access a list of all previously completed research projects, by date.

Projects Funded September 2024 - (21)

  • Availability and Characteristics of Outpatient and Residential Substance Use Treatment in Rural and Urban Areas
    Rural and Underserved Health Research Center
     This study will look at: 1) the availability of residential and outpatient treatment centers in rural and urban counties, including identifying counties with no facilities; and 2) characteristics of services offered (e.g., residential, outpatient), demographics of persons treated, and insurance plans accepted by rural vs urban centers.
  • Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
     We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
  • Changes in Rural Health Insurance Coverage, 2020-2023
    RUPRI Center for Rural Health Policy Analysis
     This project uses secondary data sources to characterize changes in health insurance coverage during the public health emergency (2020-2023) for rural and urban people according to demographic, employment, and geographic characteristics, and to describe how changes in federal policies impacted coverage. Researchers also assess the potential impact of maintaining more robust marketplace subsidies on rural and urban coverage rates once the "unwinding" of continuous Medicaid enrollment is complete.
  • Considerations for the Use of Area-Level Vulnerability and Resilience Indices and Rurality in Funding Formulas
    Rural Health Equity Research Center
     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.
  • Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
    North Carolina Rural Health Research and Policy Analysis Center
     The goal of the Rural Emergency Hospital (REH) is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.
  • Financial Consequences of Growth in the Number of Rural Referral Centers
    North Carolina Rural Health Research and Policy Analysis Center
     Since Centers for Medicare & Medicaid Services amended its regulations to allow hospitals in urban areas to reclassify as rural, over 400 hospitals have obtained status as a Rural Referral Center. This project will estimate the costs to hospital Medicare payment and profitability.
  • Going Beyond Hospital Closures: Estimating Rural and Urban Changes in Access to Hospital Service Lines
    Rural Health Equity Research Center
     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.
  • Improving Health for "Homebound" Older Adults in Rural and Urban Areas
    University of Minnesota Rural Health Research Center
     This project will describe rural-urban differences in the risk of, and characteristics associated with, being classified as "homebound." We will also identify policy and programmatic interventions to reduce the risk of becoming homebound as well as to improve outcomes for those who are homebound.
  • Measuring Rural-Urban Differences in Indigenous American Indian and Alaska Native Health
    University of Minnesota Rural Health Research Center
     This project will describe rural-urban and regional differences in health and health care access for Indigenous American Indian and Alaska Native (AI/AN) people; measure disparities in health between AI/AN people and non-Indigenous white people; and assess whether disparities are greater in rural areas.
  • Mental Health Treatment Among Rural and Urban Adults at Risk for Suicide
    Rural and Underserved Health Research Center
     This study will look at rural/urban disparities in 1) the receipt and sources of mental health treatment among adults with suicidal thoughts and attempts using data from the National Survey on Drug Use and Health; and 2) mental health follow-up visits among adults with a hospital admission or emergency department visit for self-inflicted harm using data from a national insurance claims dataset.
  • Monitoring Obstetric Unit Closures and Measuring Closure Impacts to Support Rural Maternity Care Access
    University of Minnesota Rural Health Research Center
     This project will create a public health data infrastructure with annually updated information on the loss of hospital-based obstetric services, merging policy-relevant hospital and county characteristics with transportation and geographic data, and measuring trends over time in the loss of hospital-based obstetric care.
  • Neonatal Care at Rural Hospitals: Describing Access, Closures and Levels of Childbirth-Related Care
    University of Minnesota Rural Health Research Center
     This project will describe access to childbirth-related care for families living in rural and urban communities; it will document access to neonatal care and the levels of that care, describe rural counties that have lost access to neonatal care, and identify rural counties without access to either obstetric or neonatal services.
  • Oral Healthcare Utilization and Outcomes of Rural and Urban Medicaid-Insured Children in the United States
    Rural and Minority Health Research Center
     Using nationally representative Medicaid claims data, this project will determine rural-urban differences in the prevalence of early childhood caries, preventative dental visits, and restorative dental visits.
  • Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
    RUPRI Center for Rural Health Policy Analysis
     The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
  • Rural and Urban Sepsis Outcomes as a Measure of Health Care Quality: A Nationwide Comparative Analysis Using HCUP Data
    Rural Health Equity Research Center
     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.
  • Rural Implications of Increased Medicare Beneficiary Enrollment in ACOs and MA Plans
    RUPRI Center for Rural Health Policy Analysis
     This project will leverage Centers for Medicare & Medicaid Services data showing the number of Medicare beneficiaries assigned to Accountable Care Organizations, in combination with enrollment in Medicare Advantage in rural counties, to describe implications for rural health care organizations.
  • Rural-Urban Differences in Access to and Quality of Care for People With Disabilities
    University of Minnesota Rural Health Research Center
     The purpose of this project is to identify rural-urban differences in access to and quality of health care services for people with disabilities. Results from this project will help inform policy to improve access to and quality of care for this growing population in rural areas.
  • Rural-Urban Differences in Emergency Department Utilization and Costs for Dental Conditions
    Rural and Minority Health Research Center
     Emergency Department (ED) Utilization is a de facto provider for untreated dental issues. Understanding rural-urban differences in ED use for dental conditions in recent years is essential to inform federal, state, and community-level dental health initiatives such as preventive dental care, tele-dentistry infrastructure expansion, and oral hygiene practices. Ongoing national efforts addressing rural disparities in dental care should target individuals most at risk for missing preventive care and utilizing the ED for dental care.
  • Spatial Distribution of Pre-Exposure Prophylaxis (PrEP) Need and Care
    Rural and Minority Health Research Center
     The incidence of HIV is disproportionately high in rural areas, but these communities often lack access to evidence-based interventions to prevent new HIV diagnoses such as PrEP. Using Medicaid claims data and the Centers for Medicare & Medicaid Services Provider file, this study will determine geographic disparities (by rurality and region) in the need for PrEP and PrEP availability and identify whether PrEP availability meets the needs across geography.
  • State-Level Medicaid Bundled Payments and Rural Perinatal Care
    Rural and Minority Health Research Center
     The impacts of state-level Medicaid bundled payment models will depend on many factors, such as maternity care facility structure, scope of services, and local patient bypassing behaviors during prenatal, intrapartum, and postpartum periods. For rural providers who often offer prenatal and postpartum care but not labor and delivery services, these bundled payments may impose additional financial and logistical challenges.
  • Utilization of Hospital-Based Services for Behavioral Health Conditions
    Southwest Rural Health Research Center
     This project will update the Federal Office of Rural Health Policy's portfolio on rural residents' reliance on hospital-based care for behavioral health conditions. Data will be drawn from the State Emergency Department Databases and the National Inpatient Sample and findings will be presented in the context of patient residence along the urban-rural continuum, census region, insurance coverage, and race.

Projects Funded September 2023 - (41)

Projects Funded September 2022 - (20)

Projects Funded September 2021 - (14)

  • A Closer Examination of Rural Hospital Bypass
    Rural Health Equity Research Center
     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.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
    WWAMI Rural Health Research Center
     This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
  • Differences in Rural and Urban Hospital Cost Structures: Evidence and Implications
    RUPRI Center for Rural Health Policy Analysis
     The project will compare fixed-to-variable cost ratios in U.S. rural and urban hospitals. We hypothesize that rural hospitals will realize proportionally greater fixed costs than urban hospitals, suggesting important hospital payment system implications.
  • Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care
    Rural and Underserved Health Research Center
     This study will use a large national primary care registry to compare cardiovascular disease (CVD) screening, prevention, and management quality measures between rural and urban primary care practices. It will also assess for disparities by patient composition (race/ethnicity, insurance) of the practice.
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    Rural Health Equity Research Center
     This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
  • Federal Agencies' Recent Collaboration and Innovation in Rural Cancer Control: A Model for Practice
    Southwest Rural Health Research Center
     The investigators will conduct an examination of the multi-year effort by the National Cancer Institute to focus on rural cancer issues and its collaboration with the Federal Office of Rural Health Policy. The project will explore the key pieces of evidence that served as the impetus for the emphasis on rural America in cancer control efforts.
  • Public Health Insurance Coverage Among Rural and Urban Children
    Maine Rural Health Research Center
     Medicaid and the Children's Health Insurance Program (CHIP) are important sources of health insurance coverage for rural children, yet analyses have shown a decline in overall U.S. coverage in recent years. This study will use the American Communities Survey to examine rates of Medicaid/CHIP coverage among rural versus urban children and whether these have changed over time.
  • Rural Poverty and Health: A Chartbook
    Maine Rural Health Research Center
     This chartbook will use nationally representative surveys and county-level data to provide a comprehensive overview of the health and wellbeing of rural Americans living in poverty.
  • Rural-Urban Disparities in Mental Health Access and Quality in the United States
    Rural and Minority Health Research Center
     The purpose of this project is to document the recent trends of mental health care access and quality in urban and rural communities and to assess the intersectionality of residence rurality and race/ethnicity on disparities in mental health care access and quality.
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
    Rural Health Equity Research Center
     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.
  • Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
    WWAMI Rural Health Research Center
     This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
  • The Intersection of Race/Ethnicity and Rurality in Pediatric Asthma: Trends and Predictors
    Southwest Rural Health Research Center
     Little is known about the extent to which the intersection of race/ethnicity and rurality plays a role in the disparities associated with asthma outcomes, particularly among children. Using the National Inpatient Sample from 2015 – 2019, this project identified trends in pediatric asthma-related hospitalizations and the significant predictors of them, particularly by considering interaction terms.
  • Third Party Negotiated Pricing in Rural and Urban Hospitals
    Rural and Underserved Health Research Center
     We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
    WWAMI Rural Health Research Center
     This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.

Projects Funded September 2020 - (7)

Projects Funded September 2019 - (3)

Projects Funded September 2018 - (1)

Projects Funded September 2017 - (1)

  • Health Care Use and Access Among Rural and Urban Elderly Medicare Beneficiaries
    Maine Rural Health Research Center
     This project will examine rural-urban differences in healthcare use and access to healthcare services among elderly Medicare enrollees using the 2011-2013 Medicare Current Beneficiary Survey. We also will identify the socioeconomic and health factors that may place rural seniors at risk for poor healthcare access.