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 2025 - (31)

Projects Funded September 2024 - (31)

  • Access to Treatment for Substance Use Disorders in Rural Areas: A Research Synthesis
    Northeast Rural Health Research Center
     This project will produce a comprehensive research synthesis summarizing the current knowledge on rural substance use disorder treatment access that will be an informative asset to policy makers and researchers.
  • Assessing Access to Medication Treatment for Opioid Use Disorder in Rural Communities Influenced by the Rural Communities Opioid Response Program (RCORP)
    WWAMI Rural Health Research Center
     This project will use national prescription claims data to compare access to buprenorphine treatment for opioid use disorder in rural counties with and without Rural Communities Opioid Response Program (RCORP) funding and urban counties. An accurate understanding of access to buprenorphine treatment is essential for determining the influence of RCORP funding on a critical strategy for curbing the opioid epidemic.
  • 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.
  • Considerations for the Use of Area-Level Vulnerability and Resilience Indices and Rurality in Funding Formulas
    ETSU/NORC Rural Health 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.
  • Developing a Decision Aid for Selecting Rural Designations for Public Health Research
    North Carolina Rural Health Research Center
     This project develops a CDC decision aid to help researchers select the most appropriate rural-urban classification for their work. Using federal schemes, it illustrates how classifications affect analysis, tailored to the unique needs of rural public health research and practice.
  • Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
    North Carolina Rural Health Research 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.
  • Do Standby Costs and Low Patient Volume Affect the Financial Viability of Rural Hospitals?
    North Carolina Rural Health Research Center
     Rural hospitals face high fixed costs spread over low patient volumes, raising per-case costs and threatening financial sustainability. This study estimates the "low-volume premium" and examines whether standby costs and patient volume predict rural hospital closures nationally.
  • Exploring Rural and Urban Medicare Beneficiaries' Use of Home Health Services
    ETSU/NORC Rural Health Research Center
     This study maps the geographic distribution of home health services provided to Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries and assesses how these patterns align with Medicare-approved home health agencies' service areas.
  • Financial Analysis of Rural Obstetric Care Hospitals
    Rural Maternal Health Data Support and Analysis Program, University of Minnesota Rural Health Research Center
     The purpose of this project is to describe the financial stability and hospital longevity of rural and urban hospitals before and after obstetric unit closure. Additionally, we will identify financial factors that contribute to decisions around obstetric service provision in rural communities in order to better understand the factors that lead to—or could prevent—obstetric unit closures.
  • Financial Consequences of Growth in the Number of Rural Referral Centers
    North Carolina Rural Health Research 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
    ETSU/NORC Rural Health 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.
  • Identifying Characteristics Associated With Rural and Urban Medicare Beneficiaries Bypassing Local Skilled Nursing Facilities for Post-Acute Care
    WWAMI Rural Health Research Center
     This project will compare how often rural versus urban beneficiaries receive post-acute care from skilled nursing facilities (SNFs) outside of their local communities, and which patient, provider, and community characteristics are associated with bypass of local SNFs, informing policies to support SNFs in rural communities.
  • 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.
  • 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
    University of South Carolina Rural 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 Medical School Programs that Demonstrate a Commitment to Producing Rural Physicians
    WWAMI Rural Health Research Center
     Studies of individual medical schools have identified characteristics associated with working in rural areas, but little is known about which organizational factors are the most significant predictors of rural practice. This project will examine characteristics of medical schools' missions and organizational commitments to promote physician practice in rural communities.
  • Rural and Urban Sepsis Outcomes as a Measure of Health Care Quality: A Nationwide Comparative Analysis Using HCUP Data
    ETSU/NORC Rural Health 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 Substance Use Disorder Prevalence and Treatment Access: A Chartbook
    Northeast Rural Health Research Center
     This project will produce a chartbook on rural substance use disorder prevalence and perceived access to screening, treatment, and recovery resources.
  • 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
    University of South Carolina Rural 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
    University of South Carolina Rural 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 Use of Medicaid Funding Mechanisms for Community Health Workers: Implications for Rural Populations
    ETSU/NORC Rural Health Research Center
     Community health workers (CHWs) serve on the front lines of health care, with states increasingly leveraging various funding mechanisms for their services. This project will describe and compare state use of two Medicaid mechanisms – Section 1115 demonstration waivers and state plan amendments – to support CHW services, focusing on potential implications for rural populations.
  • State-Level Medicaid Bundled Payments and Rural Perinatal Care
    University of South Carolina Rural 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.
  • The Intersection of Nursing Home, Health Care, and Ambulance Deserts: Implications for Aging in Place
    Northeast Rural Health Research Center
     This project will examine rural-urban variation in health care infrastructure in 41 states to assess the implications for rural aging of post-acute and long-term care deserts (e.g., lack of skilled nursing facilities and/or swing beds and long-term services provided by nursing homes) combined with ambulance and other health care deserts.
  • The Nursing Home and Skilled Nursing Facility Workforce in the Rural and Urban U.S.
    WWAMI Rural Health Research Center
     This project will describe the rural and urban distribution of nursing and non-nursing staff in U.S. long-term care facilities and investigate how the workforce varies by facility and community characteristics.
  • The Rural Elderly Population: Demographics, Economic Status, Health Status, and Insurance Enrollment
    Southwest Rural Health Research Center
     The project investigators will conduct a descriptive study to describe the demographics, economic status, health status, and insurance enrollment of the rural elderly population using data from nationally representative sources.
  • Using the FDI to Predict Likelihood of Specific Service Line Outcomes
    North Carolina Rural Health Research Center
     Rural hospitals face ongoing threats to service availability, including reductions in key service lines like obstetrics, behavioral health, and hospice. This study explores the potential of the Financial Distress Index (FDI) to inform planning by identifying hospitals at risk of service reductions.
  • 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, and insurance coverage.

Projects Funded September 2023 - (22)

Projects Funded September 2022 - (7)

Projects Funded September 2021 - (5)

  • 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 of the practice.
  • 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 well-being of rural Americans living in poverty.
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
    ETSU/NORC Rural Health 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.

Projects Funded September 2020 - (2)

  • Out-of-Pocket Spending Among Privately Insured Rural and Urban Residents
    Maine Rural Health Research Center
     Out-of-pocket spending for healthcare services has been on the rise as deductibles and other cost-sharing requirements among the privately insured increase. This study compares rural and urban out-of-pocket healthcare spending to identify whether rural residents have been disproportionately affected by this trend.
  • Understanding Rural Health Clinic Services, Use, and Reimbursement
    Maine Rural Health Research Center
     This study describes the scope and intensity of services provided to Medicare beneficiaries by independent and provider-based Rural Health Clinics. It will also assess the adequacy of the Centers for Medicare & Medicaid Services' changes to the outpatient evaluation and management codes in 2021 compared to the 2021 per-visit reimbursement cap.

Projects Funded September 2019 - (1)

  • Rural-Urban Differences in Out-of-Pocket Prescription Drug Spending
    Maine Rural Health Research Center
     Using data from the 2014-17 Medical Expenditure Panel Survey, this study will examine rural-urban differences in out-of-pocket costs for prescription drugs. Additional analyses will examine rural-urban differences in out-of-pocket costs by type of medication and third party payer.

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.