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.

• September 2024 - (10)
• September 2023 - (16)
• September 2022 - (7)
• September 2021 - (6)
• September 2020 - (4)
• September 2019 - (3)
• September 2018 - (1)
• September 2017 - (1)

Projects Funded September 2024 - (10)

• 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.
  
• 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.
  
• 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.
  
• 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.
  
• 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 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.
  
• 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.
  

Projects Funded September 2023 - (16)

• Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents
  WWAMI Rural Health Research Center
  Scarce rural clinical training sites are the top barrier preventing medical schools, residencies, and nurse practitioner and physician assistant education programs, among other health professional training programs, from providing rural training to their students. This study aims to describe the barriers to offering rural clinical training and the potential solutions for establishing and sustaining interdisciplinary rural clinical training.
  
• Evaluating the Variation in Rural and Urban Hospital Wages and Wage Index Pre- and Post-COVID-19 Pandemic
  North Carolina Rural Health Research and Policy Analysis Center
  The primary purpose of the wage index is to address the differences in labor costs that hospitals experience based on their geographical location.
  
• Long-term Implications of Declining Inpatient Revenue on Bed Surge Capacity and Emergency Preparedness
  North Carolina Rural Health Research and Policy Analysis Center
  Inpatient use and key health care services offered at rural hospitals have declined over the past decade. Has the quest for efficiency in hospitals led to a dangerously low surge capacity and ability to effectively handle public health emergencies?
  
• Medical and Mental Health Service Provision Amongst Rural Health Clinics
  Maine Rural Health Research Center
  This study will provide a descriptive analysis of differences in Rural Health Clinic (RHC) type, clinic size, and geographic location of RHCs providing same day medical and mental health visits, compared to RHCs that are only providing one or the other type of visits on the same day.
  
• Medicare Advantage and Financial, Hospital, and Community Characteristics of Rural Hospitals
  North Carolina Rural Health Research and Policy Analysis Center
  This project will compare financial, hospital, and community differences among rural hospitals located in areas with lower versus higher rates of Medicare Advantage penetration.
  
• Mortality Risks Associated With Living in Ambulance Deserts
  Maine Rural Health Research Center
  This project will use ambulance data from the Maine Rural Health Research Center and from CDC WONDER to assess whether living in an ambulance desert is associated with higher mortality rates among rural and urban populations.
  
• Non-Metropolitan/Metropolitan Differences in Barriers to Care and Utilization of Preventive Care and Wellness Visits Among Traditional Medicare and Medicare Advantage
  RUPRI Center for Rural Health Policy Analysis
  This project proposes to use the Medicare Current Beneficiaries Survey to examine differences across geography and plan type (Medicare Advantage vs. traditional) with regards to barriers to care (e.g., costs) and use of preventive services (e.g., flu shot).
  
• RHCs and CAHs Participating in SSP: Characteristics of the Providers and Communities
  RUPRI Center for Rural Health Policy Analysis
  This project describes characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the Medicare Shared Savings Program (SSP), and the communities they serve. Comparisons will be made to RHCs and CAHs not participating in the SSP.
  
• Rural Nursing Home Staffing, and Resident Health, Closure, and Financial Performance
  RUPRI Center for Rural Health Policy Analysis
  There are concerns about availability and quality of care provided in nursing homes in rural areas. This project aims to evaluate staffing levels and shortages, the health status of residents, closures, and financial performance of rural nursing homes both before and during the COVID-19 pandemic.
  
• Rural-Urban Differences in Medicare Advantage Plan Quality Scores
  RUPRI Center for Rural Health Policy Analysis
  This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
  
• Rural-Urban Differences in the Prevalence and Impact of Chronic Pain
  Maine Rural Health Research Center
  Limited existing evidence suggests that chronic pain may be more widespread and disabling in rural than in urban populations, and that rural residents may lack access to adequate pain treatment resources. This study will explore rural-urban differences in chronic pain prevalence, impacts, and management, and inform policies to address any identified disparities.
  
• Suicide Mortality: A Comparison of Urban and Rural Rates
  ETSU/NORC Rural Health Research Center
  Suicide contributes to significant mortality in the United States. This project will examine the differences in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. The research design of this study will adopt a cross-sectional, retrospective approach, using secondary data.
  
• The Emerging Landscape of Rural Family Medicine Residency Training: Defining Models and Assessing Their Value
  WWAMI Rural Health Research Center
  Rural residency training options for family physicians are growing, as is the evidence for rural training in promoting rural practice choice. This study aims to use a new classification of six residency program types to describe and quantify programs and positions by type and compare relative effectiveness in producing rural physicians.
  
• The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities
  WWAMI Rural Health Research Center
  A growing number of general surgery programs offer rural training that aims to address the dwindling supply of rural surgeons. This study aims to describe program models for providing rural general surgery training; quantify the availability of programs; and compare the models' effectiveness in producing rural surgeons.
  
• Use of Home and Community Based Services by Medicare Beneficiaries
  Maine Rural Health Research Center
  Using the Medicare Current Beneficiary Survey, we will examine rural-urban differences in the need for long term services and supports, rates of home and community-based services (HCBS) use, the use of different types of HCBS, and the impact of HCBS on subsequent use of emergent services such as hospitalizations and emergency department visits.
  
• Usual Source of Primary Care for Rural Medicare Beneficiaries Before and During COVID-19
  North Carolina Rural Health Research and Policy Analysis Center
  The global pandemic was highly disruptive to existing health care use patterns, potentially affecting rural America more than urban communities. This study will describe the usual sources of primary care (USC) for rural Medicare beneficiaries before and during COVID-19 to provide insight into how COVID-19 affected USC of Medicare beneficiaries.
  

Projects Funded September 2022 - (7)

• Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.
  WWAMI Rural Health Research Center
  The need for behavioral health treatment for youth has been exacerbated by the COVID-19 pandemic. Little is known about the availability of youth behavioral health providers in rural areas. This study will investigate who provides behavioral health services to youth, how the workforce is distributed, and gaps in service availability.
  
• Alternative Methods for Defining Rural Hospital Service Area Market
  North Carolina Rural Health Research and Policy Analysis Center
  Options for describing the population served by a rural hospital are limited; geopolitical areas such as counties are convenient, but ZIP-based methods may be more accurate. In this project, we will consider multiple options that tradeoff ease, accuracy, ability to capture trends, and availability.
  
• Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
  WWAMI Rural Health Research Center
  This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
  
• Hierarchical Condition Category (HCC) Risk Scores: Designed to Predict Future Cost and Health Care Resource Use – Do They Also Accurately Reflect Differences in Health Status between Rural and Urban Beneficiaries?
  ETSU/NORC Rural Health Research Center
  This CMS Hierarchical Condition Category (CMS-HCC) risk score study will investigate differences in underlying health between rural and urban populations using recent data and analyze which factors drive observed differences.
  
• Rural-based Accountable Care Organizations Accepting Downside Risk
  RUPRI Center for Rural Health Policy Analysis
  The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
  
• Socioeconomic Profiles and Market Characteristics Associated with Ambulance Deserts
  Maine Rural Health Research Center
  We will address the extent to which vulnerable, aging populations live in ambulance deserts and identify ambulance desert populations facing additional barriers to healthcare access. We will also assess the impact of hospital closures on travel distances to the nearest health care facilities.
  
• Unmet Health and Social Needs of Rural Residents with Disability
  Maine Rural Health Research Center
  We will assess rural-urban differences in access to health care and social wellbeing for rural residents with a disability. Disability rates are often higher in rural areas and, given growing evidence of COVID-related disability, this study will provide critical information about the pre-pandemic status of unmet health and social needs among disabled persons to enable future planning.
  

Projects Funded September 2021 - (6)

• 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.
  
• 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.
  
• 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.
  
• 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.
  
• 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 - (4)

• Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
  WWAMI Rural Health Research Center
  This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
  
• 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.
  
• Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S.
  WWAMI Rural Health Research Center
  This study describes and compares the treatment that rural and urban patients with opioid use disorder (OUD) receive, documenting the workforce providing care, distance that patients travel to receive care, and cost of care. Findings will inform policies to ensure that rural patients with OUD have access to care from local healthcare providers.
  
• 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 - (3)

• Methamphetamine Use, Mental Health Comorbidities, and Treatment in Rural and Urban Areas
  WWAMI Rural Health Research Center
  This study will investigate methamphetamine (meth) use in rural versus urban areas - including meth use in combination with opioids and alcohol, mental health comorbidities, and perceived need for and receipt of treatment by meth users and those with meth use disorder - to identify hotspots for targeting of prevention and treatment resources.
  
• Prevalence of Opioid Prescribing, Diagnoses of Opioid Use Disorder, Treatment Patterns, and Costs Among Rural Medicare Beneficiaries
  Maine Rural Health Research Center
  Opioid use disorder (OUD) diagnoses among the aged and disabled are among the highest and fastest growing. This study uses the 2010-2017 Medicare Current Beneficiary Survey to examine opioid prescribing rates and explore risk factors associated with OUDs and associated treatment patterns and costs within rural and urban Medicare populations.
  
• 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)

• Psychiatric Bed Closures in Rural Hospitals: An Assessment of Trends, Impact, and Policy Strategies
  Maine Rural Health Research Center
  This study will examine trends in the closure of psychiatric beds by rural hospitals using the Substance Abuse and Mental Health Services Administration Treatment Services Locator; the American Hospital Association Annual Survey of Hospitals (2010-2017); and the Area Health Resources File.
  

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.