Rural Health
Research Gateway

Completed & Past Research Projects

Browse all of the previously funded research projects that have been completed by the Rural Health Research Centers. Learn more about the research questions guiding each study, the lead researcher for each, and access any completed product(s) under each project. Completed and past projects are listed by the date they were completed.

Projects Completed 2024 - (22)

  • A Comparison of 2017-2019 Uncompensated Care of Rural and Urban Hospitals and a First Look at Uncompensated Care in 2020 and 2021
    North Carolina Rural Health Research and Policy Analysis Center
     This project compared 2017-2019 uncompensated care as a percent of operating expense for rural and urban hospitals and investigated uncompensated care data for 2020 and 2021.
  • Assessment of the Area Deprivation Index in Rural Areas
    Rural Health Equity Research Center
     The Area Deprivation Index (ADI) was created by University of Wisconsin researchers to provide a score for neighborhoods based on their level of disadvantage. This study characterized differences in ADI in rural vs urban areas, summarized the existing literature on ADI, and described expert considerations for utilizing the ADI for future policy.
  • Availability and Quality of Dialysis in Rural Counties with a High Diabetes Burden
    Rural and Minority Health Research Center
     This project examined the degree to which counties with a high population risk for end stage renal disease, defined by high diabetes prevalence, are served by dialysis providers. It assessed the accessibility and quality of services for end stage renal disease looking for disparities associated with rural residence and racial/ethnic population composition.
  • Availability of Diabetes Self-Management Education in High Need Rural Counties
    Rural and Minority Health Research Center
     This project examined the degree to which counties with a high need for diabetes education, defined by high diabetes prevalence, have such education available. Findings were linked to a related study that examined the availability of dialysis for end stage renal disease, a severe outcome of poorly addressed diabetes.
  • Clinical-Community Linkages in Non-Metropolitan and Metropolitan Hospitals: COVID-19 Impacts and Trends
    RUPRI Center for Rural Health Policy Analysis
     This study examined trends in partnerships between hospitals and public health departments and other community linkages in both non-metropolitan and metropolitan hospitals with a particular focus on the impact of the COVID-19 pandemic.
  • Developing a Post-COVID Financial Distress Index
    North Carolina Rural Health Research and Policy Analysis Center
     This project updated and improved the North Carolina Rural Health Research Program's Financial Distress Index, which uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress.
  • Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
    WWAMI Rural Health Research Center
     This study estimated the impact of three recent and upcoming Medicare home health payment policies (revised rural add-on payments, new prospective payment system, and value-based purchasing demonstration) on reimbursement for home health agencies based on rural-urban status, community factors, and home health agency characteristics.
  • Housing as a Social Determinant of Rural Health
    University of Minnesota Rural Health Research Center
     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.
  • How are Rural Health Clinics Serving Pediatric and Obstetrical Medicaid Populations?
    Maine Rural Health Research Center
     This project examined the roles of independent and provider-based Rural Health Clinics in serving pediatric and obstetrical patients covered by state Medicaid programs.
  • How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
    RUPRI Center for Rural Health Policy Analysis
     This project examined the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project provided policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
  • Low Volume Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This analysis compared rural low-volume hospitals (LVHs) to non-LVH characteristics and estimate the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
  • Medicare Advantage Plan Growth in Rural America: Opportunities for Beneficiaries?
    RUPRI Center for Rural Health Policy Analysis
     County Medicare Advantage enrollment data and plan characteristic data were used to create a model accounting for the availability of plans offering benefits addressing social determinants of health. Analyses compared rural and urban counties, and examined county characteristics to explore potential equitable opportunities for rural beneficiaries because of geography and other factors.
  • Palliative Care in the Rural U.S.
    WWAMI Rural Health Research Center
     This project described the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
  • Ransomware Attacks on Rural Hospitals
    University of Minnesota Rural Health Research Center
     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.
  • Rural and Urban Cancer Survivors' Follow-Up Care Experiences
    Rural and Underserved Health Research Center
     This project examined rural vs. urban differences in cancer survivors' follow-up care experiences using the 2017 Medical Expenditure Panel Survey.
  • Rural Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces: An Updated Analysis
    RUPRI Center for Rural Health Policy Analysis
     The project described variations in Health Insurance Marketplace plan design and availability, total and net-of-subsidy premium trends, and enrollment over time between rural and urban areas and identified associations between these factors and several key policy differences and changes, controlling for economic and demographic variation.
  • Rural-Urban Analysis of Persistent Health Professional Shortage Areas
    Rural Health Equity Research Center
     The study described rural-urban differences in persistent Health Professional Shortage Area designations for primary care, mental health, and dental care between 2010 and 2020, including those located in persistent poverty and majority minority counties.
  • Rural-Urban Differences in Domestic Violence as a Contributor to Maternal Morbidity and Mortality
    University of Minnesota Rural Health Research Center
     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.
  • Rural/Urban and Racial/Ethnic Inequities in Patient-Reported Health Care Access and Quality among Medicare Beneficiaries with Lung or Colorectal Cancer
    Rural and Underserved Health Research Center
     Incidence and mortality for colorectal and lung cancer are higher among rural versus urban residents, but many rural cancer patients lack accessible, high-quality care. This study 1) Identified rural/urban inequities in Medicare cancer patient-reported health care access and quality and 2) Determined if rural racial/ethnic minority patients have worse health care access and quality than rural White patients.
  • Rural/Urban Variations in Cancer Screening During the COVID-19 Pandemic
    Rural and Underserved Health Research Center
     Using the National Cancer Institute Health Information National Trends Survey, we examined how the COVID-19 pandemic disrupted the receipt of recommended screenings for common cancers. Findings informed policymakers about potential widening of rural/urban disparities in the receipt of cancer preventive services and the potential need to target these services toward rural residents.
  • Trends in Health Workforce Supply in the Rural U.S.
    WWAMI Rural Health Research Center
     Rural communities in the U.S. have struggled to recruit and sustain sufficient health professionals to ensure adequate access to care. This study used multiple sources of data to describe the geographic distribution (rural/urban, regional, and intra-rural) of numerous types of health professionals.
  • Understanding Rural Non-Emergent Emergency Department Use
    Maine Rural Health Research Center
     Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study used the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.

Projects Completed 2023 - (28)

  • A Chartbook of Rural Population Health
    North Carolina Rural Health Research and Policy Analysis Center
     This project created a chartbook of population health for rural areas. This resource was designed to allow policymakers and practitioners to better understand rural-urban disparities across a wide variety of population health indicators.
  • Ambulance Deserts: Addressing Geographic Disparities in the Provision of Ambulance Services
    Maine Rural Health Research Center
     This two-year study aimed to identify geographic disparities in accessing ambulance services by building a database of ambulance service locations in year one and identifying and creating maps of ambulance deserts within each of the states in year two.
  • An Innovative Approach to Targeting Rural Communities in Public Health Funding
    Southwest Rural Health Research Center
     The Centers for Disease Control launched a new initiative to address COVID-19 related health disparities and to advance health equity among underserved and at-risk populations. This effort included state funding to address the needs of rural communities. This project was designed to better understand this initiative and its impact on rural health.
  • Assessing Cancer Care Coordination in Rural Health Clinics During a Pandemic
    Rural and Minority Health Research Center
     This project aimed to understand how Rural Health Clinics perceived and implemented evidence-based cancer screening and treatment and related intervention strategies before and during the COVID-19 pandemic.
  • Assessing Geographic Variability in Key Indicators of Water Quality and Air Quality: A Comparison of Urban vs. Rural Communities
    Rural and Minority Health Research Center
     The purpose of this project was to compare air and water quality indicators across U.S. Census tracts specifically focusing on rural vs. urban differences.
  • Availability of Healthcare Infrastructure in Minoritized Racial/Ethnic Groups
    Rural and Minority Health Research Center
     This analysis compared the likelihood that selected healthcare infrastructure elements are available within rural and urban ZIP Code Tabulation Areas that contain versus do not contain a high proportion of historically disadvantaged minority residents.
  • Changes in Hospital Services Offered After Mergers, Acquisition and Affiliations
    RUPRI Center for Rural Health Policy Analysis
     Hospitals have affiliated with systems in increasing numbers since 2007, as of 2016 reaching 56.1 percent of nonmetropolitan prospective payment system hospitals and 42.8 percent of critical access hospitals. This project examined resulting changes in services offered by rural hospitals, hypothesizing shifts of some services to regional hospitals and growth in some service lines.
  • Diabetes Management in Urban and Rural Areas of the U.S.
    Rural and Underserved Health Research Center
     This project used the IBM MarketScan database to examine differences in type 2 diabetes prevalence and monitoring for a commercially insured sample. It also employed definitions from the Health Effectiveness Data and Information Set guidelines for comprehensive diabetes care to determine if rural residents are more or less likely to meet recommended standards for type 2 diabetes monitoring and control.
  • Evaluating the Federal Office of Rural Health Policy's Community-Based Division Funding Programs: Does the Performance Improvement and Measurement Systems (PIMS) Database Adequately Capture Impact
    Southwest Rural Health Research Center
     This project examined three types of Federal Office of Rural Health Policy Community-Based Division programs to determine whether the Performance Improvement and Measurement Systems captures the programs' impact and goals as set forth in their respective notices of funding opportunities.
  • Examining Rural-Urban Differences in Availability of Hospital Cardiac Testing Services Between 2010-2020
    Rural and Minority Health Research Center
     This project will examine whether the availability of hospital-based cardiac testing services has changed over the past ten years in rural and urban counties and identify the characteristics of counties where service availability has changed.
  • Examining the Burden of Public Stigma Associated with Mental Illness in the Rural U.S.
    Rural Health Equity Research Center
     This project quantitatively examined the burden of public stigma associated with mental illness in rural versus nonrural communities using a nationally representative panel-based survey. Findings inform strategies aimed at reducing stigma and improving the lives of those experiencing mental illness in rural communities.
  • Excess Deaths Associated with COVID-19 in Rural Communities
    Maine Rural Health Research Center
     Quantifying excess deaths associated with the COVID-19 pandemic can provide a more complete measure of the total burden of the pandemic on mortality. While the National Center for Health Statistics maintains an online dashboard of U.S. excess deaths associated with the COVID-19 pandemic overall and by race/ethnicity and age, excess deaths by rurality of residence are not tabulated and this project aims to fill that gap.
  • Financial Risk Assumption Among Rural Healthcare Providers
    RUPRI Center for Rural Health Policy Analysis
     This project assessed rural/urban providers' participation in different payment models and assumption of financial risk in the Medicare Quality Payment Program. We conducted qualitative interviews to examine rural providers' motivations and preparedness for participating in different risk-bearing payment models.
  • Following the Money: Do Block Grant Resources Reach Rural Communities?
    Rural Health Equity Research Center
     This project applied a mixed methods design to describe the distribution of block grant resources from federal agencies through states to the local level in rural and non-rural communities in the United States. Findings could guide federal agencies and policy makers to develop strategies to more effectively target block grant resources to ensure that the needs of vulnerable rural populations are addressed.
  • Improving Racial Equity for Rural Mothers and Infants
    University of Minnesota Rural Health Research Center
     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.
  • Inpatient Treatment Costs Associated with Substance Use Disorders
    Rural Health Equity Research Center
     The purposes of this project were to examine the costs and characteristics of inpatient stays associated with substance use disorders and to examine whether there are systematic differences in these stays and costs for persons residing in rural areas compared to urban areas.
  • Overcoming Barriers to Providing Rural Obstetrical Training for Physicians
    WWAMI Rural Health Research Center
     Rural communities struggle to maintain obstetrical (OB) services, due in part to scarce rural training opportunities for obstetricians and family physicians. This study described the availability, characteristics, and output of residency and fellowship programs offering rural OB training and identified solutions to support this training.
  • Quality Measures for Skilled Nursing Care in Rural Swing Beds: What Works and What Doesn't?
    Southwest Rural Health Research Center
     This project provided a systematic review of skilled nursing facility quality measures and how these measures apply to skilled nursing facility-level care provided in rural swing beds in both critical access hospitals and prospective payment system hospitals.
  • Rural and Racial/Ethnic Disparities in COVID-19 Mortality Rates and Associations with Community Characteristics
    RUPRI Center for Rural Health Policy Analysis
     This project examined rural and racial/ethnic disparities in COVID-19 mortality rates during the peak of COVID-19 deaths (December 2020-January 2021). Researchers examined mortality rates across non-metropolitan and metropolitan counties overall and stratified by racial/ethnic composition and U.S. census region, and spatial regression methods were used to identify community characteristics (e.g., rurality, sociodemographic, health conditions, and health care access) associated with mortality rates at the county level.
  • Rural and Urban Primary Care Physicians' Colorectal Screening Performance
    Rural and Underserved Health Research Center
     The objectives of this project were to profile, compare, and further understand rural versus urban differences in colorectal screening performance among primary care physicians nationally.
  • Rural Family Physicians' Ability to Address Patients' Social Determinants of Health Needs
    Rural and Underserved Health Research Center
     This project examines how practice-level and community-level characteristics are associated with a family physician's assessment of their practice's ability to address patients' social needs.
  • Rural Health Access: Affordability and Barriers to Care
    Maine Rural Health Research Center
     Rural-urban comparisons of healthcare access and affordability predate many policy reform efforts aimed at increasing access and decreasing costs—ongoing concerns of rural families. This study used national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
  • Rural Healthy People 2030: Challenges and Opportunities for the New Decade
    Southwest Rural Health Research Center
     Building on Rural Healthy People 2010 and Rural Healthy People 2020, this project helped to launch Rural Healthy People 2030 and analyze variations in top-ranked Healthy People objectives for rural America. We identified the most important objectives for rural Americans and how Rural Healthy People priorities have changed over time.
  • Rural-Urban Differences in Performance of Clinicians Participating in MIPS
    RUPRI Center for Rural Health Policy Analysis
     This project used quantitative methods to compare MIPS performance and reported measures for clinicians working in rural and urban areas, overall, and by practice size; evaluated differences in spending per beneficiary, overall, and stratified by drugs and medical services for rural and urban clinicians participating in MIPS; and compared MIPS performance and spending for clinicians serving a large proportion of racial/ethnic minorities in rural and urban areas.
  • Rural-Urban Differences in Three Domains of Access to Health Care Services
    Rural and Minority Health Research Center
     This study proposed to leverage 2018 and 2019 Behavioral Risk Factor Surveillance System data to examine rural-urban and racial/ethnic differences within rural in three domains of access to health care services (affordability, accommodation, and acceptability) that are less frequently examined in population-based surveys.
  • Rural/Urban Differences in Health and Health Care Access for LGBT Adults
    University of Minnesota Rural Health Research Center
     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.
  • Rural/Urban Differences in Postpartum Health Insurance, Healthcare Use, and Health Outcomes
    University of Minnesota Rural Health Research Center
     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.
  • The Direct Care Workforce in Rural Areas
    University of Minnesota Rural Health Research Center
     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.

Projects Completed 2022 - (28)

  • Aging in Place in Rural America: What Does It Look Like and How Can It Be Supported?
    University of Minnesota Rural Health Research Center
     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.
  • An Insurance Profile of Rural America: A Chartbook
    RUPRI Center for Rural Health Policy Analysis
     This chartbook describes current conditions and recent trends in rural health insurance by drawing from census data and other sources. Tables and maps, accompanied by bulleted policy takeaways, compare rural and urban coverage sources, the degree of competition among issuers, and the share of the population who are underinsured.
  • Cancer Prevention and Control Activities in Rural Hospitals
    Rural and Minority Health Research Center
     This project aimed to understand how rural hospitals perceive and implement evidence-based cancer screening and treatment and related intervention strategies.
  • Change in Service Provision at Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     The purpose of this study was to compare the services offered by rural hospitals (to urban hospitals) over time (2009-2017) and among rural hospitals of different size, region, rurality, and payment type.
  • Continuous Services in the Absence of Retail Pharmacies in Rural Communities
    RUPRI Center for Rural Health Policy Analysis
     This project identified communities with and without pharmacies by rurality and described the differences in population and market characteristics of communities with and without any pharmacies. Research findings regarding "pharmacy deserts" informed alternative methods of securing services based on community characteristics.
  • Estimation of the Fixed and Variable Costs of a Rural Emergency Hospital
    North Carolina Rural Health Research and Policy Analysis Center
     This project: 1) informed the design of CMS Rural Emergency Hospital (REH) payment methods, particularly the Medicare monthly additional facility payment; 2) estimated patient break-even volumes for the long-run financial sustainability of REHs; and; 3) provided a tool that rural hospitals can use to estimate the cost of operating a REH.
  • Evaluating the Rural HIV/AIDS Planning Grant Program
    University of Minnesota Rural Health Research Center
     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.
  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    North Carolina Rural Health Research and Policy Analysis Center
     This project updated our 2014 brief: Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where? In addition to examining health conditions of patients discharged from rural Prospective Payment System hospitals and Critical Access Hospitals to swing beds and skilled nursing facilities, this project also looked to see what has changed over time and whether race and ethnicity, sex, or age explain differences.
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    Maine Rural Health Research Center
     The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
  • How Have the Sources of Revenue for Rural Hospitals Changed Since 2005?
    North Carolina Rural Health Research and Policy Analysis Center
     Rural hospitals have seen a steadily decreasing average acute daily census. If outpatient revenue is not expanding to fill that decrease, the decrease in patient revenue could further threaten hospital viability.
  • Impacts of Rural Hospital Closures on Community Health Outcomes and Access to Care
    Rural and Minority Health Research Center
     This proposal examined the impact of rural hospital closures occurring between 2005-2017 across the nation on change in potential demand within safety-net healthcare systems as well as changes in all-cause and cause-specific mortality.
  • Living Alone: Rural-Urban Differences in Prevalence, Socio-Demographic Correlates, and Health Needs Across the Lifespan
    University of Minnesota Rural Health Research Center
     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.
  • Location and Characteristics of Nursing Homes in the Rural and Urban U.S.
    RUPRI Center for Rural Health Policy Analysis
     This project examined rural and urban nursing home availability; assessed the nursing home bed supply relative to the elderly population in rural and urban counties; summarized resident and nursing home characteristics; and analyzed the relationship between the rural location of nursing homes and resident and nursing home characteristics.
  • Longitudinal Trends in Community Mental Health Center and Federally Qualified Health Center Supply in Nonmetropolitan and Metropolitan Counties
    Rural and Underserved Health Research Center
     This study described how the supply of community mental health centers and Federally Qualified Health Centers has changed over time in nonmetropolitan and metropolitan counties nationally.
  • Medicare Beneficiary Access to Prescription Drugs Under Part D
    RUPRI Center for Rural Health Policy Analysis
     This study built on RUPRI Center work describing patterns of enrollment into Medicare Part D plans (including access to zero deductible plans) by using transaction files to analyze how medications are actually acquired and implications for access to local pharmacy services.
  • Northern Border Regional Commission State and Region Chartbooks: A Health-Focused Landscape Analysis
    Maine Rural Health Research Center
     The aim of this study was to compile the most recent publicly available data related to health and healthcare access at the county-level and state-level for the Norther Border Region and the individual states: ME, NH, VT, and NY. We highlighted counties with worse health outcomes, as compared to the rest of the counties in the region.
  • Planning and Pilot Testing of Evidence-Based Cancer Prevention and Control Interventions with Rural Health Clinics
    Rural and Minority Health Research Center
     This project leveraged growing collaborative efforts between the Rural and Minority Health Research Center, South Carolina Office of Rural Health, South Carolina Primary Health Care Association, and Center for Rural and Primary Healthcare to assess and improve cancer prevention and control among rural South Carolina residents.
  • Post-acute Care Quality for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
     This study examined rural post-acute care quality for rural Medicare beneficiaries and potential disparities in post-acute care between urban and rural providers. Publicly reported quality measures for rural skilled nursing facilities and home health agencies were compared with state and national averages as well as urban providers.
  • Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Provider Experience and Provision of Evidence-based Care
    WWAMI Rural Health Research Center
     This study described the relationship between prehospital emergency medical services (EMS) providers' accumulated experience and provision of evidence-based care for rural and urban populations using newly available data on EMS agencies, personnel, and patient care.
  • Rural and Urban Variation in Family Physicians' Demographics and Practices
    Rural and Underserved Health Research Center
     This project examined changes in personal demographics of family physicians comparing urban and rural areas, how these changes aligned with those of the populations they serve, and how rural physician practices have changed over time. This project used American Board of Family Medicine data.
  • Rural Health Clinics Chartbook
    Maine Rural Health Research Center
     This project produced a comprehensive, descriptive chartbook detailing the characteristics and status of rural health clinics (RHCs) nationally. It also assessed the use of secondary data to construct a national set of indicators for RHCs and identify gaps in our knowledge that cannot be addressed using secondary data.
  • Rural Hospital Closure and Effect on Local Economies
    North Carolina Rural Health Research and Policy Analysis Center
     Several research projects have analyzed the health effects of rural hospital closures. However, highly cited evidence on the economic effects of rural hospital closures is more than a decade old. The purpose of this study was to quantify the economic impact rural hospital closures have on communities.
  • Rural-Urban Differences in Adverse and Positive Childhood Experiences: Results from the National Survey of Children's Health
    Rural and Minority Health Research Center
     Using the 2016-2018 National Survey of Children's Health, the prevalence of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) exposure in all 50 states and the District of Columbia were examined and whether ACE and PCE exposure differed between rural and urban residents, by type, by count, and by racial/ethnic group.
  • Rural-Urban Differences in Child and Adolescent Mental Health pre and during the COVID-19 Pandemic
    Rural and Minority Health Research Center
     This project examined rural-urban differences in the prevalence and severity of anxiety and depression among children and adolescents before and during the COVID-19 pandemic, as well as examined rural-urban differences in access to mental health care professionals and the receipt of care from a mental health professional before and during the COVID-19 pandemic.
  • Safe Obstetric Care Access for All Rural Residents: Minimum Standards for Clinical, Workforce, and Financial Viability of Rural Obstetric Units
    University of Minnesota Rural Health Research Center
     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.
  • Serious Mental Illness and Access to Care Among Rural and Urban Adults
    Rural and Underserved Health Research Center
     Very little research has examined the prevalence of serious mental illness and access to mental health treatment among rural relative to urban adults in the U.S. Using nationally representative data, this project shed new light on the prevalence and correlates of serious mental illness and related access to mental health services.
  • Three Models of a Rural Emergency Hospital
    North Carolina Rural Health Research and Policy Analysis Center
     This project used secondary data about small rural emergency departments and expert opinion to develop three clinical and operational models of a Rural Emergency Hospital (REH). The REH models were based on case mix, service mix, patient volume, clinical staffing, and technology.
  • Unintentional Injury in Metropolitan and Nonmetropolitan Settings by Race or Ethnicity
    Rural and Underserved Health Research Center
     This study described the rates of fatal and nonfatal unintentional injury comparing metropolitan and nonmetropolitan areas, stratified by race or ethnicity. This study used Centers for Disease Control WONDER data (2014-2018) and the 2018 National Hospital Ambulatory Medical Care Survey.

Projects Completed 2021 - (32)

  • A Current Examination of HIV and Hepatitis C in Rural Counties
    Maine Rural Health Research Center
     Using data from federal and state sources, we produced a chartbook on county-level data on human immunodeficiency virus (HIV) prevalence and acute hepatitis C virus (HCV) incidence, examined the availability of Ryan White HIV/AIDS medical providers and other HIV and HCV treatment/testing services across the rural-urban continuum, and estimated county-level prevalence of maternal HCV infection.
  • Capacity of Rural Counties to Respond to an HIV or Hepatitis C Outbreak
    Maine Rural Health Research Center
     Rural counties may be potentially vulnerable to an HIV or Hepatitis C outbreak among persons who inject drugs. Using mixed methods, we provided an understanding of the rural areas at risk of an outbreak based on their state and county characteristics and an assessment of their public health infrastructure.
  • Cardiovascular & Cancer Rates for the Rural Delta Region
    North Carolina Rural Health Research and Policy Analysis Center
     This interactive tool can be used to compare county-level rates and incidence of cancer and cardiovascular related health measures for people residing in the lower Mississippi River Delta Region. Users may filter by various health measures and download images and data.
  • Comparison of Rural Hospital Closures and the Communities Served, 1990-2020
    North Carolina Rural Health Research and Policy Analysis Center
     This project examined rural hospital closures during three decades to profile community characteristics, health status, health care services, and resources available in communities where rural hospitals have closed.
  • Creating County Level Estimates of Childhood Obesity in the U.S.: A Spatial Multilevel Modeling Approach
    Rural and Minority Health Research Center
     Using the 2016 National Survey of Children's Health, spatial multilevel models were constructed to estimate county level rates of childhood obesity in the U.S. Particular emphasis was placed on rural areas, for which direct estimates are often unavailable because of small sample sizes in population-based surveys.
  • Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
    North Carolina Rural Health Research and Policy Analysis Center
     This project involved surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
  • Decline in Inpatient Volume at Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     The purpose of this study was to compare the decline in inpatient volume of rural hospitals to urban hospitals and among rural hospitals of different size, region, rurality, and payment type.
  • Do Rural Breast and Colorectal Cancer Patients Present at More Advanced Disease Stages than Their Urban Counterparts?
    WWAMI Rural Health Research Center
     Access to recommended cancer screening is more difficult for rural residents than their urban counterparts. This study used the Surveillance, Epidemiology and End Results Program (SEER) data to examine the extent to which rural residents present at more advanced disease stages for breast and colorectal cancer diagnosis than urban residents.
  • Estimating the Number of Hospitals that Might Convert to Rural Emergency Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project reviewed the literature to establish what is known about freestanding emergency centers (FECs) and implications for a rural community. The number and types of rural hospitals that would be eligible to convert to an FEC as an alternative to closure of acute inpatient care was estimated.
  • Evaluating the Rural Health Network Development Planning Grant Program
    University of Minnesota Rural Health Research Center
     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.
  • Geographic Access to Healthcare for Rural Medicare Beneficiaries: An Update and National Look
    WWAMI Rural Health Research Center
     This objective of this study was to compare, at a national and census division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care.
  • Hospital Readmission Following Care in a Swing Bed
    North Carolina Rural Health Research and Policy Analysis Center
     This study built on our portfolio of swing bed work by examining the rate of hospital readmission for patients who receive post-acute care in swing beds compared to skilled nursing facilities and informed the discussion on use, cost, and benefit of swing bed care.
  • How Do Costs for Rural Medicare Beneficiaries Using Swing Beds Compare to Those Using Skilled Nursing Facilities?
    North Carolina Rural Health Research and Policy Analysis Center
     This study estimated and compared total Medicare expenditures for episodes of care that include post-acute stays in either swing beds or skilled nursing facilities (SNFs). Results informed federal and state agencies, rural providers and communities as to how post-acute care in swing bed versus a SNF affects the trajectory of costs and utilization for rural Medicare beneficiaries.
  • How Medicare Payment Standardization Affects the Perceived "Cost" of Post-Acute Care Provided in Critical Access Hospital Swing Beds
    North Carolina Rural Health Research and Policy Analysis Center
     Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aimed to identify the effects of the payment standardization method on the perceived "cost" of post-acute care provided in Critical Access Hospital swing beds.
  • Impact of the Opioid Crisis on Rural Emergency Departments
    Maine Rural Health Research Center
     This study used data from the Nationwide Emergency Department Sample and information from a panel of rural emergency care experts to assess the impact of the opioid crisis on rural emergency departments. Findings informed policies designed to help rural healthcare systems and communities address the growing problem of opioid abuse.
  • Lung Diseases Among Coal Miners
    Rural and Underserved Health Research Center
     Coal miners are at increased risk of lung diseases. Using secondary datasets, we will assess the distribution of lung diseases across regions, identify patterns of healthcare utilization among miners relative to HRSA-funded Black Lung Clinics, and compare healthcare utilization patterns, behaviors, and comorbidities among miners and non-miners.
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
     Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly during the last decade. This study examined post-acute care utilization for rural Medicare beneficiaries following acute hospitalization, describing use of home health and skilled nursing care and trajectories of care across settings.
  • Predictors and Barriers to Achieving Immunization in Rural and Urban Areas
    Southwest Rural Health Research Center
     Prenatal and timely childhood immunizations offer the optimal strategy for preventing severe morbidity and mortality due to vaccine-preventable disease. This project evaluated possible gaps in immunization services for pregnant women and their infants in rural areas as compared to urban areas.
  • Rural and Urban Sources of Insurance Coverage: the Role of Public and Private Coverage over Time
    RUPRI Center for Rural Health Policy Analysis
     We estimated the percent of rural residents obtaining insurance coverage under each of the major options available to them using multiple data sets and a methodology that accounts for multiple sources of coverage. We compared rural and urban coverage sources and changes in coverage over time.
  • Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access
    RUPRI Center for Rural Health Policy Analysis
     This project built a database of nursing home closures across rural and urban areas in the U.S. and evaluated the changes in access to post-acute and/or long-term care providers. It also described the differences in organizational, financial, and market characteristics between open vs. closed nursing homes in rural vs. urban areas.
  • Rural Variation in Access to Naloxone for Opioid Overdose Prevention
    Rural and Underserved Health Research Center
     This project examined variability in access to naloxone-based metropolitan/nonmetropolitan dispensing counts from a representative sample of outpatient pharmacies across the U.S.
  • Rural Versus Urban Prevalence of Intimate Partner Violence
    Southwest Rural Health Research Center
     This project determined rural-urban disparities in the prevalence of intimate partner violence-related hospitalizations using a national representative sample of hospital admissions for the period between 2009-2014 using data from the national Healthcare Cost and Utilization Project.
  • The Association of Occupation with Mental Illnesses and Death by Suicide
    Rural and Underserved Health Research Center
     This study examined the association of occupational risk factors with mental illnesses, all-cause mortality, and suicide.
  • The Availability of Optional Benefits in Medicare Advantage (MA) Plans in Rural and Urban Areas and the Implications for MA Payment Policy
    RUPRI Center for Rural Health Policy Analysis
     Enrollment and landscape files containing data regarding Medicare Advantage plan activities by county were used to describe the geographic differences in what is available to beneficiaries in benefit design and total out-of-pocket liability. Findings revealed potential for policy actions to address equity of benefits and cost to beneficiaries.
  • The Current Distribution of the General Surgery Workforce in Rural America
    WWAMI Rural Health Research Center
     This project described the current national supply and distribution of general surgeons in rural vs. urban areas of the United States as well as geographic variability in the supply of general surgeons across the rural/urban and intra-rural dimensions at the regional level.
  • The Geographic Expansion of Medicaid MCOs
    RUPRI Center for Rural Health Policy Analysis
     This project characterized the counties into which Medicaid Managed Care Organizations (MCOs) expanded in 2012-18, focusing on population and provider density, sociodemographics, and health indicators. We assessed the extent to which MCO geographic expansion occurred in compliance with previous network adequacy standards and evaluated how well MCOs were performing in rural areas.
  • Tobacco Treatment in Rural Primary Care
    Maine Rural Health Research Center
     This study used the National Ambulatory Medical Care Survey to compare rural and urban rates and predictors of tobacco counseling and tobacco treatment medication prescribing by primary care providers to their smoking patients.
  • Trends and Predictors of Human Immunodeficiency Virus (HIV) in Light of the Opioid Crisis Along the Urban-Rural Continuum
    Southwest Rural Health Research Center
     This project explored trends in the burden of HIV and predictors of HIV-related mortality and morbidity. The study examined how the opioid crisis has changed the nature of the burden of HIV, especially considering differential disease burdens between residents of rural areas relative to their urban counterparts.
  • Trends in Preterm Birth by Rural Status in the U.S.
    Southwest Rural Health Research Center
     This project determined rates of preterm birth by rural versus urban residence and across census regions. The project also examined the relationship between preterm birth and maternal characteristics, including race and ethnicity as well as pregnancy complications among women in rural versus urban residence.
  • Variations in Travel Burdens Associated with Access to Care Between Rural and Urban Residents
    Southwest Rural Health Research Center
     This project focused on geographic access to medical and dental care, recognizing that travel time and distances can hinder individuals from obtaining necessary care. The study explored the travel time and distances to care for specific sub-populations and in specific geographic settings, particularly urban versus rural residence and region.
  • What Is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine?
    WWAMI Rural Health Research Center
     This project updated statistics on the supply of providers (physicians, nurse practitioners and physician assistants) with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine and examine supply trends over time and also established baseline numbers of other eligible providers (e.g., midwives, clinical nurse specialists).
  • What Makes Successful Rural Accountable Care Organizations Successful?
    RUPRI Center for Rural Health Policy Analysis
     The U.S. Department of Health and Human Services plans to shift at least 50% of traditional Medicare spending into alternative payment models by 2018. Accountable Care Organizations (ACOs) represent a popular model in both the Medicare and Medicaid programs. This study used multiple methods to find what makes a successful ACO.

Projects Completed 2020 - (30)

  • Acuity Differences Among Newly Admitted Rural and Urban Nursing Home Residents
    Maine Rural Health Research Center
     This study used nursing home assessment data to examine rural-urban differences in resident acuity upon admission; whether differences persisted among newly admitted Medicare and non-Medicare residents; and whether and how nursing home, local health system, and market characteristics were associated with differences in resident acuity.
  • Assessing Potential Unmet Need for Home Healthcare in Rural Areas
    WWAMI Rural Health Research Center
     This study estimated potential unmet need for home healthcare in rural areas for fee-for-service Medicare beneficiaries. We compared rates of home healthcare utilization in rural areas with urban areas, accounting for acute hospital discharges and utilization of inpatient rehabilitation facilities and skilled nursing facilities.
  • Changes in Care-Seeking After Rural Hospitals Merge
    North Carolina Rural Health Research and Policy Analysis Center
     This project seeks to understand how mergers affect the inpatient care-seeking of markets served by merging hospitals.
  • Community Context and Rural Strategies to Support the Oldest Old
    University of Minnesota Rural Health Research Center
     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.
  • Continuing Data Collection on a Common Set of Measures for the School-Based TNGP Grantees
    Rural Telehealth Research Center
     The primary purpose of this project is to continue data collection from School-Based Telehealth Network Grant Program (SB TNGP) grantees to evaluate school-based telehealth using a common set of measures that will help build the evidence base and inform future policy changes and sustainability efforts.
  • Disaster Planning, Preparedness, & Response for Rural Long-Term Care Providers
    Southwest Rural Health Research Center
     This project collected and analyzed data that captures how disasters affect long-term care services and patient experiences in rural areas. We developed and pilot test long-term care provider survey, and conducted case studies of disaster-impacted, rural communities with respect to implications for long-term care services.
  • Disparities in Preventive Care by Race and Ethnicity Among Rural Adults
    University of Minnesota Rural Health Research Center
     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.
  • Emergency Obstetrics in Communities Without Hospital-Based Maternity Care
    University of Minnesota Rural Health Research Center
     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.
  • Healthcare Use and Access Among Rural & Urban Non-elderly Disabled Medicare Beneficiaries
    Maine Rural Health Research Center
     This project explored healthcare use and barriers to healthcare access among disabled Medicare beneficiaries under 65 in rural and urban areas. The study was based on quantitative analyses of the 2009-2013 Medicare Current Beneficiary Survey.
  • How Well are We Doing Meeting Healthy People 2020 Mortality Objectives at Midterm? Rural v. Urban Differences
    Southwest Rural Health Research Center
     The purpose of this project was to conduct a midterm examination of urban versus rural disparities in meeting Healthy People 2020 mortality objectives for the top 10 leading causes of death in the U.S. utilizing existing secondary databases.
  • Investigating Differences in School-Based Telehealth Implementation and Services in the School-Based TNGP Grantees
    Rural Telehealth Research Center
     The principal goal of this project is to gather contextual information from School-Based Telehealth Network Grant Program (SB TNGP) grantees regarding project design and implementation, and the practicalities of delivering telehealth services in school settings that will help explain the heterogeneity found in the data across the grantees.
  • Launching Data Collection on a Common Set of Measures for the EB THNP and SAT TNGP Grantees
    Rural Telehealth Research Center
     The primary purpose of this project is to launch data collection among Evidence-Based Tele-Behavioral Health Network Program (EB THNP) and Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) grantees on a common set of measures.
  • Making It Work: Models of Success in Rural Maternity Care
    University of Minnesota Rural Health Research Center
     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.
  • Malpractice Claims Among Rural and Urban Providers: Do State Telehealth Laws Make a Difference?
    Southwest Rural Health Research Center
     This project examines trends in state telehealth laws and whether they have affected the rural and urban malpractice environments differentially. Data from the National Practitioner Data Bank are used to determine whether changes in telehealth laws are associated with increased malpractice claims and other adverse actions against providers.
  • Medicare Beneficiaries' Access to Preventive Services: Diabetes Self-Management Training, Medical Nutrition Therapy, and Health and Behavior Assessment and Intervention
    Rural and Underserved Health Research Center
     Medicare offers preventive services focused on self-management through several programs: Diabetes Self-Management Training, Medical Nutrition Therapy, and Health and Behavior Assessment and Intervention.
  • Mental Health Treatment Access: How Do Mental Health Treatment Use and Unmet Treatment Need Vary Among Rural and Urban Adults Nationally?
    Rural and Underserved Health Research Center
     This project will estimate the prevalence and policy-modifiable correlates of unmet mental health treatment need and utilization among metropolitan, micropolitan, and other non-metropolitan adults nationally who have a mental health condition. Additionally, the study will investigate the same issues among Native Americans/American Indians.
  • Patterns of Inpatient Care-Seeking by Rural Residents
    North Carolina Rural Health Research and Policy Analysis Center
     This study seeks to gain an understanding of inpatient care-seeking behavior by rural residents to provide insight into drivers of bypass rates, the extent to which a community uses a hospital other than its local rural hospital.
  • Rates of Telemental Health Use Among Rural Medicaid Enrollees: Associations with Telehealth Policy and Mental Health Access
    Rural Telehealth Research Center
     This study examined telemental health use among rural and urban Medicaid beneficiaries with mental illness. The goals were to: 1) compare rates and patterns of telemental health; 2) assess how use rates are associated with state-level Medicaid telehealth policies; and 3) determine the extent to which telemental health provides access to care.
  • Risky Substance Use Among Adolescents and Adults in Nonmetropolitan and Metropolitan Counties
    Rural and Underserved Health Research Center
     Little research has examined the prevalence of risky substance use (alcohol and drugs) among nonmetropolitan adolescents and adults relative to their metropolitan counterparts. Using nationally representative data, this project shed new light on the prevalence and correlates of risky substance use that could inform prevention strategies.
  • Rural Colon and Cervical Cancer Environmental Scan
    Rural and Minority Health Research Center
     Detailed research was needed to provide a complex, textured picture of rural healthcare and the ways in which existing federally supported providers could provide adequate services across the continuum of cancer care from prevention through survivorship.
  • Rural Community Response to Hospital Closure
    RUPRI Center for Rural Health Policy Analysis
     The Rural Community Response to Hospital Closure project will study how rural communities adapt to local hospital closure. Within selected communities, the project will evaluate the impact of hospital closure on multiple community health-related services and characteristics.
  • Rural-Urban Variation in CMS Hierarchical Condition Categories (HCC) Risk Scores
    North Carolina Rural Health Research and Policy Analysis Center
     CMS uses hierarchical condition categories (HCC) to risk-adjust Medicare beneficiaries for multiple conditions. This adjustment is used for multiple programs, but it's unknown whether the adjustment works similarly in rural and urban areas. This project investigated the distribution of beneficiaries' and providers' HCC risk scores across rurality.
  • Team-Based Primary Care in Rural Communities
    University of Minnesota Rural Health Research Center
     This project will describe primary care practice structure in rural communities and quantify characteristics of primary care teams associated with high-quality care.
  • The Supply and Distribution of the Primary Care Health Workforce in Rural America
    WWAMI Rural Health Research Center
     This study will describe the supply and distribution of primary care providers in the rural U.S. at national, regional, and state levels using the most recent data available. Primary care health professionals include family physicians, general practitioners, general internists, pediatricians, nurse practitioners, and physician assistants.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
    WWAMI Rural Health Research Center
     This project will use multiple data sources to characterize the distribution of the obstetrical care workforce in the U.S., comparing health professional-to-population ratios in rural and urban areas. Health professionals examined in this study include obstetricians, family physicians, and certified nurse midwives.
  • Understanding Rural-Urban Mortality Differences
    Maine Rural Health Research Center
     This study will address rural-urban mortality gaps in our understanding of rural mortality disparities using the 1985-2009 National Health Interview Survey (NHIS), linked to national death certificate data, to explore the individual-level characteristics and health behaviors of rural and urban adults and their association with mortality.
  • Understanding Trends in Telehealth Use: An All-Payer Analysis in Maine
    Rural Telehealth Research Center
     This project's primary purpose was to use Maine's All-Payer Claims Database and key informant interviews to develop a descriptive overview of telehealth use in Maine, examining how telehealth use had changed over time (2008-2017) among rural and urban patients and providers.
  • What Factors Influence Rural Hospitals' Participation in Accountable Care Organizations?
    RUPRI Center for Rural Health Policy Analysis
     This project examined rural hospitals' participation in Accountable Care Organizations (ACOs), identified factors that influenced ACO participation, compared whether different factors influenced rural/urban hospital participation in ACOs, and analyzed factors influencing Critical Access Hospitals' participation in the Medicare Shared Savings Program.
  • Who Provides Mental Health Services to Rural Medicare Beneficiaries?
    WWAMI Rural Health Research Center
     Most rural counties do not have a psychiatrist to care for the common conditions of depression or anxiety. This study describes the provider workforce that cares for rural elderly patients with depression/anxiety, including regional and rural-urban variations in mental healthcare provision.
  • Women, Infants, and Children (WIC) 2009 Food Package Revisions on Participants in Rural Areas with Extreme Poverty Levels: Impact on Infant Breastfeeding, Infant Feeding, and Health Outcomes
    Southwest Rural Health Research Center
     This study examines the effects of the revised Women, Infants, and Children (WIC) Program food packages on breastfeeding rates among WIC participants in areas designated as rural, with high levels of extreme poverty and food deserts, and/or high rates of those who are overweight and obese.

Projects Completed 2019 - (37)

  • Access and Quality of Care for Rural Patients with Chronic Obstructive Pulmonary Disease
    University of Minnesota Rural Health Research Center
     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.
  • Access to Care for Rural Medicare Beneficiaries
    University of Minnesota Rural Health Research Center
     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.
  • Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project characterized the volume, cost, and case mix of ambulatory care provided to rural Medicare beneficiaries by rural and urban federally qualified health centers (FQHCs), rural health clinics (RHCs), and acute hospitals. The study included urban-rural and geographic comparisons of volume, cost, and case mix by provider type.
  • An Empirical Study of Health Insurance Firm Participation over Time in Rural Counties
    RUPRI Center for Rural Health Policy Analysis
     We examined changes in firm participation in multiple health insurance markets (FEHBP, MA, HIMs) over time in rural counties. We had hypothesized that participation would be related inversely to population density, because it becomes more difficult to spread risk, and network formation becomes more challenging when primary and specialty care becomes less available.
  • Analysis of Trends in Characteristics of Rural Beneficiaries Enrolling in Medicare Advantage Plans
    RUPRI Center for Rural Health Policy Analysis
     This study compared characteristics of rural and urban beneficiaries enrolling in Medicare Advantage (MA) plans, including their age, health status, income, and race/ethnicity. We analyzed the consequences of increasing use, promoted by policy choices, of a market-based approach in the Medicare program.
  • Analyzing Data from the Evidence-Based Telehealth Network Grant Program Grantees and Preparing Manuscripts to Further the Evidence Base for Tele-ED
    Rural Telehealth Research Center
     This project's main purpose was to analyze data using the revised Tele-Emergency Performance Assessment Reporting Tool gathered from Evidence-Based Tele-Emergency Network Grant Program grantees on all of their cases using telehealth in the emergency department (tele-ED) and a matched sample of non-tele-ED records to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.
  • Community Health Worker Roles, Regulation and Growth in Rural America
    Southwest Rural Health Research Center
     This study looked at the role of Community Health Workers in improving access to healthcare services in rural and urban environments. The project focused on the growing and changing roles of these influential actors and how their responsibilities vary based on setting (hospital, clinic, community, etc.), location (rural vs. urban), and regulations.
  • Comparisons of Rural Definitions
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project will lead to the creation of a mega rural and frontier website. This website will emphasize the use of various rural definitions and datasets for healthcare policy, policy analysis, and research. Additionally, researchers will review Dartmouth's Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas.
  • Cost of Running a Rural Ambulance Service
    North Dakota and NORC Rural Health Reform Policy Research Center
     This study will address the cost of running ambulance services in rural areas by organizational structure/source of funding, the factors contributing to differences in costs, and factors contributing to differences in financial viability.
  • Developing Rural-Relevant Strategies to Reduce Maternal Morbidity
    University of Minnesota Rural Health Research Center
     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.
  • Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas
    WWAMI Rural Health Research Center
     This study examined differences between rural, fee-for-service Medicare beneficiaries who were admitted to home health from the community (community-entry) and those who were admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
  • Do Rural Communities Have a Higher Rate of Avoidable Deaths?
    North Carolina Rural Health Research and Policy Analysis Center
     Based on some estimates, roughly half of deaths were avoidable in the sense they stem from risky behavior. What was less well known was the degree to which there was a rural-urban disparity in this rate.
  • Establishing a Common Set of Measures for Tele-Behavioral Health and Tele-Substance Abuse
    Rural Telehealth Research Center
     The Rural Telehealth Research Center worked cooperatively with the Federal Office of Rural Health Policy to establish data collection protocols and tools on a set of measures that are being used for a cross-grantee evaluation of the Evidence-Based Tele-Behavioral Health Network Program.
  • Examining the Legal Landscape in Rural America: Implications for the Healthcare Workforce, Access to Care, and Population Health
    Southwest Rural Health Research Center
     This project explores potential rural/urban differences in the prevalence of malpractice claims, clinical privilege actions, and state licensure actions among health care providers. We will also examine whether variations in nurse practitioner scope of practice laws affect rural residents differentially, especially with respect to preventive care.
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    North Dakota and NORC Rural Health Reform Policy Research Center
     Given the complexity of the Global Budget reimbursement model, we were interested to learn if there are aspects of the model that could be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
  • Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
    North Carolina Rural Health Research and Policy Analysis Center
     This study assessed the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
  • How Rural Communities Respond and Recover after a Hospital Closure
    North Carolina Rural Health Research and Policy Analysis Center
     Current rates of rural hospital closures are the highest seen in the last few decades. What can we learn from the experiences of communities experiencing hospital closures?
  • Identification of High-Need Rural Counties Lacking an FQHC Presence
    Rural and Minority Health Research Center
     Federally Qualified Health Centers (FQHCs) have been key safety net providers since the program was initiated. However, many rural communities lack this resource. Expanding on the index of relative rural deprivation developed by the SCRHRC, we identified high-need rural counties that currently are not served by an FQHC or similar provider.
  • Identifying Obesogenic Communities in the U.S.: An Urban-Rural Comparison
    Rural and Minority Health Research Center
     In this study, we created an obesogenic environment score for all U.S. counties and Census tracts, explored urban versus rural differences in obesogenic environment scores, and examined associations between obesogenic environments and childhood obesity overall and by level of rurality.
  • Impact of Capping Medicare Disproportionate Share Hospital Payments on Rural Hospitals
    RUPRI Center for Rural Health Policy Analysis
     Rural hospitals receiving Medicare prospective payment system payment and receiving disproportionate share hospital payments are subject to a 12% cap on those payments. This project provided information on the number and location of rural hospitals subject to this cap and the fiscal impact.
  • Launching Data Collection on a Common Set of Measures for the School-Based Telehealth Network Grant Program Evaluation
    Rural Telehealth Research Center
     The Rural Telehealth Research Center worked cooperatively with the Federal Office of Rural Health Policy to establish data collection protocols and tools on a set of measures that are being used for a cross-grantee evaluation of the School-Based Telehealth Network Grant Program.
  • Perceived Facilitators and Barriers to Rural Ambulatory Care Practice Among Registered Nurses
    Rural and Minority Health Research Center
     Although a quarter of all registered nurses work in ambulatory care settings, little research has addressed the factors associated with their remaining in the profession and current job settings. The study surveyed a sample of rural and urban nurses to ascertain perceived facilitators and barriers to remaining in rural practice.
  • Predictors of Buprenorphine Prescribing by Family Physicians in Rural Areas Nationally
    Rural and Underserved Health Research Center
     This project examined how physician and practice-level characteristics are associated with family physicians prescribing buprenorphine for opioid use disorder across rural and urban areas. The study made use of a unique dataset collected among family physicians nationally in 2017.
  • Preventive Health Service Use Among Rural Residents
    Maine Rural Health Research Center
     Examining differences in rural-urban preventive health service use is critical to assessing the impact of health benefit design changes on access to preventive services and their use among rural and urban populations. We used National Health Institute Survey data to compare receipt of preventive health services among rural and urban adults.
  • Promotion of Rural Health Research Center Attendance at Cancer-Related Meetings
    Rural and Minority Health Research Center
     This project will promote attendance at cancer-related meetings by Rural Health Research Centers by facilitating the dissemination of information regarding important cancer meetings and handling the travel arrangements for Rural Health Research Center personnel.
  • Rural and Urban Differences in Access to Psychiatric Partial Hospitalization Programs
    Rural and Underserved Health Research Center
     The project informed policymakers about the accessibility of psychiatric partial hospitalization programs, which provide moderately intensive and structured psychiatric services in outpatient settings, particularly hospital-based outpatient clinics.
  • Rural Health Clinic Financial Performance and Productivity
    Maine Rural Health Research Center
     This study used Medicare cost reports for independent and provider-based clinics to provide a detailed national picture of the financial and operational performance of RHCs and describe variations in performance related to revenue, costs, staffing, payer mix, productivity levels, and hours of operation across independent and provider-based clinics. The project also developed measures that can be used to benchmark RHC performance over time.
  • Rural Hospice Surveys Regarding Family Members & Health Workforce
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project's two parts surveyed both hospice users' family members and hospice CEOs regarding their health workforce staffing and shortages. The family member survey involved a sample of hospices from a geographically disperse group of states and the CEO survey involving a national random sample of hospice CEOs.
  • Rural Nursing Workforce: Current Educational Characteristics and Options for Improvement
    Rural and Minority Health Research Center
     This project examined the current distribution of nurses, subset by educational attainment, across the rural U.S. using data from Census Public-Use Microdata files. Then surveyed approximately 750 registered nurse to bachelor of science in nursing (RN-to-BSN) educational programs across the U.S. identifying the proportion of programs offering rural content or facilitating rural placement.
  • Social Determinants of Health Among Minority Populations in Rural America
    Rural and Minority Health Research Center
     This project compiled information from the U.S. Census, the Area Health Resource File, and the Robert Wood Johnson Foundation County Rankings data set into a comprehensive summary of key social determinants of health among rural populations: demographic characteristics, economic characteristics, health facility availability, and selected health outcomes.
  • Substance Use, Depression, and Suicide: What Are the Individual and Policy-Modifiable Correlates Amongst Metropolitan and Non-metropolitan Adults?
    Rural and Underserved Health Research Center
     We estimated the prevalence of depression and suicidal ideation and attempts amongst metropolitan and non-metropolitan adults nationally. We also investigated how demographic, social, economic, and health (including alcohol and drug abuse) as well as healthcare access factors explain depression and suicide indicators amongst residents.
  • The Rural MACRA Experience
    RUPRI Center for Rural Health Policy Analysis
     The Rural MACRA Experience project studied rural effects of the new Medicare Quality Payment Program (QPP) implementation and operation. Rural QPP effects included provider eligibility, program preparation and data collection challenges, data analysis bias, and differential fiscal impact.
  • The Rural/Urban Impact of Insurance Coverage Changes
    RUPRI Center for Rural Health Policy Analysis
     We examined the impacts of changes in health insurance coverage during the last several years on use of health services and health outcomes separately for rural and urban areas. Due to differences in demand and supply level factors, we hypothesized that the effects of coverage changes differ by rural/urban status.
  • Understanding Differences in Rural and Urban Adolescent and Young Adult Substance Use
    Maine Rural Health Research Center
     Using National Survey of Drug Use and Health data, we'll examine rural-urban adolescent/young adult substance use differences. While substance use has declined among all adolescents in recent years, it's unclear whether the trends apply to rural adolescents/young adults who have historically higher substance use rates than their urban counterparts.
  • Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine
    WWAMI Rural Health Research Center
     This study investigated the extent to which nurse practitioners and physician assistants who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients.
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.
  • What Impact Will Unified GME Accreditation Have on Rural-focused Physician Residencies
    WWAMI Rural Health Research Center
     The impending unification of allopathic and osteopathic graduate medical education (GME) under a single accreditation system has uncertain implications for small and rural-focused residency programs. This study aimed to (1) quantify the rural practice outcomes of residencies in rurally-relevant specialties such as pediatrics, internal medicine, obstetrics/gynecology, emergency medicine, surgery, anesthesia, and psychiatry, and (2) interview key stakeholders to identify anticipated challenges of the accreditation merger and potential policies to strengthen vulnerable rural-focused residencies during the transition.

Projects Completed 2018 - (26)

Projects Completed 2017 - (31)

  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    RUPRI Center for Rural Health Policy Analysis
     This paper describes opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from centering on inpatient hospital-based care to new models of care delivery in rural places.
  • Are Rural Mothers and Infants Benefiting from Changes in National Women, Infants and Children (WIC) Policy?
    Southwest Rural Health Research Center
     This study explored breastfeeding practices among rural participants in the Women, Infants and Children (WIC) Program before and after a federal policy change in WIC Food Packages. National Food and Nutrition Survey data was used to examine the potential impact on breastfeeding, infant feeding practices, and food/beverage consumption.
  • Assessing the Impact of Medicaid Policy Changes
    RUPRI Center for Rural Health Policy Analysis
     Goals of this project included: 1) clearly articulating the rural considerations in Medicare reform by synthesizing information on the impact of Medicare on rural people, places, and providers; 2) assessing the impact of specific proposals to reform Medicare; and 3) analyzing the effects of market-based reform on rural populations, focusing on specific provisions of Medicare reform proposals.
  • Assessing the Stability of Rural Pharmacy Services
    RUPRI Center for Rural Health Policy Analysis
     This project's goals include deepening our understanding of economic forces beyond the immediate control of local pharmacies that are affecting their ability to remain in business, assessing the future of sole community retail pharmacies in rural places, and exploring alternative modalities for delivering pharmacy services in the absence of retail pharmacy businesses.
  • Catastrophic Consequences: The Rise of Opioid Abuse in Rural Communities
    Maine Rural Health Research Center
     This project will analyze national data on the prevalence of opioids in rural and urban settings as well as describe state and local efforts to promote prevention and access to treatment.
  • Characteristics of Rural Hospitals at High Risk of Financial Distress
    North Carolina Rural Health Research and Policy Analysis Center
     Updates the Financial Distress Index Model with current hospital and market data. Evaluates changes in risk status and geographic distribution over time. Conducts an in-depth analysis of high risk hospitals.
  • Collecting and Analyzing Data on a Uniform Set of Measures from the Evidence-Based Telehealth Network Grant Program Grantees
    Rural Telehealth Research Center
     The primary purpose of this project will be to routinely collect and analyze data on a uniform set of measures reported by the Evidence-Based Telehealth Network Grant Program grantees to help establish the evidence base for tele-ED.
  • Disparities in Access to Oral Health Care Among Rural Children: Current Status and Models for Innovation
    Rural and Minority Health Research Center
     The ACA contains key provisions on addressing oral health disparities among vulnerable populations. This project will provide baseline information on trends in rural health and describe the experiences of four states taking innovative approaches to implementation of key ACA oral health provisions.
  • Do Rural Health Clinics (RHCs) Provide Services that Lower Rates of Preventable Hospitalizations?
    RUPRI Center for Rural Health Policy Analysis
     This project uses 3 years of individual-level Medicare claims data to analyze the relationship between receiving care at a Rural Health Clinic (RHC) and the likelihood of potentially preventable hospitalization and/or potentially preventable emergency department (ED) visits. The project will explore this relationship among both fee-for-service Medicare enrollees and Medicare-Medicaid dual eligibles.
  • Examination of Rural and Frontier Home Health Services
    North Dakota and NORC Rural Health Reform Policy Research Center
     This mixed-method study is an in-depth examination of access to and utilization of home health services provided in rural and frontier areas. The study begins to explore how influential patient-centered decision-making is in determining the type of post-acute care services used by rural and frontier Medicare beneficiaries.
  • Exploring Regional Differences in Rural and Urban Mortality Trends
    North Carolina Rural Health Research and Policy Analysis Center
     Explores the differences in U.S. mortality rates by urban and rural location, census division, and urban and rural location within each census division. The gap in nationwide urban-rural mortality is often told as a national story, but the changes are regional. This implies different regions may need different strategies for addressing the gap.
  • Exploring the Impact of Rural Hospital Closures on Use of Emergency Medical Services
    Rural and Underserved Health Research Center
     Using a unique national database, The Enterprise Data Trust, we will explore pre- and post-closure hospital emergency department use with specific emphasis on those who used public emergency medical transportation, testing for significant changes. This study will be the first to look at the impacts of rural hospital closure at the patient level.
  • Healthcare Access and Affordability Among Rural Children with Public Versus Private Health Insurance
    Maine Rural Health Research Center
     To examine differences in healthcare access and affordability among rural children with public (i.e., Medicaid or CHIP) and private health insurance coverage, the study will address the a number of research questions, using data from the 2011-12 National Survey of Children's Health.
  • Identifying Adverse Drug Events and Improving Patient Safety in Rural Hospitals
    University of Minnesota Rural Health Research Center
     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.
  • Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
    Maine Rural Health Research Center
     Using the Health Reform Monitoring Survey (HRMS), this project will produce two briefs examining rural-urban comparisons in insurance status, open enrollment knowledge and perceptions, and perceived affordability of coverage available through the Health Insurance Marketplaces.
  • Obstetric Unit and Hospital Closures and Maternal and Infant Health in Rural Communities
    University of Minnesota Rural Health Research Center
     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.
  • Paving the Way: Addressing Transportation as a Social Determinant of Health for Rural Residents
    University of Minnesota Rural Health Research Center
     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.
  • Potential Impact of ESRD Payment Reform on Rural Dialysis Patients
    Rural and Minority Health Research Center
     This study will estimate the potential implications of rural dialysis facility loss for rural patients. Specifically, we will identify low-volume dialysis facilities in rural areas, profile the patients they serve, and estimate the additional travel burden that these patients would experience if facilities close.
  • Provide Guidance on Measures for the School-Based Telehealth Network Grant Program Evaluation
    Rural Telehealth Research Center
     The primary purpose of this project was to provide guidance on a set of measures that could be used for a cross-grantee evaluation of the School-Based Telehealth Network Grant Program.
  • Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds
    Southwest Rural Health Research Center
     This project will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas of the U.S. Our national comparison will include indicators such as service mix, length of stay, discharges, volume and census, and certifications and provider characteristics.
  • Rural Implications of Quality-Based Physician Payment Reform
    University of Minnesota Rural Health Research Center
     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.
  • Rural-Urban Differences in Medicare Service Use and Expenditures in the Last Six Months of Life
    Rural and Minority Health Research Center
     Patterns of end-of-life care are known to vary by rurality and by minority status, and the availability of facilities such as hospice also vary with rurality. This study will examine the relationship between level of service use during the last six months of life and facility availability in county of residence (hospital, SNF, IRF, home health, hospice), as well as minority status of the beneficiary and whether the beneficiary is also eligible for Medicaid ("dual eligible").
  • Skilled Nursing Facility Care for Rural Residents with Complex Care Needs
    University of Minnesota Rural Health Research Center
     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.
  • State Policy Issues That May Impact HIMs' Success in Rural Places: A Regional Analysis
    RUPRI Center for Rural Health Policy Analysis
     Goals of this project include gathering detailed data and providing analysis and policy recommendations on issues relating to network adequacy and service areas for HIMs, with additional investigation of other state-level policy variables (such as the Medicaid expansion decision) which may have a confounding or moderating effect on the relationship between network adequacy and enrollees' choices and premiums.
  • The Financial and Community Experience of Sole Community Hospitals in Comparison to Other Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This research will investigate the financial and community experience of Sole Community Hospitals (SCHs) in comparison with other rural hospitals. The availability of alternative facilities, and the socioeconomic and demographic characteristics of SCH service areas will be compared to other rural hospital service areas.
  • The Supply and Distribution of the Behavioral Health Workforce in Rural America
    WWAMI Rural Health Research Center
     Data from the National Plan and Provider Enumeration System (NPPES) file, linked to RUCA codes and population data will be used to identify behavioral health providers and describe their geographic (rural/urban, regional and intra-rural) distribution. Behavioral health professions identified in the file include psychiatrists, addiction medicine specialists, psychiatric nurse practitioners, clinical nurse specialists in mental health, clinical psychologists and licensed social workers.
  • Transitions of Care Among Rural Medicare Beneficiaries: The Care Continuum
    Rural and Minority Health Research Center
     Because they are often hospitalized outside their home community, rural Medicare beneficiaries may experience a different sequence of services after discharge than do urban beneficiaries. This study will follow beneficiaries across the continuum of post-hospital care to determine if rural beneficiaries, particularly minority beneficiaries, are more likely to experience care disruption and adverse outcomes, such as re-hospitalization.
  • Trends in Rural Children's Health and Access to Care
    Rural and Minority Health Research Center
     The past ten years have seen positive trends in the availability of health insurance coverage for children, coupled with worsening trends for poverty. This project will examine data from three iterations of the National Survey of Children' Health (2003, 2007, 2012) to see whether rural children have benefited equally from any improvements in health insurance, healthcare use, and health status.
  • Use of Telehealth Services Among Rural Medicaid Enrollees: A Baseline Inventory
    Rural Telehealth Research Center
     The goal of this project was to generate a multi-state, baseline description of telehealth services provided to Medicaid enrollees in rural and urban settings.
  • What Constitutes An Adequate Provider Network For Rural Health Populations?
    University of Minnesota Rural Health Research Center
     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.
  • Who Treats Opioid Addiction in Rural America? Quantifying the Availability of Buprenorphine Services in Rural Areas
    WWAMI Rural Health Research Center
     This study will investigate the extent to which physicians who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients. This study will also estimate the need for office-based opioid disorder treatment in rural locations.

Projects Completed 2016 - (35)

  • Access To and Use of Home and Community-Based Services in Rural Areas
    Maine Rural Health Research Center
     This study will use data from the 2010 Medicaid Analytic eXtract (MAX) file and in-depth policy reviews and interviews in four states to examine differences in the use of institutional and home and community-based service (HCBS) use by older adults across urban and rural areas, and the policy and community factors that contribute to differences or comparability in use.
  • Access to Home Care Services in the Rural United States
    WWAMI Rural Health Research Center
     This study will identify and describe the scope of home health services required to meet current and future needs in rural areas of the U.S., identify current and anticipated barriers to accessing those needs, and describe ways that may help overcome these barriers.
  • Adverse Childhood Experiences and the Health Status of Rural Residents
    Maine Rural Health Research Center
     The proposed project will (1) assess the prevalence of adverse childhood experiences (ACEs) in rural populations and (2) examine associations of ACEs with health outcomes in rural versus urban settings.
  • Analyzing the Variation in the Performance of Accountable Care Organizations Serving Rural Medicare Beneficiaries
    RUPRI Center for Rural Health Policy Analysis
     The goals of this project are to characterize ACOs that operate in rural areas, describe the models being used to organize those ACOs, and to test relationships of those characteristics to performance measures related to financial success and quality. The study will identify potential changes in legislative and regulatory policies that could strengthen the utility of the ACO model to achieve high performing rural healthcare delivery organizations.
  • Can a Model Predict Financial Distress Among Rural Hospitals?
    North Carolina Rural Health Research and Policy Analysis Center
     This project will extend an existing model of CAH financial distress to other types of rural hospitals. A valid model would be helpful to ORHP and state Offices of rural Health interested in predicting financial distress or closure of rural hospitals.
  • Colorectal Cancer Screening Bypass Behavior and Outcomes
    Rural and Minority Health Research Center
     Studies have shown that increased distance to the closest endoscopy provider is associated with lower screening utilization among Medicare enrollees. The purpose of this study is to expand beyond the Medicare population to examine the travel behaviors of the entire population, comparing urban vs. rural residents in obtaining endoscopies for colorectal cancer screening.
  • Designing a Study for Collection of Uniform Measures by the EB TNGP Grantees
    Rural Telehealth Research Center
     The Federal Office of Rural Health Policy funded six grantees through the Evidence-Based Telehealth Network Grant Program to implement and evaluate tele-emergency services in rural areas.
  • Exploring Rural and Urban Mortality Differences
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project examines the impact of rurality on mortality and explores the regional differences in the primary and underlying causes of death. It also explores the role of the rural public health systems in addressing social determinants of health.
  • Family Medicine Rural Training Track Graduates: Determinants of Rural and Urban Practice
    WWAMI Rural Health Research Center
     This project will survey physicians trained in "1-2" Rural Training Track (RTT) family medicine residencies to understand the characteristics, experiences, and attitudes that influenced their rural or urban practice choices.
  • Frontier and Rural Definition Development and Dissemination Project
    North Dakota and NORC Rural Health Reform Policy Research Center
     The Frontier and Remote (FAR) codes are a new geographic definition that delineates frontier/remote areas in the U.S.
  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals?
    North Carolina Rural Health Research and Policy Analysis Center
     This two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); (3) financial performance; and (4) hospital revenue cycle management. Results will inform federal and state agencies, rural providers and communities as to how implementation of the Patient Protection and Affordable Care Act is impacting reimbursement and financial performance of rural hospitals, allowing the Office of Rural Health Policy to identify emerging challenges and develop strategies or policy changes needed to deal with any unintended consequences.
  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals? (Year 2)
    North Carolina Rural Health Research and Policy Analysis Center
     The second year of this two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); and (4) financial performance.
  • Identification of Highly Vulnerable Counties: The Intersection of Race, Poverty, and Health Care Resources
    Rural and Minority Health Research Center
     The United States rural population has changed since the 2000 Census; minority populations have increased while overall population growth has slowed. This analysis will identify places of high vulnerability, defined as counties with high proportions of poor and/or minority populations with low or reduced healthcare resources.
  • Influence of State Policies and Practices on J-1 Visa Waiver Physicians Service in Rural Areas
    WWAMI Rural Health Research Center
     This study will collect information from all states regarding their efforts to track IMG practice after their Conrad 30 program waiver obligations are satisfied, quantify long-term retention for states with available data, and assess how state policies shape IMG practice and long-term retention.
  • Launch of a Study for Collection of Uniform Measures by the EB TNGP Grantees
    Rural Telehealth Research Center
     Study concepts were vetted, protocols were developed, and this project launched a study where the Evidence-Based Tele-Emergency Network Grant Program grantees began to collect data on a uniform set of measures to help establish the evidence base for tele-ED.
  • Novel Master File of Rural Family Medicine Residency Training: Program Models and Graduate Outcomes
    WWAMI Rural Health Research Center
     This study expands current work by the WWAMI RHRC to establish a comprehensive database of rural-focused family medicine residency training programs. We will use this database to (1) create a typology of rural-focused family medicine training and (2) evaluate program graduates' outcomes and the success of different program models.
  • Policy Analysis Using the Financial Distress Model: Does Medicaid Expansion Affect the Risk of Hospital Financial Distress and Closure?
    North Carolina Rural Health Research and Policy Analysis Center
     This study will build on the 2014-15 approved project entitled "Can a Model Predict Financial Distress among Rural Hospitals?" The newly developed model uses current financial performance and market characteristic data to assign rural hospitals to one of four categories of risk of financial distress. The study will use Medicare Cost Report data for 2014, if available. Otherwise, simulation will be used to estimate the effects on financial distress.
  • Practice Characteristics of Rural Nurse Practitioners in the United States
    WWAMI Rural Health Research Center
     This study will use data from HRSA's first National Sample Survey of Nurse Practitioners (NSSNP) to expand on the agency's basic descriptive analyses of rural and urban nurse practitioners (NPs).
  • Quality Measures and Sociodemographic Risk Factors: The Rural Environmental Context
    University of Minnesota Rural Health Research Center
     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.
  • Relationship Between Service Utilization and Costs for High Cost Rural Medicare Patients
    University of Minnesota Rural Health Research Center
     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.
  • Role and Early Impact of CO-OPs in the Rural Health Insurance Marketplace
    Maine Rural Health Research Center
     This study will combine quantitative analysis with administrative health plan practice data with targeted case studies to examine the rural availability and pricing of CO-OP plans, and the early experiences of these plans.
  • Rural Health Clinics: Medicare & Medicaid Profile (Year 2)
    North Carolina Rural Health Research and Policy Analysis Center
     Year 2 of a project developing a longitudinal data collection/tracking mechanism of key RHC Medicare claims data and cost report elements. RHC Medicaid data for a sample of states also will be requested and analyzed to determine utilization patterns and identification of potential quality metrics.
  • Rural Hospital Obstetric Workforce, Procedure Utilization, and Quality of Care
    University of Minnesota Rural Health Research Center
     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.
  • Rural Population Hospice Care
    North Dakota and NORC Rural Health Reform Policy Research Center
     Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
  • Rural Training Track Technical Assistance Program
    WWAMI Rural Health Research Center
     This project looks into the Rural Training Track Technical Assistance (RTT-TA) Program which is a recognized model for addressing rural primary care physician shortages. The WWAMI RHRC has led the research component to investigate RTT program characteristics, graduate outcomes, and factors affecting RTT sustainability and resilience.
  • Rural-Urban Differences in Anticipated Need for Aging-Related Assistance Among Pre-Retirement Age Adults
    Rural and Minority Health Research Center
     We will use information from a nationally representative survey to ascertain how rural and urban adults aged 40-64 view their future and their plans for coping.
  • Rural-Urban Differences in Insurer Participation, Premiums, Health Plan Provider Networks in Federal and State Marketplaces
    University of Minnesota Rural Health Research Center
     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.
  • The Impact of Emergency Telemedicine on Timeliness, Process of Care, and Clinical Outcomes in Rural North Dakota Trauma Care
    Rural Telehealth Research Center
     This project was a comparative effectiveness study of North Dakota trauma patients to measure the impact of telemedicine-enabled emergency care between 2008-2014 on a number of issues.
  • Trends in Medicare Advantage Quality and Enrollment: The Effects of Quality Based Payment Incentives on Rural People and Places
    RUPRI Center for Rural Health Policy Analysis
     This research will analyze the quality of Medicare Advantage (MA) plans offered to rural MA beneficiaries currently, in relation to urban beneficiaries, and how it has evolved over the past four years. In addition, the effect of quality-based payment incentives will be measured by: 1) changes that have been made to improve the quality of existing plans in rural areas or to encourage the entry of high quality plans into rural areas, and 2) the movement of plans' entry and exit into the MA market by plan type and rural/urban location.
  • Use of Emergency Departments for Behavioral Health Related Care
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project will study the prevalence of emergency department utilization for behavioral health diagnoses between rural and urban communities.
  • Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Hospital Readmission
    WWAMI Rural Health Research Center
     This study will examine the 60-day post-acute care outcomes of rural Medicare patients who were discharged from hospitals and admitted to home healthcare services. Key predictors include home health services provided, type of Medicare home health reimbursement, and available community healthcare resources.
  • What Are the Possible Impacts of Nurse Practitioners and Physician Assistants on Future Provision of Primary Care in Rural Areas?
    WWAMI Rural Health Research Center
     This study will explore how many nurse practitioners (NPs), physician assistants (PAs) and physicians will be required to meet rural health care demand resulting from expanded access to health insurance through implementation of the Affordable Care Act (ACA).
  • What Is the Potential of Community Paramedicine to Fill Rural Healthcare Gaps?
    WWAMI Rural Health Research Center
     Community paramedicine (CP) has been promoted as a strategy to help communities achieve the Triple Aim of improving healthcare and population health while lowering costs. This study proposes to collect descriptive information on CP programs that can be identified in the U.S., and for those programs with outcome data, compare rural with urban programs in terms of their goals, services offered, outcomes measured, and results, where available.
  • What Would be the Financial Consequence of Eliminating Low Volume Hospital Payments?
    North Carolina Rural Health Research and Policy Analysis Center
     Analysis will include comparison of the long-term profitability of low-volume hospitals to other rural hospitals and estimation of the potential profitability consequences of eliminating the payment classification altogether.
  • Which Physician Assistant Training Programs Produce Rural Physician Assistants? A National Study
    WWAMI Rural Health Research Center
     This study will identify the physician assistant (PA) training programs that are most successful at producing graduates who practice in rural areas. The study will focus particularly on PAs who graduated from training in the past ten years.

Projects Completed 2015 - (32)

  • 21st Century Rural Hospital: Outpatient Services and Access to Care
    North Carolina Rural Health Research and Policy Analysis Center
     The rural hospital has changed dramatically with hospitals becoming increasingly outpatient-centered. This project is designed to inform policymakers about rural hospitals' provision of outpatient care, including publication of a Primer, detailing the variability in outpatient services provision by key characteristics that can be used to examine the potential impact of proposed policy changes on patients' ability to access different services.
  • Affordable Care Act Outreach and Enrollment: Case Studies of Rural Hospitals in Four States
    University of Minnesota Rural Health Research Center
     The purpose of this project is to identify best practices used by rural hospitals to educate uninsured rural patients and consumers about available health insurance coverage options and to assist them in enrolling in a Qualified Health Plan or Medicaid.
  • Are Part D Plans Meeting the Needs of Rural Medicare Beneficiaries?
    University of Minnesota Rural Health Research Center
     The purpose of this project is to assess whether the Medicare Part D prescription drug plans available in rural counties are sufficient to meet the needs of rural Medicare beneficiaries.
  • Assessing Health Information Technology (HIT) Strategies to Improve Access for Rural Veterans
    Maine Rural Health Research Center
     Rural veterans face unique barriers to care including insufficient communication and coordination of care provided across multiple settings—both within and outside of the Veteran's Administration. To help reduce these barriers, multiple agencies within the federal government have promoted technology as an opportunity to improve access and care coordination to veterans living in remote areas. Most recently, programs in Maine, Montana and Alaska have received grants to use health information technology (HIT) to expand and integrate services—including mental health services—for rural Veterans. However, little is known about the challenges these programs face on the ground, or what conditions and program strategies may facilitate success. This study will consist of case studies of these programs in each of the three states, and will identify best practices and barriers for implementing rural HIT initiatives that could inform future strategies in this area.
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    WWAMI Rural Health Research Center
     This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier (NPI) data.
  • Dentist Supply, Access to Dental Care, and Oral Health Among Rural and Urban Residents: A National Study
    WWAMI Rural Health Research Center
     This study will determine whether shortages of dentists in rural areas of the U.S. are associated with impaired access to dental care and a higher prevalence of dental disease.
  • Early Rural Experiences of Changes to Medicaid
    North Carolina Rural Health Research and Policy Analysis Center
     This project will 1) develop baseline state-level snapshots of rural enrollment in Medicaid and 2) estimate and model enrollment expansion in each state. We will also conduct a baseline provider key informant interviews in late 2013 to gauge expected effects, with follow up interviews in Summer 2014 as a sentinel warning system of early effects of changes to Medicaid in order to inform timely policy development.
  • Expanded Look at Rural Access to Care
    Maine Rural Health Research Center
     This study will use newly available national health survey data to examine rural-urban differences in access to medical care, access to insurance, and affordability of care.
  • General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study
    WWAMI Rural Health Research Center
     This study will examine the degree to which access to inpatient surgical care in rural areas is affected by the diminishing workforce of general surgeons. Using inpatient surgical procedure data, we will examine the availability and content of general surgical procedures in rural and urban hospitals nationally as a function of surgeon supply.
  • HIT Workforce Development in Rural-Serving Community Colleges
    WWAMI Rural Health Research Center
     This study will describe trends in the number of students completing Health Information Technology (HIT) programs in community colleges located near rural populations in the U.S.; assess the extent to which these programs have incorporated, or plan to incorporate, components of the recently released community college curriculum by the Office of the National Coordinator for HIT (ONC) into their programs; and identify factors that affect the ability of programs to reach rural student populations.
  • How will Plan Offerings and Premiums Change in Rural and Urban Areas in the Second Year of Health Insurance Marketplaces?
    RUPRI Center for Rural Health Policy Analysis
     This project analyzes changes in Health Insurance Marketplaces plan and premium data between 2014 and 2015 by geographic region.
  • Identifying Limitations of PPS Reimbursement for Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project will investigate the potential financial and access consequences of returning rural hospitals to PPS payment. Characteristics of the hospitals and communities at highest risk of adverse consequences will be identified.
  • Impact of Private Sector Quality Initiatives on Rural Providers and Patients
    University of Minnesota Rural Health Research Center
     The purpose of this project is to assess the impact of private sector quality reporting and quality improvement initiatives on rural providers and on the quality of care provided to rural patients.
  • Impact of the CMS Value-Based Purchasing and Readmission Reduction Programs on Rural Hospitals
    University of Minnesota Rural Health Research Center
     The purpose of this project is to assess the initial impacts of the Value-Based Purchasing (VBP) and Readmission Reduction Programs on rural Prospective Payment System (PPS) hospitals.
  • Out-of-Pocket Costs Among Rural Medicare Beneficiaries
    Maine Rural Health Research Center
     The purpose of this project is to examine out-of-pocket spending among Medicare beneficiaries, to identify whether there are rural-urban differences in out-of-pocket costs, and to explore what factors account for these differences. Should Medicare redesign occur, this study will provide important information against which to assess the possible impact of different design options on rural Medicare beneficiaries.
  • Perspectives of Rural Hospice Directors
    North Dakota and NORC Rural Health Reform Policy Research Center
     Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
  • Post-Acute Stroke Care Delivery for Rural Medicare Beneficiaries
    Rural and Minority Health Research Center
     Post-stroke rehabilitation has been shown to improve outcomes among patients, but the limited available evidence suggests that rural residents and African Americans are less likely to receive this care. Our analysis will determine whether residence or race-based disparities exist in post-stroke care, after taking into consideration differences in patient status.
  • Post-Hospital Transitions in Care Among Dually-Eligible Medicare Beneficiaries
    Rural and Minority Health Research Center
     This project will examine the hospitalization rates, post-discharge physician follow-up, and subsequent readmission rates among Medicare beneficiaries who are also enrolled in Medicaid. We will examine these dual-eligible beneficiaries by level of rurality to determine if residence is a significant factor in these rates. We will also control for co-morbidities, county characteristics, and other factors related to readmission rates.
  • Pre-hospital Emergency Medical Services Personnel in Rural and Urban Areas: Results from a Survey in Nine States
    WWAMI Rural Health Research Center
     This study uses a survey of all ground-based pre-hospital emergency medical services (EMS) agencies in nine states (AR, FL, KS, MA, MT, NM, OR, SC, WI) to examine supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation, in rural and urban agencies.
  • Quality of Surgical Care services in Critical Access Hospitals (CAHs)
    RUPRI Center for Rural Health Policy Analysis
     This project builds on prior work examining rural residents' bypass behavior of their local CAH to hospitals outside their community. Using recently identified inpatient surgical procedures that are commonly performed in CAHs, we will examine and compare outcomes (e.g. post-surgical complication rates, adverse events) of these procedures between CAHs and non-CAHs.
  • Role of Free Clinics in the Rural Safety Net
    Rural and Minority Health Research Center
     This two-part study will combine a mapping project that documents the location of free clinics across the US with a telephone survey of the 21 state and 2 regional free clinic associations.
  • Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Sensitive Conditions
    Rural and Minority Health Research Center
     Rural areas with reduced social and economic resources may be particularly vulnerable to inadequate primary care for children.
  • Rural Health Clinics: Medicare & Medicaid Profile
    North Carolina Rural Health Research and Policy Analysis Center
     This study builds on our work with the 2009 RHC Medicare claims. This project will result in the development of a longitudinal data collection/tracking mechanism of key RHC Medicare claims data and cost report elements (provider-based cost reports only at this point in time). RHC Medicaid data for a sample of states will be requested and analyzed to determine utilization patterns and identification of potential quality metrics.
  • Rural Maternal Smoking Behaviors
    Maine Rural Health Research Center
     In this project, we will develop a chart book documenting the prevalence of mental health/substance abuse conditions and describing the utilization of mental health services in rural and urban settings.
  • Rural Mental Health First Aid Evaluation
    Maine Rural Health Research Center
     This project is a mixed-methods case study that focuses on the Mental Health First Aid training program, with a view toward clarifying the rural reach, feasibility, impact, and appropriateness of the program for rural communities.
  • Rural Women Giving Birth in Non-Local Hospitals: Implications for Obstetric Access and Quality
    University of Minnesota Rural Health Research Center
     The purpose of this project is to: 1) analyze recent data from nine geographically diverse states on delivery by rural women at non-local hospitals; 2) characterize the roles of medical vs. non-medical factors in delivery at a non-local hospital by identifying lower-risk and higher-risk women using established criteria; and 3) analyze the relationship between delivery at a non-local hospital and obstetric quality.
  • Transformation of Rural Health Clinics: Are They Ready to Serve as Patient-Centered Medical Homes?
    Maine Rural Health Research Center
     Rural Health Clinics (RHCs) face pressure to transform their practices by becoming patient-centered medical homes (PCMHs). This study will document the readiness of RHCs to serve as PCMHs and provide information to assist policymakers in developing technical assistance and other policy resources to support RHCs in doing so.
  • Use and Performance Variations in Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    North Dakota and NORC Rural Health Reform Policy Research Center
     This project describes rural usage of rural emergency departments (EDs). It will examine the conditions that are treated in these EDs and describe those that are more and less appropriate for ED use. Rural ED use is described by community characteristics including rural level. The findings provide a baseline from which to measure the future influence of the Accountable Care Act implementation on the usage of rural EDs and the appropriateness and cost efficiency of changes.
  • What Does it Cost to Operate a Rural Free-Standing Emergency Department (RFED)?
    North Carolina Rural Health Research and Policy Analysis Center
     In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to healthcare is a rural free-standing emergency department (RFED).
  • What Factors Explain Rural Residents Seeking Care Outside of the Rural Community?
    RUPRI Center for Rural Health Policy Analysis
     This project will examine factors that explain rural residents seeking care outside of the rural community.
  • What Happens after Acute Inpatient Care is No Longer Provided by a Rural Hospital?
    North Carolina Rural Health Research and Policy Analysis Center
     This project will investigate the precursors to closure of acute inpatient care by rural hospitals and the post-closure configuration of health care services in the community.
  • Year 2 of the Sentinel Cohort of Rural Health Clinics: Testing, Evaluating and Refining a Set of Rural Health Clinic Quality Measures
    Maine Rural Health Research Center
     This project implements the set of core consensus quality measures identified during Year One of the Rural Health Clinic (RHC) Sentinel Cohort project among a group of approximately 130 RHCs in 13 states.

Projects Completed 2014 - (29)

  • Adequacy of Home Health Care Availability in Rural Counties
    Rural and Minority Health Research Center
     This project will describe current distribution of HHC agencies, by ZIP Code and county of facility location and of service provision, across levels of rurality. Second, the project will estimate whether rural populations at risk for inadequate access to HHC, based on projected population need population / provider ratios.
  • Analysis of Medicare Advantage Quality in Rural Areas: Historically and Moving Forward
    RUPRI Center for Rural Health Policy Analysis
     This project examines the role that geography and demographics play in the success and quality of different types of MA plans in particular regions of the country.
  • Assessing HIT Readiness of Rural Health Clinics: A National Survey
    Maine Rural Health Research Center
     We will design and conduct a national survey of rural health clinics, both independent and provider-based, to determine the current level of health information technology adoption and readiness in these clinics
  • Characteristics and Utilization Patterns of Rural Dual-eligible Medicare Beneficiaries
    Rural and Minority Health Research Center
     Persons who are eligible for both Medicare and Medicaid insurance coverage (dual eligible) represent 21% of total Medicare enrollment, but account for more than 36% of Medicare expenditures. The purpose of this study is to ascertain whether dual-eligible beneficiaries living in rural areas differ from their urban counterparts in demographic characteristics and Medicare expenditures.
  • Comprehensive Study of Swing Bed Use in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project will comprehensively address questions about how swing beds are used by rural hospitals. Questions to be answered include whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities.
  • Developing a Sentinel Cohort of Rural Health Clinics for Use in Developing Relevant Quality Measures and Monitoring Program Performance
    Maine Rural Health Research Center
     This two year project will assemble a cohort of Rural Health Clinics (RHCs) from ten to thirteen states to participate in a sentinel quality measurement process. During the first year of the project, the cohort of RHCs will participate in the identification, development, and refinement of a discrete set RHC quality measures in conjunction with the project team and an expert panel of RHC and quality measurement experts. During the second year, the cohort will be asked to implement, report, and evaluate the measures.
  • Early Rural Experiences of Changes to Medicaid: Year 1
    North Carolina Rural Health Research and Policy Analysis Center
     In January 2014, some states will expand eligibility through the Medicaid program, while other states will not. Because rural residents are likely to be disproportionately affected by Medicaid expansion, understanding this interstate variation has important policy implications.
  • Effects of Changing Medicare Advantage Landscape on Rural Enrollees
    RUPRI Center for Rural Health Policy Analysis
     The goal of this project is to assess the impact of changes in Medicare payment policy on the availability of choices for rural Medicare beneficiaries. The objectives are quantify the impact of payment policy on the number of competing plans in strata of rural counties and the effects of using quality star ratings on choices in rural counties.
  • Engagement of Rural Providers in Accountable Care Organizations (ACOs)
    RUPRI Center for Rural Health Policy Analysis
     The RUPRI Center's work assessing the development of ACOs in rural places including updating our data base showing the location of Medicare ACOs and using the data to create maps for each Census Region showing the counties in which Medicare ACOs have assigned beneficiaries.
  • Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform
    North Dakota and NORC Rural Health Reform Policy Research Center
     The purpose of this project is to update and supplement the seminal Health, United States, 2001: Urban and Rural Health Chartbook. Resulting information can not only be compared to the 2001 Chartbook but provides a baseline from which to measure future change related to the Accountable Care Act implementation. Where appropriate additional charts are included wherein rural areas are subdivided by type.
  • Health Information Technology (HIT) Workforce Needs in Rural America
    WWAMI Rural Health Research Center
     Health care increasingly relies on effective health information technology (HIT) to capture and exchange key patient information, and requires a trained workforce to implement this technology. To understand the specific needs and constraints of rural health systems to employ an effective HIT workforce, this study will survey rural primary care clinics across the country to determine their current and projected level of HIT adoption and demand for workers with HIT skills.
  • Health Insurance Stability Among Rural Children Following Public Coverage Expansions
    Maine Rural Health Research Center
     While estimates indicate that the uninsured rate among rural children has dramatically decreased since the 1997 passage of the State Children's Health Insurance Program (CHIP), it is not clear whether or not coverage has become more stable and uninsured spells shorter. The purpose of this study is to investigate changes in insurance stability among rural and urban children following CHIP, and whether this is affected by specific state eligibility and enrollment policies or clusters of policies. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we will measure rural-urban differences in uninsured spell length and frequency, sources of coverage before and after uninsured spells, movement between sources of coverage, how these measures of stability have changed over time, and the factors that relate to greater continuity of coverage among rural children.
  • High Quality Rural Hospitals and Post-Acute Care Providers
    University of Minnesota Rural Health Research Center
     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.
  • Implications of Mental Health Comorbidity and Rural Residence for Health Care Use Patterns of Individuals with Chronic Disease
    Maine Rural Health Research Center
     This study will use the 2005-2010 panels of the Medical Expenditure Panel Survey to compare the prevalence of concurrent mental health and chronic illnesses across rural and urban populations and to describe relationships among comorbidity, residence, and healthcare use. Findings will inform public and private decisions on how best to allocate new resources available for mental health/primary care integration efforts.
  • Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services
    Rural and Minority Health Research Center
     This study will assess whether Medicare beneficiaries in rural areas receive a lower intensity of home health (HH) services compared to their urban counterparts. Specifically, the study will examine (1) the distribution of levels of HH services for four conditions: joint (hip and knee) replacement, stroke, end-stage renal disease (ESRD), and diabetes; (2) the distribution of type of provider for each condition across the levels of rurality; and (3) the median charge and payment per beneficiary for these services across the levels of rurality.
  • Observation Care Services in Rural Hospitals: Reimbursement and Quality Implications
    University of Minnesota Rural Health Research Center
     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.
  • Obstetric Care Practice Models and Quality in Rural Hospitals
    University of Minnesota Rural Health Research Center
     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.
  • Patterns of Care in Small Rural Areas: Implications for New Models of Care Provision and Payment such as Bundled Payments and Accountable Care Organizations
    North Carolina Rural Health Research and Policy Analysis Center
     This study will describe usual patterns of care in rural areas to determine whether rural areas are part of a single service area, or whether smaller communities utilize services from a variety of larger hubs. The results of this analysis will inform a thought piece on how the concepts of bundled payments and Accountable Care Organizations might play out in small rural areas and whether small rural communities can be assigned to a single service area without major disruption of current patterns of care.
  • Prevalence and Impact of High Deductible Health Insurance Plans in Rural Areas
    Maine Rural Health Research Center
     This study will use national health survey data to examine whether privately insured rural residents are more likely than their urban counterparts to have plans with high deductibles. It will also assess whether high deductible health plans create health care barriers for rural residents, and if these differ from the barriers experienced by those in urban areas.
  • Profiling Health and Health Resource Availability in U.S. – Mexico Border Counties
    Rural and Minority Health Research Center
     This project will augment a previous SCRHRC chartbook on Border health with additional information on health resources and health outcomes in US counties adjacent to Mexico.
  • Quality Implications of Transferring Emergency Department Patients from Rural Hospitals
    University of Minnesota Rural Health Research Center
     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.
  • Rural and Urban Differences in Case-Mix Among Recipients of Home Health Care
    Rural and Minority Health Research Center
     We will examine current patient case-mix for the Medicare population receiving skilled health care from a home health agency to determine if there are rural or race/ethnicity-based disparities with regards to receipt of services and clinical acuity indicators.
  • Rural Hospital Mergers and Acquisitions - Who is Being Acquired and What Happens Afterwards?
    North Carolina Rural Health Research and Policy Analysis Center
     This study compares the financial and market characteristics of recently acquired rural hospitals to other rural hospitals and investigates the post-acquisition change in services and financial performance of these hospitals. This study will inform rural advocates, federal and state agencies, and regulators as to how mergers and acquisitions (M&amp;As) of small rural hospitals affect access to care for Medicare beneficiaries, and the potential financial consequences of M&amp;As to small rural hospitals.
  • Rural Inclusion in the Development of Health Insurance Exchanges
    RUPRI Center for Rural Health Policy Analysis
     State plans for developing Health Insurance Exchanges (HIEs) will be analyzed to determine likely benefits for rural residents and communities. Three elements of each plan will be described and assessed: strategies to seek out and enroll rural residents eligible for subsidized insurance coverage or categorically eligible for plans offered through exchanges; minimum standards for participating health plans, including access to essential services; and simulations of impact on availability of plans and enrollment of currently uninsured rural residents.
  • Rural Residential Care: The Implications of Federal and State Policy Changes
    Maine Rural Health Research Center
     This project will assess the impact on Medicaid-funded rural residential care options of new and proposed federal policy guiding state compliance with the Americans with Disabilities Act (ADA). The extent to which rural facilities are able to comply with the proposed guidelines may affect their eligibility for funding through Home and Community-Based Services waiver programs.
  • Supply of Physicians Waivered to Treat Opioid Addiction in Rural America: Policy Options to Remedy Critical Shortages
    WWAMI Rural Health Research Center
     This study will determine the extent to which a trained workforce exists in rural America that has received the necessary waiver to treat opioid addiction in outpatient settings with buprenorphine, a highly effective medication. It will identify areas with critical shortages and discuss policy options for expanding the supply of these qualified providers.
  • Use of Telehealth to Deliver Services to Rural People and Implications for Public Policy
    RUPRI Center for Rural Health Policy Analysis
     This project analyzes national datasets to examine the extent of use of inpatient telehealth services, organizational factors contributing to use, and payment and other policies that limit uptake. This project will identify approaches that could aid spread of this effective delivery approach throughout rural service areas.
  • What Strategies Are Nurse Practitioner Educational Programs Using to Encourage Rural Practice?
    WWAMI Rural Health Research Center
     This study will quantify and describe nurse practitioner (NP) education programs that encourage NPs to practice in rural areas, and identify data sources that could be used in future studies of the effectiveness of these programs.
  • Will Health Insurance Marketplaces Deliver Affordable Options in Rural America
    RUPRI Center for Rural Health Policy Analysis
     This project analyzes early Health Insurance Marketplaces plan and premium data by geographic region, controlling for state policy decisions, to assess the degree to which affordable health insurance will be available through individual and/or small business marketplaces.

Projects Completed 2013 - (20)

  • Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others?
    WWAMI Rural Health Research Center
     This study will identify rural locations with high proportions of generalist physicians nearing retirement age.
  • Agricultural Health: Current Knowledge and Future Directions
    West Virginia Rural Health Research Center
     The health of rural populations is impacted by many factors, of which agricultural activities are one of the most important. Agriculture potentially impacts health through a variety of means, including exposures to pesticides and fertilizers, dust from fields or harvesting, accidents and injuries, or contaminants from animal feed lots including antibiotics, hormones or animal waste. There are also issues facing special populations such as migrant workers, and potential agricultural risks facing children and families of workers.
  • Assessing Rural Implications of Changes in Insurance Markets
    RUPRI Center for Rural Health Policy Analysis
     The goal of this project is to understand and predict changes in the insurance market in which rural people will participate and how state and national policies might influence activity in that market. The specific objectives of the project are to analyze state policies designing and implementing health insurance exchanges and to model the behavior of health insurance plans as regards entering and exiting rural markets.
  • Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act
    Maine Rural Health Research Center
     This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
  • Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
    WWAMI Rural Health Research Center
     This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs.
  • Do Rural Patients with Early Stage Prostate Cancer Gain Access to All Treatment Choices?
    WWAMI Rural Health Research Center
     This research will use cancer registry data from 10 states to examine the degree to which rural residents diagnosed with early stage prostate cancer access the full range of surveillance, surgical, and radiation treatment options. Study findings will inform cancer centers, advocacy groups, rural program planners, and policymakers about services and programs needed to ensure that rural prostate cancer patients can choose from among all treatment options.
  • Has the Medicare Part D Program Improved Medication Access and the Health Status of Rural Beneficiaries?
    University of Minnesota Rural Health Research Center
     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.
  • Impact of Payment Policy on Access to Physician Care in Rural America
    RUPRI Center for Rural Health Policy Analysis
     Profiles of physician practices will be constructed that specify the percent of payments derived from specific current procedural terminology (CPT) codes, dichotomized into evaluation and management (often considered to define primary care) or procedural. Differences across rural practices and between rural and urban practices will be analyzed, with implications for payment policies intended to reward rural primary care.
  • Patterns of Care for Rural and Urban Children with Mental Health Problems
    Maine Rural Health Research Center
     This study will assess whether use of office-based care and psychotropic medicine by children differs between rural and urban areas, as well as the role of insurance coverage and availability of mental health providers on use of these services.
  • Perinatal Health in the Rural United States, 2005
    WWAMI Rural Health Research Center
     This study examines perinatal outcomes in rural areas across the United States in 2005.
  • Pharmacy Services in Communities After the Only Local Pharmacy Closes
    RUPRI Center for Rural Health Policy Analysis
     This project will investigate patterns of utilization of prescription drug and other health care services in rural communities in the years since the only local pharmacy closed. We will also examine changes in local economies and Medicare spending, trended to include time before closure through as many years possible after closure.
  • Progress Toward Meaningful Use of Health Information Technology Among Rural Physician Practices
    University of Minnesota Rural Health Research Center
     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).
  • Promotion and Protection of Rural Miner Health: Are the Resources in Place?
    West Virginia Rural Health Research Center
     Miners are exposed to various potentially harmful agents and dangerous work conditions, and may have difficulty accessing care in some rural settings. The study aims to 1) Locate and map mining communities in the US and rural safety net providers (RHCs, FQHCs and Critical Access Hospitals) in those communities; and 2) Identify environmental health competencies (specifically related to miner health) in rural primary care providers practicing in identified mining communities.
  • Quality of Obstetric Care and Perinatal Safety in Rural Hospitals
    University of Minnesota Rural Health Research Center
     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.
  • Racial and Rural Differences in Cervical Cancer Screening Practices
    Rural and Minority Health Research Center
     The purpose of this study is to describe and compare racial and rural differences in cervical cancer screening practices using data from the National Ambulatory Medical Care Survey. The findings will inform policies to increase appropriate access to quality cancer-preventive services.
  • Recent Rates of Black Lung Disease in Relation to Black Lung Treatment Centers
    West Virginia Rural Health Research Center
     Recent evidence indicates that black lung disease among coal miners, after a long period of declining incidence, has begun to increase. This increase is disturbing because safety standards, if adhered to faithfully, should be able to prevent most black lung disease from occurring. The reasons for the increase are not known, although evidence has revealed that the mines most likely to show increases are smaller coal mines located in some areas of central Appalachia, and there are concerns that safety regulations at these smaller mines may not be practiced with complete fidelity.
  • Rural E-Mental Health: Models That Enhance Access, Service Delivery, and Integration of Care
    Maine Rural Health Research Center
     E-mental health programs have been developed in rural areas as a promising approach to address the chronic challenges of low availability of mental health clinicians, long travel distances, and stigma surrounding mental health care. The literature has established the technical feasibility of these programs and interest remains strong in developing and implementing them more broadly. However, we lack a clear understanding of the viability of current rural e-mental health programs - both the business case for starting and sustaining them and the clinical case for what services and functions may be provided _ and what impact they have had. The current rural health environment is changing significantly and it is important to understand where and how e-mental health programs have been established and sustained, what impact they have had, and what value they may add to other initiatives. To address this gap we will conduct interviews with between 24-30 current rural e-mental health programs.
  • Rural H1N1 Experience
    West Virginia Rural Health Research Center
     This project aims to describe the rural H1N1 experience, including comparisons of rural vs. urban H1N1 vaccination rates, and describe rural H1N1 incidence, care patterns, and mortality. Additionally, through key stakeholder interviews, we will describe the rural needs in decisions relative to H1N1 vaccine distribution.
  • System Integration and Rural Provider Participation in Accountable Care Organizations (ACOs)
    RUPRI Center for Rural Health Policy Analysis
     This project will develop a national descriptive database of both rural providers and larger (often urban) health systems participating in Medicare ACOs and health system networks. Case studies of four ACOs will generate an awareness of decisions being made that affect configuration of services in rural places and provide suggestions for further research with representative samples of ACOs.
  • Use of Rural Health Clinics by Medicare Beneficiaries
    North Carolina Rural Health Research and Policy Analysis Center
     Determination of Medicare beneficiaries utilization of available RHCs and development of a descriptive profile of Medicare beneficiaries who utilize RHCs including both geographic and diagnostic elements and a comparison to Medicare beneficiaries who utilize FQHCs.

Projects Completed 2012 - (25)

  • Adolescent Alcohol Use in Rural Areas: What Are the Issues?
    Maine Rural Health Research Center
     This study will use the National Survey on Drug Use and Health (NSDUH) to examine the effect of developmental, individual, and environmental factors on adolescent alcohol use across the urban-rural continuum.
  • Agricultural Medicine Training for Rural America
    West Virginia Rural Health Research Center
     The purpose of the research is to identify the availability and characteristics of agricultural medicine training opportunities for health care professionals. Agricultural workers and their families face numerous threats to health and safety, and yet there is limited information on health care expertise in place to recognize and prevent threats, and to diagnosis and treat agriculturally-related injury and illness.
  • Analysis of State Dental Hygiene Practice Acts and Medicaid Policies for Children's Dental Care: Services Covered and Practitioners Reimbursed
    Rural and Minority Health Research Center
     The purpose of this qualitative analysis will be to obtain a clear picture of the degree to which (1) state SCHIP and Medicaid programs are implementing waivers, or other programs, to improve access to dental care for vulnerable populations including children and pregnant women; and (2) dental hygienists impact the dental safety net for rural America.
  • Analysis of the Effects of Federal Debt Reduction and Long Term Budget Adjustment on Rural Health Care Delivery
    RUPRI Center for Rural Health Policy Analysis
     The RUPRI Center for Rural Health Policy Analysis will examine suggested changes in Medicare and Medicaid as stated in proposals to reduce spending as part of achieving deficit reduction.
  • Assessing the Community Impact of the MMA
    RUPRI Center for Rural Health Policy Analysis
     This project will measure the community-level impacts of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and will provide feedback to policymakers regarding the impact of the MMA on its policy targets (providers and beneficiaries), in the context of rural places.
  • Cancer Hospitalizations in Rural-Urban Areas in Relation to Carcinogenic Discharges from Toxics Release Inventory Facilities
    West Virginia Rural Health Research Center
     The purpose of the research is to understand whether discharges of carcinogens from Toxics Release Inventory facilities are related to higher cancer hospitalization rates in rural and urban settings. Evidence for this association will have potential implications for improvements to environmental policy or policies for improved cancer detection and treatment in rural settings.
  • Childhood Asthma and Air Quality in Rural-Urban Areas
    West Virginia Rural Health Research Center
     This study will examine the prevalence of childhood asthma across urban and rural settings. We will examine how asthma may be related to measures of ambient air quality, as well as how asthma may be related to agricultural activity of different types, to proximity to metropolitan areas, and to measures of demographics and health care insurance.
  • Community and Financial Experience of Medicare Dependent Hospitals in Comparison to Other Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This research will investigate the community and financial experience of Medicare Dependent Hospitals (MDHs) in comparison with other rural hospitals. Analysis of the financial experience will include comparison of the long-term profitability of MDHs to other rural hospitals, estimation of the potential profitability consequences of eliminating the payment classification, and estimation of the potential consequences of maintaining the payment classification but failing to update the base year from which costs are trended forward.
  • Community College's Contributions to the Education of Allied Health Professionals in Rural Areas of the U.S.
    WWAMI Rural Health Research Center
     This study will identify rural-serving community colleges across the U.S. and their 5-year graduation trends for specific allied health professions, examine the spectrum of how rural allied health professions education currently is being allocated and delivered, and explore how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs.
  • Dental Sealant Utilization Among Rural and Urban Children
    Rural and Minority Health Research Center
     Dental sealants can prevent or reduce dental caries among children, but only about a third of children currently have sealants. This project will explore the dissemination of sealants among rural children, identifying characteristics of children and communities with low sealant use.
  • Dialysis Availability in Rural America
    Rural and Minority Health Research Center
     Working from Medicare Dialysis Compare files and the Standard Analysis File of the US Renal Data System, we will evaluate the current availability of dialysis services across rural America. We will examine general availability of services, service to population ratios, and patient outcome measures across levels of rurality.
  • Do Communities Make a Difference in Access? A National Study
    RUPRI Center for Rural Health Policy Analysis
     This project will examine the effect of community-level resources on an individual's access to healthcare, particularly whether urban and rural individuals' access to healthcare differs, given community differences.
  • Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries
    Upper Midwest Rural Health Research Center
     The purpose of this project is to: 1) determine how location of hospitals used for initial admissions by rural patients affects readmission rates; 2) assess how the use of swing beds affects rural patients' readmissions; and 3) examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.
  • Environmental Workforce Characteristics in the Rural Public Health Sector
    West Virginia Rural Health Research Center
     Environmental risks to rural populations are understudied relative to urban areas despite increasing recognition that rural populations are potentially exposed to these risks from agricultural, mining, industrial or other sources. This project analyzes the environmental workforce characteristics of the rural public health sector to inform policy relative to coordination of rural environmental health services.
  • Examining the Applicability of the AHRQ's Inpatient Quality Indicators to Rural Hospitals and the Implications of the Relationship Between the Indicators and Financial Measures for Medicare Payment Policies
    RUPRI Center for Rural Health Policy Analysis
     This study will investigate how the Agency for Healthcare Research and Quality's inpatient quality indicators can be applied to rural hospitals and will explore the application of those indicators in answering relevant policy questions.
  • Factors Associated with Rural-Residing Registered Nurses' Choices to Work in Urban Locations and Larger Rural Cities
    WWAMI Rural Health Research Center
     While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study will explore factors that may be associated with RNs' decisions to commute away from their rural areas of residence to work in less rural areas.
  • How Would Health Insurance Exchanges Work in Rural America?
    RUPRI Center for Rural Health Policy Analysis
     The passage of the Patient Protection and Affordable Care Act (PPACA) of 2010 has created the potential for states to create Health Insurance Exchanges (HIEs). This project will assess the potential of these plans to meet the needs of rural residents. Empirical work will establish baseline measures of choices available to rural residents and literature reviews will yield prospective analysis of how exchanges could operate to benefit rural residents.
  • Impact of Changing Medicare Advantage Landscape on Rural Enrollees
    RUPRI Center for Rural Health Policy Analysis
     This project will explore three important questions related to Medicare Advantage (MA) plans. What is the impact of recent changes in the MA market on rural Medicare beneficiaries, providers and communities? In particular, how have recent changes in markets and payment policy led to changes in the choices of plans facing beneficiaries, and the quality of those plans (as defined by the coverage offered by the plans)? Finally, what is the likely impact of changes made in Medicare Advantage payment rates passed in the Patient Protection Affordable Care Act of 2010 (PPACA) on rural enrollment in MA plans in 2011 and beyond?
  • Impact of Hospitalists on Inpatient and Primary Care in Rural Communities
    Upper Midwest Rural Health Research Center
     This project will analyze primary data from a survey of rural hospitals about their use of hospitalists along with several sources of secondary data to examine why and how hospitalists are being used in rural hospitals and the impact of their use.
  • Medicare Advantage and Medicare Prescription Drug Plans in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
     The rapid growth in Medicare Advantage (MA) plans, as well as evidence that MA plans are being paid significantly more than traditional fee-for-service Medicare, has created the impetus for reform of the MA program, especially reductions in payment to MA plans. This project will continue the RUPRI Center's work in tracking and analyzing the trends in MA plan enrollment in rural areas, including changes in types of plans.
  • Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
     Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • Rural Border Chartbook
    Rural and Minority Health Research Center
     This chartbook is the first study to examine the health status of residents living in U.S. counties that border Mexico as a single region rather than as four distinct state areas. We examined select health status indicators among residents of the four border states, Arizona, California, New Mexico, and Texas, comparing indicators by ethnicity (Hispanic vs. non-Hispanic), rurality (rural vs. urban), and proximity to border (border vs. non-border).
  • Rural HIV: Estimated Prevalence of Persons Living with HIV/AIDS (PLWHA) in Rural America
    Rural and Minority Health Research Center
     This study will describe the prevalence of HIV/AIDS by county, or when county-level data are not available, by sub-state region or state, together with information on the availability of health services, including Ryan White Clinics. A sub-study will develop models identifying rural counties at highest risk for increases in the population of PLWHA.
  • Use of Recommended Radiation Therapy in the Rural U.S.
    WWAMI Rural Health Research Center
     This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy, and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service locations and cancer support program development.
  • Water Quality Issues in Rural-Urban Areas: The Good (Fluoridation), the Bad (Chemical Pollutants) and the Ugly (Health Consequences)
    West Virginia Rural Health Research Center
     This study will investigate the availability of fluoridated water across urban-rural settings, and relate measures of fluoride availability to survey measures of dental health. The study will also investigate rural population exposure to chemical pollutants in surface water by measuring volumes and types of discharges from EPA-recognized water pollution sources, including sources located in rural areas and in upstream urban areas, and relating these measures to population health outcomes.

Projects Completed 2011 - (13)

  • Assessing the Rural Relevance of Hospital Outpatient Quality Measures
    Upper Midwest Rural Health Research Center
     The purpose of this project is to: 1) determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and 2) to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures.
  • Consequences of Rural Uninsurance
    Maine Rural Health Research Center
     This study will assess whether uninsured rural residents have different levels of access to care than their urban counterparts, and the factors associated with any differences (including sub-analyses for individuals with identified chronic conditions). In doing so, it will provide policymakers with critical information for improving rural health systems.
  • Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status
    RUPRI Center for Rural Health Policy Analysis
     This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics.
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    Maine Rural Health Research Center
     This project aims to examine rural-urban differences in the proportion of employed adults with private health insurance who experience an employment transition (defined as a change in jobs or hours worked, or no job) and the impact of that change on health insurance status.
  • Implementation of Health Reform Legislation in Rural America
    RUPRI Center for Rural Health Policy Analysis
     The RUPRI Center has developed particular expertise, including the use of simulations, in how changes in public policy that are now part of the Patient Protection and Affordable Care Act (PPACA) affect the rural health care providers and communities. We have published policy briefs and papers related to Medicare Advantage and Part D plans, effects of insurance reform on the percentage of uninsured in rural areas, and effects of changes in physician payment on projected total income of rural primary care physicians. The purpose of this project is to take advantage of RUPRI's capacity for further simulation analysis and empirically based analyses of changes occurring as a result of the PPACA.
  • Importance of Surgery to Rural Hospital Financial Condition and Market Share
    North Carolina Rural Health Research and Policy Analysis Center
     This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored.
  • Mini-Studies to Inform Health Reform Efforts
    North Carolina Rural Health Research and Policy Analysis Center
     Rural health care systems are far more vulnerable to changes in federal health care policy than are those in urban areas. The purpose of this project is to conduct rapid turnaround mini-studies that will be essential to maintain an effective rural voice in both the ongoing adjustments to current policies and the development of new policies.
  • Patient-Centered Medical Home: A Model for Rural Physician Practices and Communities?
    RUPRI Center for Rural Health Policy Analysis
     Rural practices will need to meet the expectations inherent in the patient-centered medical home (PCMH) model or lose any payment advantage that comes with participating as a PCMH. The goal of this project is to assess rural readiness to adopt services seen as part of a PCMH.
  • Premature Mortality: Potential Role of Health Insurance in Moderating Race/Ethnicity and Rural/Urban Disparities
    Rural and Minority Health Research Center
     This project will explore the degree to which lack of health insurance may contribute to high mortality rates among rural minority men and women aged 45-64.
  • Rapid Research Response on Health Care Reform Issues
    Rural and Minority Health Research Center
     The focus of the SC Rural Health Research Center is on investigating persistent inequities in health status within the population of the rural US, with an emphasis on inequities stemming from socioeconomic status, race and ethnicity, and access to healthcare services. Building on existing expertise, the SC Rural Health Research Center will create an internal process that allows for rapid turnaround of analysis on race/ethnicity and rural-based health disparity inquiries from policymakers.
  • Rural Food Security, Food Availability, and Health Outcomes
    West Virginia Rural Health Research Center
     This project will examine the characteristics of food security and food availability across the rural-urban continuum. The study will test the hypotheses that food insecurity will differ significantly between rural and urban counties in the U.S. with rural areas experiencing more adverse conditions; and that there will be a significant relationship between food insecurity, food availability and selected adverse health outcomes in non-metropolitan counties in the U.S.
  • Rural Socioeconomic Risk and Resiliency Inventory and Associated Health Outcomes
    West Virginia Rural Health Research Center
     This study will create a national inventory of social and economic risks and resiliencies for every county in the nation, and relate those risks to health outcome data. The study will test whether rural areas with fewer risks and greater resiliencies are related to better health outcomes.
  • Transitions in Care for Rural Medicare Beneficiaries with Diabetes
    Rural and Minority Health Research Center
     Hospital readmission rates among persons with diabetes, as well as absolute admission rates, may be used to study health disparities among rural and minority populations. This project will use data from the Medicare Chronic Conditions Data Warehouse to explore residence- and race-based disparities in diabetes admission rates, effective transitions to outpatient care, and re-admission rates, to help guide rural policy-makers and healthcare providers.

Projects Completed 2010 - (27)

  • Access to Mental Health Services and Family Burden of Rural Children with Significant Mental Health Problems
    Maine Rural Health Research Center
     The needs of rural children with serious emotional disturbance and the burden these needs place on their families are intertwined and may place these rural children and their families at "double jeopardy" of having their mental health and other needs go unmet. Using the National Survey of Children with Special Health Care Needs and information on community characteristics from the Area Resource File we will examine the factors associated with whether children and their families have their needs meet across the rural continuum.
  • Analysis Related to Health Care Reform Issues
    RUPRI Center for Rural Health Policy Analysis
     The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.
  • Characteristics and Educational Needs of Rural Acute Care Hospital Boards of Directors
    Rural and Minority Health Research Center
     Rural hospital boards face challenges in an environment of increasing legal and financial complexity. This study will characterize rural hospital Board of Directors' backgrounds, perceptions of board function, and perceived need of training and development.
  • Diet and Physical Activity as Risk Factors for Childhood Obesity: An Urban and Rural Comparison
    Rural and Minority Health Research Center
     Obesity is more prevalent among rural than urban children, despite higher reported physical activity levels. This project will explore diet among rural children to explore how diet and physical activity may differ for rural children, particularly minority children.
  • Exploring the Black Box: Design and Implementation Issues of P4P for Rural Physicians
    NORC Walsh Center for Rural Health Analysis
     Information about how pay-for-performance (P4P) payment systems work in ambulatory care settings, and in particular, how rural physicians might be affected, is scarce. This study employs qualitative research methods to explore the design and implementation of P4P systems and to investigate effects of P4P on rural physicians in a variety of settings.
  • Factors Associated with Provision of Ambulance Services by Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This two-part study will use existing national data to determine how many hospitals have regularly offered ambulance services as well as how many have recently acquired or discontinued such services. In-depth interviews with selected rural hospital administrators will explore the factors related to a hospital's decision regarding these important health care services.
  • Future of Family Medicine and Implications for Primary Care Physician Supply
    WWAMI Rural Health Research Center
     This project describes recent trends in medical student interest and national match rates in primary care and family medicine, the effect of increasing proportions of female physicians on rural practice patterns, and implications of declining interest in primary care on health and the health workforce.
  • Health Reform-Rapid Response
    Maine Rural Health Research Center
     This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health.
  • Key Environmental Competencies for Rural Primary Care Providers
    West Virginia Rural Health Research Center
     This study will develop, from existing single discipline standards, a competency guide that will address competencies that are essential for providing environmentally conscious care. The study will then systematically evaluate content validity, completeness and clarity of the competencies.
  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    Maine Rural Health Research Center
     This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.
  • Medicaid and SCHIP Participation in Rural and Urban Areas
    North Carolina Rural Health Research and Policy Analysis Center
     This project examines state-level Medicaid and SCHIP participation rates for children in rural and urban areas. It also updates the State Profiles of Medicaid and SCHIP in Rural and Urban Areas web site and documents changes in program characteristics relevant to rural areas over the past few years.
  • National Study of Rural-Urban Differences in Use of Home Oxygen for Chronic Obstructive Lung Disease: Are Rural Medicare Beneficiaries Disadvantaged?
    WWAMI Rural Health Research Center
     To understand disparities in care among rural and urban Medicare beneficiaries, data from Medicare's Durable Medical Equipment (DME) files were used to assess rural/urban variation in the home use of supplemental oxygen.
  • Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project
    Upper Midwest Rural Health Research Center
     The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the CMS/premier Inc. Hospital Quality Incentive Demonstration project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.
  • Organizational Impact of the Deployment of Ambulance Quality Feedback Systems (QFS) on Rural Volunteer EMS Agencies
  • Outpatient Payment Policy Under Medicare: Recent Policy Developments from the Rural Perspective
    NORC Walsh Center for Rural Health Analysis
     This study was designed to examine outpatient payment options for rural hospitals, the advantages and disadvantages of each, and their potential impact on hospital revenue and rural access to health services.
  • Policy Analyses of Rural Issues Related to Health Care Reform
    WWAMI Rural Health Research Center
     Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation.
  • Potentially Preventable Rural Hospital Readmissions
    Upper Midwest Rural Health Research Center
     This project focuses on the analysis of potentially preventable rural hospital readmissions, a potential quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and MedPAR inpatient claims data from 9 geographically representative states, this study will explore the relationship between readmission rates and geographic regions, categories of rural hospitals, discharge destination, clinical diagnoses and patient attributes.
  • Provision of Specialty Mental Health Services by Rural Health Clinics
    Maine Rural Health Research Center
     This project will document the extent to which Rural Health Clinics (RHCs) are employing mental health staff nationally, understand why more RHCs are not employing specialty mental health staff, and analyze the barriers to and opportunities for the delivery of mental health services by RHCs. The results will identify opportunities and interventions to encourage RHCs to offer this important service.
  • Rural Emergency Department Preparedness for Pediatric Care
    North Carolina Rural Health Research and Policy Analysis Center
     While many large cities have dedicated children's hospitals or facilities with pediatric emergency departments, many general hospitals do not have either the equipment necessary to provide optimal pediatric emergency care nor staff that is specifically trained in the care of pediatric emergencies. This project will use secondary data analysis and semi-structured interviews with emergency room directors in order to address how the availability of pediatric services, expertise and supplies in U.S. emergency departments differs between urban and rural facilities, and to determine which factors impede the availability of pediatric services, expertise, and supplies in rural emergency departments.
  • Rural Family Medicine Residency Training Survey: Follow-up to 2000 Survey
    WWAMI Rural Health Research Center
     National survey of family medicine residency training programs to quantify the amount and location of rural training. The survey also identified training that occurs in federally-qualified health centers.
  • Rural Implications of Health Care Reform: Issues Related to Quality of Care, Health Information Technology and Care Coordination
    Upper Midwest Rural Health Research Center
     The purpose of this project is to provide support to the Office of Rural Health Policy on rural health care reform issues.
  • Rural Medicaid and CHIP Mini-Studies
    North Carolina Rural Health Research and Policy Analysis Center
     Medicaid and the Children's Health Insurance Program (CHIP) are important sources of health insurance coverage in rural communities and it is likely that the importance of Medicaid/CHIP will grow as job-based health insurance coverage continues to erode and policymakers pursue the goal of expanding coverage. This project is composed of three mini-studies that: 1) Update our State Profiles of Medicaid and CHIP in Rural and Urban Areas website, adding information on Medicaid Disproportionate Share Hospital (DSH) payments to rural hospitals; 2) Analyze trends in Medicaid/CHIP enrollment in rural and urban areas over the past two to three years; and 3) Explore the future role of CHIP given increasing levels of childhood poverty.
  • Rural-urban Comparison of Hospital Financial Performance by Medicare Payment Classification
    North Carolina Rural Health Research and Policy Analysis Center
     This project will compare the financial performance of rural and urban short term general hospitals by Medicare payment classifications (PPS only, Medicare dependent hospitals, sole community hospitals, rural referral centers, and critical access hospitals).
  • Safety Net Activities of Independent Rural Health Clinics
    Maine Rural Health Research Center
     This national study will investigate and describe the safety net role of independent Rural Health Clinics (RHC). It will further examine the market effect of Federally Qualified Health Centers (FQHC) on the safety net role of independent RHCs at the county level.
  • Toxics Release Inventory Sites and Population Health across Rural and Urban Areas
    West Virginia Rural Health Research Center
     Previous research has identified higher mortality rates in rural areas in association with exposure to pollution sources. This study conducts mortality outcome analyses specific to discharges from Toxics Release Inventory sites across the spectrum of rural to urban settings.
  • Use of Emergency Departments and Inpatient Care for Conditions Related to Poor Oral Health Care
    NORC Walsh Center for Rural Health Analysis
     This study combines patient-level data from emergency departments and inpatient hospitals from selected states with data on dental HPSA designation, Medicaid dental coverage, and area population characteristics to document the extent to which ED and inpatient settings are used to treat problems related to poor oral health care, the charges for such care, and variations in the use of such services by characteristics of the patient and the area.
  • Volunteerism in Rural EMS
    North Carolina Rural Health Research and Policy Analysis Center
     Semi-structured telephone interviews will be used to examine issues facing rural emergency medical services (EMS) that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS.

Projects Completed 2009 - (19)

  • Addressing Suicide Potential and Prevention in Rural and Frontier Areas and Development of a Suicide-Prevention Training Protocol
    WICHE Center for Rural Mental Health Research
     Depression and suicide are especially relevant today in rural areas. This project will determine rural high-risk suicide areas, and develop a suicide prevention training protocol for primary care providers in these rural areas.
  • Availability, Characteristics, and Role of Detoxification Services in Rural Areas
    Maine Rural Health Research Center
     This project will produce a comprehensive description of the distribution and characteristics of detoxification (detox) services across rural areas including a discussion of access issues, the role of detox services within local systems of care, barriers to the delivery of detox services by rural providers, and policy and regulatory incentives needed to encourage the development of rural detox services. Products will include a working paper and related journal articles addressing these topics.
  • Chartbook: Racial and Ethnic Disparities in the Health of Rural Populations
    Rural and Minority Health Research Center
     This study will provide a cross-sectional, descriptive study that uses large, nationally representative data sets to illustrate health and health care among rural populations. The data sets to be used include the 2005 Behavioral Risk Factor Surveillance Survey, the 2005 National Health Interview Survey, and the Area Resource File.
  • Critical Access Hospital Readiness for CMS Value-Based Purchasing
    Upper Midwest Rural Health Research Center
     The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
  • Descriptive Analysis of the Health Status of a National Asbestos-Related Cohort
    FORHP-funded Individual Grantees
     A collaborative study to establish a more comprehensive understanding of the health status and health service needs of persons exposed to Libby asbestos is being conducted by nurse researchers at Montana State University College of Nursing and healthcare providers at the Center for Asbestos Related Disease in Libby, Montana. Results of the descriptive study will provide healthcare providers and policy makers a better understanding of the health effects and healthcare needs of exposed persons.
  • Developing Quality Measures and Communication Strategies for Rural Patient Transfers
    Upper Midwest Rural Health Research Center
     The purpose of this project is to quantify the complexity of the coordination of patient care in rural health care systems and to expand our work on developing quality measures for rural patients whose care is transferred between providers.
  • Effect of Safety Net Providers on Ambulatory Care Sensitive Hospitalization Rates in Rural Counties
    Rural and Minority Health Research Center
     This project will determine if the presence of a community health center or rural health clinic in a county reduces ambulatory care sensitive hospitalizations for children, working age adults, and older adults.
  • Evaluation of an Outpatient Modified Paper Prescription Form
    FORHP-funded Individual Grantees
     This project will evaluate a modified paper prescription form that may be implemented in rural primary care settings cheaply and quickly with the goal of outpatient prescription error reduction.
  • Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
     This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
  • Health Information Technology and Quality in Rural Hospitals
    Upper Midwest Rural Health Research Center
     The purpose of this project is to: 1) examine the adoption of health information technology (HIT) among rural hospitals and identify hospital and market characteristics that facilitate or impede HIT diffusion; 2) measure the effect of HIT on clinical quality in rural hospitals; and 3) identify technologies that may be promoted to improve quality of care in rural areas.
  • Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
    Upper Midwest Rural Health Research Center
     This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.
  • Improvement in the Quality of Care for Acute Myocardial Infarction (AMI): Have Rural Hospitals Followed National Trends?
    WWAMI Rural Health Research Center
     This project will determine whether overall improvements in the quality of care for AMI among Medicare patients, as measured by adherence to guidelines, have taken place in both rural and urban hospital settings.
  • Measuring Quality Performance in CAHs
    University of Minnesota Rural Health Research Center
     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.
  • Mental Health Services in Rural Jails
    Maine Rural Health Research Center
     This project will investigate how rural jails manage the mental health and substance abuse problems of their inmates. Through analysis of the National Survey of Jails and semi-structured interviews with state-level and county-level/local officials, barriers to providing such services will be assessed and promising practices will be documented.
  • Patient Assessments and Quality of Care in Rural Hospitals
    Upper Midwest Rural Health Research Center
     This study will 1)analyze the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care; and 2) assess whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
  • Preventive Care: Supports and Barriers to Best Practices for a National Sample of Rural Medicare Beneficiaries
    FORHP-funded Individual Grantees
     Preventive health screenings are generally underutilized in the United States by the elderly, especially those residing in rural areas. Using an integrative approach, including secondary data analysis of a large nationally representative dataset (Medicare Current Beneficiary Survey) and complementary qualitative interviews with rural elders, the proposed research study aims for a more complete understanding of the factors influencing use of these practices.
  • Rural Environmental Hazards Inventory and Associated Health Outcomes
    West Virginia Rural Health Research Center
     This study will create a national inventory of potential environmental hazards for rural populations. Population health outcomes such as CDC mortality statistics will be examined to determine if poor health outcomes are related to greater exposures to potential hazards.
  • Stay or Leave: Evidence from a Cohort of Young Rural Physicians
    NORC Walsh Center for Rural Health Analysis
     This project aims to improve understanding of the dynamics of physician practice location decision making by examining and analyzing changes in practice locations for a sample of rural physicians.
  • Turnover Costs in Rural Emergency Medical Services
    FORHP-funded Individual Grantees
     Costs associated with providing Emergency Medical Services (EMS) transportation in rural areas are much higher than in urban communities. This study will measure the annual rate of turnover among rural EMS systems, identify costs associated with turnover, and create a budgeting tool for calculating the costs of turnover.

Projects Completed 2008 - (32)

  • Advantages and Disadvantages of Hospital-Based Emergency Medical Services in Rural Areas
    NORC Walsh Center for Rural Health Analysis
     This project sought to clarify issues surrounding hospital decisions to acquire and maintain ownership of community ambulance services.
  • Assessing the Impact of Transfer of Pharmacy Services for Dual Eligible Beneficiaries to Medicare Part D
    North Carolina Rural Health Research and Policy Analysis Center
     This project will focus on the implementation of the new Part D benefit for those dually eligible for Medicare and Medicaid. The study will examine the impact on rural dual eligibles and their local pharmacies of the transfer to Part D coverage. The project is a joint undertaking with the RUPRI Center, taking advantage of unique data sets held at each center, the analytical and programming resources of both centers, and the ability to conduct qualitative analysis in multiple states efficiently.
  • Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings
    WICHE Center for Rural Mental Health Research
     This study will use nationally representative data to assess how mental health (MH) services are paid for in rural areas and determine differences in payment sources between rural and urban areas. If payment sources significantly vary in rural vs. urban settings, then policies that are aimed specifically at sources of funding may have a differential impact on subsequent access to and utilization of care and point to the need for policies that are specifically targeted to rural communities.
  • Augmenting Efforts for a Tool to Predict Post-Event Rural Population Surge
    NORC Walsh Center for Rural Health Analysis
     The Walsh Center is developing a tool to predict post-event rural population surge following public health emergencies, with funding originating from CDC. To enhance predictive accuracy of this tool and to more generally inform rural preparedness efforts, this project will gather information using key informant and survey methodologies.
  • Changes in U.S. Rural Perinatal and Infant Health Care During the Last Decade
    WWAMI Rural Health Research Center
     This study examined changes in rates of adverse birth outcomes and prenatal care among rural Americans of different racial and ethnic groups during two time periods. The study used national data from the Linked Birth Death Data Sets to assess differences in low birth weight, neonatal death, post neonatal mortality and inadequate prenatal care.
  • Chartbook: Oral Health and Unmet Needs for Dental Care Among Children
    Rural and Minority Health Research Center
     This study will characterize oral health status, dental care utilization, and unmet dental care needs among U.S. children by urban/rural residence. It will provide a descriptive analysis, using cross-sectional data from the 2003 National Survey of Children's Health.
  • Critical Access Hospital Conversion Tracking
    North Carolina Rural Health Research and Policy Analysis Center
     Information regarding new CAH conversions will be gathered from Flex coordinators and CMS, and added to the CAH management information dataset that is housed at UNC. Flex coordinators will also be queried regarding topics of interest to the coordinators, the monitoring team, and the federal Office of Rural Health Policy.
  • Developing a Financial Performance Measurement System for Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.
  • Diabetes and Obesity: Is there a Rural-Urban Difference in the Burden?
    FORHP-funded Individual Grantees
     Persons with diabetes are more likely to be obese, increasing the economic burden of diabetes related care. Purpose of this study is to examine if being overweight and obese places additional economic burden and if there is a rural-urban difference in this regard. It will help understand the health and economic consequences of diabetes and obesity epidemic on people's health.
  • Differences In Antipsychotic Medication Prescribing Patterns Between Rural And Urban Prescribers
    WICHE Center for Rural Mental Health Research
     Second-generation antipsychotics have become the treatment of choice for persons with schizophrenia and other serious mental illnesses. Compared to first generation antipsychotics, many second generation medications reduce symptoms with fewer problematic side-effects and related major health problems. However, one aspect that has seen little empirical attention is how longitudinal trends, benefits, and costs may differ between urban and rural areas.
  • Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers
    WICHE Center for Rural Mental Health Research
     This is an investigation of the extent to which psychotropic medication is prescribed to youth (17 and under) by primary care physicians, psychiatrists, or other prescribers in rural versus urban areas. It will also look at the particular types of medications being prescribed by age, sex, and other demographic variables.
  • Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals
    RUPRI Center for Rural Health Policy Analysis
     This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style.
  • Financial Impact of Mental Health Services on Rural Individuals and Families
    Maine Rural Health Research Center
     This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed.
  • Financing Rural Public Health Activities in Chronic Disease Prevention and Health Promotion
    NORC Walsh Center for Rural Health Analysis
     This project describes the federal-state funding streams for selected local public health activities in the area of chronic disease prevention and health promotion, and assesses potential barriers to program implementation in less populated, local areas of a state.
  • Impact of CAH Conversion on Hospital Costs and Mix of Services
    NORC Walsh Center for Rural Health Analysis
     This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
  • Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
     This project focuses on the analysis of Medicare Advantage (MA) plan choices for rural beneficiaries and what the concentration of plan choices in rural areas may mean in the context of how rural beneficiaries are making their choices. Using measures of concentration from the economics literature, this project will explore the relationship between market concentration in MA plans and the generosity of MA plans, and how it varies by the location of residence of Medicare beneficiaries.
  • Impact of Mental and Emotional Stress on Rural Employment Patterns
    Maine Rural Health Research Center
     This study will use the National Longitudinal Survey of Youth to investigate how mental health symptoms affect employment patterns, and the extent to which these effects differ by rural and urban residence.
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    Upper Midwest Rural Health Research Center
     The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.
  • Long Term Trends in Characteristics of the Rural Nurse Workforce: A National Health Workforce Study
    WWAMI Rural Health Research Center
     This national study characterizes changes in the demographic, education and practice characteristics of registered nurses (RNs) in rural and urban areas from 1980 to 2004. This study provides important information for projecting future trends in rural RN supply.
  • Medicare Modernization Act: Reality for Rural Beneficiaries and Providers
    RUPRI Center for Rural Health Policy Analysis
     This project will focus on two areas of new activity in Medicare beneficiary participation in Medicare Advantage (MA) plans and prescription drug plans and implementation of the new Part D benefit through private health plans. We will describe enrollment into specific types of MA prescription drug plans and other prescription drug plans, and analyze differences across regions, states, and types of counties. We will also examine the impact of the transfer to Part D coverage on rural dual eligibles and their local pharmacies.
  • Move Toward Clinical Doctorates in the Allied Health Professions: Implications for Rural Areas
    North Carolina Rural Health Research and Policy Analysis Center
     Allied health occupations play a major role in health care delivery and comprise a significant proportion of the health care workforce in the United States. Researchers have found empirical evidence of allied health shortages in many states. Given the longstanding history of health professional shortages facing rural areas, there are concerns that the existing and impending shortages in allied health professions may be particularly acute in rural areas. This study will synthesize information on allied health professions, such as credentialing requirements and wage comparisons, with telephone and in-person interviews of rural health care employers, educators, and practitioners in order to assess the degree of alignment between community needs for allied health care services and existing and proposed certification and educational training for these health care providers.
  • National Changes in Physician Supply
    WWAMI Rural Health Research Center
     This project describes the supply of allopathic and osteopathic physicians in rural and urban areas of the US. Study results will provide a current picture of rural physician supply and its variation by state and by region.
  • National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas
    Maine Rural Health Research Center
     This project will research the prevalence of the abuse of legal and illegal substances across rural populations and geographic areas, including the extent to which rural individuals are receiving treatment for their substance abuse and barriers to the receipt of treatment.
  • Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
    North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
     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.
  • Quality Improvement Organizations' Contributions to Rural Hospital Performance
    NORC Walsh Center for Rural Health Analysis
     This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.
  • Rural Dimensions of Medicare Payment Policies
    NORC Walsh Center for Rural Health Analysis
     This project examines major Medicare fee-for-service payment policies from the rural perspective.
  • Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
     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.
  • Rural Provider Participation in a Statewide Health Information Project
    RUPRI Center for Rural Health Policy Analysis
     Nebraska has recently constructed a communication infrastructure that links all the hospitals in the state with broadband, high-speed systems (using T1 lines to the Critical Access Hospitals). That infrastructure is considered to be the backbone for a statewide health information network being designed by a coalition of organizations. The aim of this project is to delineate reasons for rural providers to participate in the coalition by assessing the associated costs and benefits.
  • Rural-Urban Differences in Access to Children's Mental Health Services
    Maine Rural Health Research Center
     This study uses data from the Urban Institute's National Survey of America's Families to examine and compare the use of mental health services by rural and urban children, age 6 to 17, relative to their need for mental health care, family income, and insurance status.
  • Rural-Urban Differences In The Use, Type, And Quality Of Depression Treatment
    WICHE Center for Rural Mental Health Research
     As access to evidence-based treatment for affective disorders (major depressive disorder, dysthymia, and bipolar disorder) improves in urban areas, it is critical to monitor rural-urban differences in the use and quality of treatment over time to identify and address rural disparities, especially for vulnerable populations such as the elderly and ethnic minorities.
  • Targeted Rural Health Primary Care Research in HIT Adoption and Scope of Use
    FORHP-funded Individual Grantees
     This project will conduct a national mail survey of 5,200 primary care practices in all 50 states and the District of Columbia to assess use of various forms of Health Information Technology (HIT) as well as physician-perceived barriers to and facilitators of HIT adoption. It will provide current, relevant data for designing targeted policies to promote expansion of HIT in diverse rural settings.
  • Using Program Logic Models to Monitor the Performance of State Flex Programs
    Maine Rural Health Research Center
     This project will use a program logic model approach to track state program activities and develop tools that allow states to systematically monitor and manage their accomplishments in the context of Flex Program goals.

Projects Completed 2007 - (28)

  • Assessment of Small Rural Hospital Activities to Report Medication Errors
    RUPRI Center for Rural Health Policy Analysis
     This research will determine how small rural hospitals have responded to the environmental pressure to improve patient safety and quality by implementing safe medication practices and by reporting and monitoring medication errors.
  • Beyond Simple Ranking: Identifying and Empirically Testing Alternative Approaches for Recognizing Quality in Rural Hospitals
    Upper Midwest Rural Health Research Center
     The purpose of this project is to explore several alternative methods for assessing the relative quality of hospitals using data from the Hospital Quality Incentive Demonstration Project and Hospital Compare.
  • Breast, Cervical, Colorectal, and Prostate Cancer Screening in Rural America: Does Proximity to a Metropolitan Area Matter?
    WWAMI Rural Health Research Center
     The study compared cancer screening rates among various levels of rural versus urban Behavioral Risk Factor Surveillance System respondents and among white respondents versus those from racial/ethnic minority groups.
  • Burden of Asthma Among Rural Residents: A National Study
    WWAMI Rural Health Research Center
     This study uses data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the prevalence of and trends in asthma among rural residents by type of geographic location and by key risk factors.
  • Chartbook: Obesity in Urban and Rural Children
    Rural and Minority Health Research Center
     By providing a descriptive analysis of the disparities of childhood obesity by residence, socioeconomic status and race/ethnicity, the study will offer important information about the needs of children and adolescents living in rural areas and from families of low socioeconomic status.
  • Describing Geographic Access to Physicians in Rural America Using Statistical Applications in GIS
    North Carolina Rural Health Research and Policy Analysis Center
     This study will use a geographically weighted regression to assess the influence of distance and travel time on the distribution of physicians in rural America. The ultimate goal of the study will be to improve our measures of access by identifying the extent to which border resources can be considered in indices of access.
  • Developing and Using a Classification Schema to Identify Sentinel Communities in the U.S.
    RUPRI Center for Rural Health Policy Analysis
     This project will enable rural researchers to track the effect of current policies on rural communities, anticipate the effect of proposed policies, and demonstrate policy effects that link one sector to another.
  • Diabetes Burden and the Lack of Preventive Care in the Rural United States
    FORHP-funded Individual Grantees
     The project is designed to determine if there are disparities in diabetes care provided to persons with diabetes residing in rural areas as compared to those in urban areas. Additionally, the project will examine diabetes related health care resource utilization with implications for improving care and reducing the economic burden.
  • Hospitalizations of Rural Children for Ambulatory Care Sensitive Conditions
    Upper Midwest Rural Health Research Center
     This project uses state inpatient discharge data from six states, data from the Area Resource File and the AHRQ Pediatric Quality Indicators to examine Ambulatory Care Sensitive Condition admission rates for rural children.
  • Investments in Health Information Technology by Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
     This study involved a national survey of rural hospitals conducted in late spring 2006 to gather data about readiness to adopt health IT, current use of different technologies, perceptions about the benefits and barriers to health IT adoption, future implementation plans, use of Federal programs designed to facilitate IT adoption, and interest in various health IT policy options.
  • Locating Community Pharmacies (Independent and Chain) in Rural America
    RUPRI Center for Rural Health Policy Analysis
     A comprehensive database of all rural U.S. pharmacies including pharmacy name, pharmacy type (chain or independent), town, ZIP code, county, state, RUCA code, and Federal Information Processing Standards will be developed. The databases will be usable in most widely used statistics and geographic information systems software packages.
  • National Study of Rural Medicaid Disease Management
    FORHP-funded Individual Grantees
     This project will identify those states with Medicaid disease management (DM) programs that serve clients in rural areas; analyze the characteristics of the rural DM programs, and identify benefits, challenges and issues for Medicaid programs providing DM services in rural areas.
  • Nationwide Analysis of New Entrants into Medicare+Choice Demonstrations
    RUPRI Center for Rural Health Policy Analysis
     This project will examine the effects of recent changes in the Medicare+Choice program on enrollment in rural areas and on activities of rural-based health plans.
  • Occupational Mix Differences Across PPS Hospitals: Analysis of Hospital Occupation Mix Survey Data and Implications for Rural Hospital Payments
    North Carolina Rural Health Research and Policy Analysis Center
     This study addresses the occupation-mix adjustment that has recently been added to the computation of the area wage index used to adjust Medicare prospective rates for all institutional healthcare providers. The study will review the policy objectives as well as the mechanics of the adjustment, and then analyze the data from the most recent occupation-mix survey to obtain a better understanding of occupation mix differences across labor markets and hospital types.
  • Pay-for-Performance and Quality Improvement in Rural Hospitals
    Upper Midwest Rural Health Research Center
     This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.
  • Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals
    NORC Walsh Center for Rural Health Analysis
     The purpose of this project is to examine: (1) the extent to which elimination of Medicare Bad Debt payments will reduce reimbursement to rural prospective payment system (PPS) hospitals and (2) how rural hospitals would respond to this reduction in reimbursement.
  • Role of English Proficiency and Area of Residence in the Use of Adult Preventive Health Services Among Latino Subgroups
    Rural and Minority Health Research Center
     This project will examine whether and how language and residence influence the utilization of preventive health services by Latino adults.
  • Role of Inpatient Psychiatric Units in Small Rural Hospitals and Rural Mental Health Systems
    Maine Rural Health Research Center
     This is a descriptive, exploratory study which will investigate the role of the small rural hospital Inpatient Psychiatric Units from the perspectives of both the rural hospital, in terms of scope of services and revenue enhancement, and the regional mental health system, meeting the needs of outpatient mental health and primary care providers, law enforcement, and human services.
  • Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
    Upper Midwest Rural Health Research Center
     This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
    Upper Midwest Rural Health Research Center
     This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs' role as safety net providers.
  • Rural Emergency Medical Services: Workforce and Medical Direction
    North Carolina Rural Health Research and Policy Analysis Center
     This two year study will examine the status of medical direction for rural EMS systems and the nature of the challenges and impediments to obtaining adequate medical direction in rural areas across the country. In addition, the study will address issues surrounding the recruitment and retention of paid and volunteer staff for rural EMS systems.
  • Rural Hospital Participation in the 340B Drug Discount Program
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
     The 340B drug discount program enables certain types of safety net organizations to obtain deeply discounted medications, at prices below the 'best price' typically offered to Medicaid agencies. This study used telephone interviews and mail surveys to explore the experiences that rural hospitals have had in seeking 340B eligibility status.
  • Rural-Urban Differences in Nursing Home Admissions, Service Usage and Discharge
    FORHP-funded Individual Grantees
     An in-depth examination of rural-urban differences in recent nursing home first admissions, their service utilization patterns, and their discharge status over 12 months will be conducted to determine whether persons from rural areas admitted to rural nursing homes have higher functioning, receive fewer special nursing home services, and remain in care longer than rural admissions to urban nursing homes, urban admissions to urban nursing homes, or urban admission to rural nursing homes.
  • State Facts about Medicaid: Rural Specific Data
    North Carolina Rural Health Research and Policy Analysis Center
     This project will develop state-specific fact sheets which will include information on the groups covered (and income eligibility), structure of the state's SCHIP program, services covered, delivery system, some provider payment information for certain safety net providers, and percentage of the state's rural and urban population that are enrolled in Medicaid. Additional information comparing urban and rural areas of the state will be provided, when available. The rural and urban comparisons will include total numbers of Medicaid recipients, Medicaid expenditures, and enrollment in different types of managed care plans.
  • Tribal Long-Term Care: Barriers to Best Practices in Policy and Programming for a National Sample of Rural Tribes
    FORHP-funded Individual Grantees
     This project will examine barriers experienced by rural American Indian and Alaska Native (AI/AN) tribes in developing long term care policy and service provision, identify tribes which exemplify best practices in the area of long term care policy, and document what other tribes would need to know to develop successful long term care programs (i.e., lessons learned).
  • U.S. Hospitalizations for Ambulatory Care Sensitive Conditions: A Rural/Urban Comparison
    FORHP-funded Individual Grantees
     This project will assess trends, patterns, and predictors of hospitalizations for three ambulatory care sensitive conditions (ACSCs) (i.e., uncontrolled diabetes, bacterial pneumonia, and pediatric asthma) among rural and urban residents in the United States. The study will involve the examination of 2003 HCUP Nationwide Inpatient Sample data.
  • Webcast: What Rural Primary Care Physicians Need to Know about Treating Patients with Mental Health Diagnoses
    WICHE Center for Rural Mental Health Research
     Training via distance learning technology that promotes collaborative care models in primary care is consistent with federal and state policy recommendations.
  • Which Training Programs Produce Rural Physicians? A National Health Workforce Study
    WWAMI Rural Health Research Center
     This national study is using comprehensive, longitudinal data on medical schools and residency location to determine the extent to which the nation's medical schools and residency programs vary in their production of rural physicians by specialty.

Projects Completed 2006 - (28)

  • Analysis of Critical Access Hospital Inpatient Hospitalizations and Transfers from CAHs to Other Acute and Post-Acute Care Settings Using State Inpatient Databases
    University of Minnesota Rural Health Research Center
     The purpose of this project is to analyze Critical Access Hospital (CAH) inpatient hospitalizations and transfers from CAHs in order to help inform the development of quality indicators for CAHs, especially quality indicators focused on the transfer process.
  • Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
    University of Minnesota Rural Health Research Center
     This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.
  • Community Impact Assessment
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
     This project will evaluate the impact of the Flex program on local communities. Activities will focus on identifying the ways in which the program could have a measurable effect, as well as the ways in which Flex program coordinators intended to affect community health. A briefing paper that integrates information on scope of services, networking, and quality will be produced. Additionally, case studies will be conducted in six CAH communities.
  • Critical Access Hospital Participation in the Hospital Quality Alliance and Initial Quality Measure Results
    University of Minnesota Rural Health Research Center
     This project examined the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presented the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia.
  • Database for Rural Health Research in Progress
    Maine Rural Health Research Center
     This searchable database of current rural health services research and policy analysis includes all ORHP-funded studies as well as research funded by other federal agencies, major private foundations and other sources.
  • Declining Access to Hospital-based Obstetric Services in Rural Areas: Causes and Impact
    NORC Walsh Center for Rural Health Analysis
     This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It examines potential causes for this trend and explores the effects of medical malpractice reforms.
  • Developing a Quality Performance Measurement System for Critical Access Hospitals
    University of Minnesota Rural Health Research Center
     This project continues to support activities related to quality performance measurement relevant for Critical Access Hospitals. By the end of 2005, the technical expert panel had reviewed the findings of the initial field test of the small rural hospital quality measure set and made recommendations for revisions.
  • Development of State Flex Program Logic Models and Related Toolkit
    Maine Rural Health Research Center
  • Distance Learning in Depression for Rural Primary Care Providers
    WICHE Center for Rural Mental Health Research
     This project will develop effective distance learning methods to train rural primary care providers (PCPs) in integrated care models for depression using computer based training as an approach to improving mental health outcomes in rural areas.
  • Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
    North Carolina Rural Health Research and Policy Analysis Center
     Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.
  • Identifying At-Risk Rural Areas for Targeting Enhanced Schizophrenia Treatment
    WICHE Center for Rural Mental Health Research
     The goal of this project is to identify rural areas that should be targeted for early adoption of evidence-based schizophrenia treatment. This project proposes a scientifically-based method to identify counties in greatest need for quality improvement to inform national, regional, and local decision-makers about distributing scarce resources to areas which would most benefit from improved schizophrenia treatment.
  • Identifying Stakeholders to Pay for Enhanced Depression Treatment in Rural Populations
    WICHE Center for Rural Mental Health Research
     The goal of this project is to identify stakeholders who economically benefit when rural patients receive enhanced depression treatment, which will, in turn, encourage health plans to provide enhanced depression treatment to their rural enrollees without raising premiums.
  • Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural American Indian Elders
    Upper Midwest Rural Health Research Center
     This project examined the types of health insurance coverage of rural Native American elders ages 55 and older, and examine how different types of health insurance coverage and lack of health insurance coverage impact access to health care services among Native American elders by geographic location (rural frontier, rural non-frontier and urban).
  • Implementation of the Medicare Prescription Drug Benefit: What is Available to Rural Beneficiaries?
    RUPRI Center for Rural Health Policy Analysis
     This study will focus on the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on rural beneficiaries, based on actual prescription drug plan contracts, comparing the impact of the legislation on rural beneficiaries to their urban counterparts.
  • Mode of Travel and Actual Distance Traveled for Medical or Dental Care by Rural Residents
    Rural and Minority Health Research Center
     This project examined the influence of race and rural isolation on distance traveled to receive medical or dental care, and how the potential interaction of these factors might exacerbate disparities in access to care.
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    FORHP-funded Individual Grantees
     This project drew on a survey of patients sampled from the service areas of 25 Critical Access Hospitals (CAHs) from different regions of the country. The purpose of this project is to identify policy and programmatic issues related to bypass, specifically targeting CAHs in order to offer evidence and guidance to policymakers, CAH administrators, and planners on the location of healthcare resources, factors that affect patient actions for planning programs, and the adjustment of policies in order to retain patients locally.
  • Pharmaceutical Data Validity in Estimating Rural Population Health
    FORHP-funded Individual Grantees
     This project will allow for the quantification of variation in morbidity (via prescription use) across rural areas; identify locations that might be at risk for stunted economic development due to high levels of chronic illness in the working population; and potentially lead to the development of a valid and reliable measure of county-level rates of chronic illness using prescription data as a proxy.
  • Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured
    North Carolina Rural Health Research and Policy Analysis Center
     This project examines the experience of states that have implemented premium assistance programs in rural areas to determine whether there are certain design features or certain types of rural communities where these programs may be more feasible.
  • Rapid and Flexible Analysis of Data from Centers for Medicare and Medicaid Services
    North Carolina Rural Health Research and Policy Analysis Center
     Project staff will provide rapid and flexible analysis of Centers for Medicare and Medicaid Services (CMS) data in response to requests from Office of Rural Health Policy (ORHP) staff. Work will be ongoing throughout the contract year, with the design of individual products determined in response to ORHP staff needs.
  • Roadmap for the Adoption of Health Information Technology in Rural Communities
    NORC Walsh Center for Rural Health Analysis
     This project developed a resource document intended to help rural health care providers of all types as they think about whether an investment in health information technology makes sense for them and work through various implementation issues. The document was distributed at the September 2006 conference entitled "Health Information Technology: A Rural Provider's Roadmap to Quality," sponsored by ORHP.
  • Rural Health Center Expansion and Recruitment Survey
    Rural and Minority Health Research Center, WWAMI Rural Health Research Center
     This collaborative project between WWAMI and the South Carolina Rural Health Research Centers examined and described the current staffing needs of rural health centers (RHCs), ascertained the staffing, recruitment, and retention issues that RHC CEOs regard as most critical; distinguished how issues differ between CEOs contemplating development of expansion sites versus those who are not; and described how these findings correlate with the literature and current national supply projections for the categories of health professions needed by the RHCs.
  • Rural Public Health Department Structure and Infrastructure
    FORHP-funded Individual Grantees
     This project is intended to generate hypotheses about the relationship of local public health department structure and infrastructure to performance. Using case studies of 12 rural public health departments in six geographically diverse states, investigators hope to identify elements of local health department (LHD) structure to serve as independent variables for future studies of LHD performance.
  • Rural Safety Net Provision and Hospital Care in 11 States
    FORHP-funded Individual Grantees
     This project evaluated whether access to primary care is more effective at improving health outcomes and reducing costs in rural than urban markets, and identified the characteristics of communities which contribute to improved health outcomes and reducing preventable hospitalizations. This research informs policy relating funding access provision through public clinics to reduce the burden of uncompensated or under-compensated care on financially strained rural hospitals.
  • Rural-Urban Physician Payment Differences Across the Nation: Methodological Changes
    RUPRI Center for Rural Health Policy Analysis
     This project will simulate the effects of changes to the methodologies used to calculate the three geographic practice cost indices currently used to adjust physician payment across the 89 Medicare payment areas in the U.S. and territories. Changes to the payment formula will be analyzed to determine potential impact on payment across areas and revenues for rural physician practices.
  • State Flex Program Quality Improvement Activities
    Maine Rural Health Research Center
  • Uninsurance and Welfare Reform in Rural America
    RUPRI Center for Rural Health Policy Analysis
     This project used widely accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. Additionally, the project concentrated on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period when welfare reform was phased in.
  • Urban and Rural Differences in Access to Care and Treatment for Medicare Beneficiaries with Cancer
    FORHP-funded Individual Grantees
     Little is known about the differences in the diagnosis, treatment and outcomes of care for cancer patients across urban and rural regions of the country. This study will extend our understanding of the challenge of providing high-quality cancer care to Medicare beneficiaries and how provider availability influences access to needed care in urban and rural areas.
  • Why Are Health Care Costs Increasing and Is There a Rural Differential in National Data?
    RUPRI Center for Rural Health Policy Analysis
     This project will determine whether growth in health insurance premiums and out-of-pocket spending differs in rural areas as compared to urban areas.

Projects Completed 2005 - (42)

  • Access to Health Care for Young Rural Medicaid Beneficiaries
    North Carolina Rural Health Research and Policy Analysis Center
     This study examined access to health care among rural children ages 0-17 who are enrolled in some type of Medicaid managed care program, and will compare this access across types of programs and, within program type, to that of urban beneficiaries.
  • Access to Physician Care for the Rural Medicare Elderly
    WWAMI Rural Health Research Center
     This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
  • Analysis of 2004-2005 State Flex Grant Plans
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
     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.
  • Chartbook of Family Practice Graduate Medical Education Programs in Rural America
    WWAMI Rural Health Research Center
     Little is known about the volume, location, and types of rural training for family physicians. This project will produce a chartbook that makes previously unreported information about family physician residency directors more fully available to medical educators and other policymakers.
  • Community-Level Risk Factors for Depression Hospitalizations
    WICHE Center for Rural Mental Health Research
     In this exploratory analysis, we examined the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.
  • Depression and Generalized Anxiety Disorder across Rural Populations
    Rural and Minority Health Research Center
  • Diabetes and Hypertension in Rural Hispanics
    Rural and Minority Health Research Center
     The project will examine the similarities and differences between rural and urban Hispanics and Caucasian adults diagnosed with diabetes mellitus and hypertension.
  • Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
    WICHE Center for Rural Mental Health Research
     This project will explore whether rural populations achieve outcomes with depression treatment quality intervention comparable to their urban counterparts, and whether any outcome differences are explained by treatment mediators (e.g., evidence-based care) or psychosocial mediators (e.g., stressful life events and social support). Findings from this study can be used to refine interventions before they are disseminated to rural delivery systems.
  • Disability Burdens Among Rural and Urban Older Americans
    Rural and Minority Health Research Center
     This project will use the 1994-2000 Second Longitudinal Study of Aging to develop detailed estimates of healthy, disabled, and total life expectancy among rural and urban populations. We will develop and compare the estimates between women and men, by race/ethnicity, and across differing levels of education.
  • Discrepancies of Financial Data between Medicare Cost Report and Hospital Audited Financial Statement and Its Implication for Measuring Financial Impact of Payment Policy on Rural Hospitals
    RUPRI Center for Rural Health Policy Analysis
  • Effects of Alcohol Use on Educational Attainment and Employment in Rural Youth
    Rural and Minority Health Research Center
     This study will examine the effects of alcohol use during the teen years on subsequent educational attainment and employment in a panel of rural residents.
  • Effects of Uninsurance during the Preceding 10 Years on Health Status Among Rural Working Age Adults
    Rural and Minority Health Research Center
     Utilizing data from the 1979 National Longitudinal Survey of Youth, the effects of long-term, continuous uninsurance on health status will be analyzed through a comparison of rural and urban populations who were between the ages of 14-22 in 1979.
  • Health Insurance Dynamics of Uninsured Rural Families
    Maine Rural Health Research Center
     To better understand the dynamics of insurance coverage among rural and urban families, this study will use the Medical Expenditure Panel Survey (MEPS) to compare family health insurance coverage among non-elderly rural and urban families.
  • How Rural Hospitals Are Meeting the Needs of Low-English Proficiency Patients
    Rural and Minority Health Research Center
     This study will determine the extent to which rural hospitals have implemented plans for compliance with the DHHS Low-English Proficiency regulations, describe the difficulties rural hospitals must overcome in order to provide health care to Hispanic clients, ascertain the translation techniques most commonly used by rural hospitals, and describe the most effective approaches in the provision of culturally competent health care to Hispanic clients.
  • Identifying At-Risk Rural Areas for Targeting Enhanced Depression Treatment
    WICHE Center for Rural Mental Health Research
     This project will identify characteristics of rural areas that are associated with increased risk of depression-related hospitalizations, and will identify high risk rural areas within the U.S. that should be targeted for early adoption of enhanced depression treatment models based on patient need.
  • Impact of Bioterrorism on Rural Mental Health Needs
    FORHP-funded Individual Grantees
     This project aims to assess and improve the preparedness of rural primary care professionals to care for mental health conditions in the wake of bioterrorism and infectious disease outbreaks.
  • Impact of the Home Health PPS on Access in Rural America
    NORC Walsh Center for Rural Health Analysis
     This study is designed to help policymakers understand whether patterns of home care use in rural communities have been affected by the PPS. Analyses will provide information on the characteristics of the patients served, the number and mix of services rendered, and quality of care.
  • Impact of The Medicaid Budget Crisis on Rural Communities: A 50-State Survey
    North Carolina Rural Health Research and Policy Analysis Center
     The impact of the Medicaid budgetary crisis on rural communities across the US will be assessed through a 50-state survey of state Medicaid agencies, state Offices of Rural Health and state rural health associations.
  • Informing Primary Care Depression Intervention: A Comparison of Hospitalization Rates in Depressed Rural and Urban Patients
    WICHE Center for Rural Mental Health Research
     The goal in this research was to examine whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling).
  • Is Medicare Beneficiary Access to Primary Care Physicians At Risk?
    RUPRI Center for Rural Health Policy Analysis
     This project examined the impact of changes in Medicare payment to physicians on access to care for rural beneficiaries.
  • Is Rural Residency Training of Family Physicians an Endangered Species? An Interim Follow-up to the 1999 National BBA Study
    WWAMI Rural Health Research Center
     This study examined the proportion of rural-based family medicine residencies that have ceased operations since 2000, the residency-match experiences of the surviving programs, the proportion of U.S. medical school graduates and international medical graduates, major issues confronting these rural residencies, and likely impacts of these changes on the preparation of future family physicians for rural America.
  • Medicaid Budget Cuts: Effects on Rural Nursing Homes and Rural Elderly and Disabled
    Southwest Rural Health Research Center
     This project will investigate whether nursing home quality and access to nursing home care have eroded in rural areas as a result of changes in Medicare payments or reductions in Medicaid nursing home payments from 2000-2003.
  • Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies
    NORC Walsh Center for Rural Health Analysis
     This study will compare the performance of rural and urban home care agencies, and identify agency characteristics that contribute to better patient care outcomes.
  • Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
    Maine Rural Health Research Center
     This project will survey Emergency Room (ER) managers in a nationally representative sample of Critical Access Hospitals (CAHs) to determine the proportion of ER encounters involving mental health pathology, types of mental health problems most commonly seen in these encounters, and resources available to CAHs to address the problems encountered.
  • Mental Health Risk Factors, Unmet Needs and Provider Availability for Rural Children
    Rural and Minority Health Research Center
     The study will examine the prevalence of subclinical problems in rural children, assess risk factors associated with problems in children, and assess the influence of local provider availability on healthcare provider contact.
  • Mental Health Services: The Effect of Variations in State Policies
    Southwest Rural Health Research Center
     This study will identify variations in state licensure and payment or coverage polices and examine the effect of these variations on the availability of mental health services in rural areas.
  • National Study of Home Health Access in Rural America
    FORHP-funded Individual Grantees
     This project will develop home health care service areas that will allow for the measurement of access to home health care for rural Medicare beneficiaries who die of cancer, and recommend options for increasing access to home health care in underserved rural areas.
  • National Trends in the Perinatal and Infant Health Care of Rural and Urban American Indians (AIs) and Alaska Natives (ANs)
    WWAMI Rural Health Research Center
     This project examined and compared trends in prenatal care and mortality rates of rural and urban AI/AN and non-AI/AN populations in order to determine the level of disparity between these populations and their temporal changes.
  • Native Elder Care Needs Assessment: Development of a Long Term Care Planning Tool Kit
    FORHP-funded Individual Grantees
     A long term care planning tool kit will assist tribes with interpreting long term care data obtained through a national Native Elder Care Needs Assessment. It will also assist tribes in using the data to develop long term care infrastructure and comprehensive services that respond to local needs and services.
  • Post-Acute Care: A Rural and Urban Comparison
    NORC Walsh Center for Rural Health Analysis
     This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.
  • Poverty, Parental Stress, and Violent Disagreements in the Home Among Rural Families
    Rural and Minority Health Research Center
     Using the National Survey of Children's Health, this study will address the prevalence of poverty, parental stress and violent disagreements in the home in rural and urban families. Associations among economic hardships, parent stress, violent disagreements in the home and mental health problems in children will also be investigated.
  • Preventing Hospitalization in Depressed Rural Patients
    WICHE Center for Rural Mental Health Research
     This project will explore whether depressed rural patients are more likely than their urban counterparts to be hospitalized for depression and other health reasons over the course of two years; explore whether any current rural-urban hospitalization differences are reduced in models which control for previous intensive outpatient specialty care utilization; and explore rural-urban differences in the prevalence and consequences of administrative constraints on intensive outpatient specialty care use.
  • Quality of Women's Care in Rural Health Clinics: A National Analysis
    FORHP-funded Individual Grantees
     This study will analyze the rates at which women patients receive five recommended preventive screening interventions in a national, geographically stratified random sample of Rural Health Clinics. Results of the analysis will be used to derive implications for rural health policy.
  • Role of Intensive Care Units in Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
     This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.
  • Rural Access and State Loan Repayment for Dentists
    FORHP-funded Individual Grantees
     This project will identify and evaluate the effectiveness of state loan repayment programs for dentists on improving access to rural health care. This study will establish baseline information about these programs that can be used by states to design and tailor similar programs for rural access.
  • Rural and Urban Differences in Utilization of Formal Home Care
    FORHP-funded Individual Grantees
     This project uses the Medical Expenditure Panel Survey and other data sources to examine rural and urban differences in the utilization and costs of formal home care, including changes in utilization patterns and costs across residence types over time.
  • Rural Minority Health: A Comprehensive Assessment
    Rural and Minority Health Research Center
     This study will profile demographics of rural African Americans by region of the U.S.; describe clinical problems prevalent in rural African American populations; explore available health care facilities and practitioners in rural areas; investigate outpatient treatment provided to rural African American populations by type of practitioner; explore expenditures for health care among rural African Americans by region of the U.S.; and determine barriers to care such as insurance, provider availability, and health beliefs and behaviors.
  • Rural Quality Improvement Focus on Diabetes
    RUPRI Center for Rural Health Policy Analysis
     This project focused specifically on diabetes care management and quality improvement programming in rural areas as a way to understand the adaptability and policy implications of using chronic care coordination and other models in a rural environment.
  • Rural-Urban Commuting Area (RUCA) Development Project: Demographic Description and Frontier Enhancement
    WWAMI Rural Health Research Center
     This project augments the initial RUCA work by producing and describing the base 1998 demography of the RUCA code areas, creating quality state maps of the RUCA codes, and making this information and the codes easily available on the Web.
  • Special Study of EMS Issues
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
     This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
  • Successful Implementation of Medication Safety Initiatives in Rural Hospitals: The Role of Pharmacists and Technology
    Upper Midwest Rural Health Research Center
     This project will assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, and will identify factors that facilitate successful implementation of medication safety practices in rural hospitals.
  • Trends in Swing Bed and Skilled Nursing Facility Use in Rural Hospitals, 1996-2003
    North Carolina Rural Health Research and Policy Analysis Center
     This study will examine trends in the distribution of skilled nursing facility (SNF) services in rural hospitals during a period of dramatic change in Medicare reimbursement, most notably the transition from cost-based reimbursement to SNF prospective payment system (PPS).

Projects Completed 2004 - (22)

Projects Completed 2003 - (58)

Projects Completed 2002 - (30)

Projects Completed 2001 - (14)

Projects Completed 2000 - (4)

Projects Completed 1999 - (8)