2003 Research Publications

Browse the full list of research publications from the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

Grantee Sustainability in the Rural Health Outreach Grant Program
University of Minnesota Rural Health Research Center
Date: 12/2003
This paper describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients and focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
Care Across the Continuum: Access to Health Care Services in Rural America
RUPRI Center for Rural Health Policy Analysis
Date: 12/2003
This paper proposes that a continuum of care serve as the framework with which to consider rural healthcare policies, focusing on people and on places where people live rather than on the wants of providers and constituencies.
Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Full Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2003
Hourly wage data collected were used to examine urban/rural patterns in average hourly nursing home wages and pattern variation within the statewide rural labor markets. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
Rural Minority Children's Access to and Timeliness of Immunizations: 1993-2001
Rural and Minority Health Research Center
Date: 11/2003
The purpose of this study is to assess the quality of pediatric healthcare provided to rural minorities using timeliness of immunization receipt as a marker for quality.
Chronic Disease Management in Rural and Underserved Areas: Patient Responses and Outcomes
Southwest Rural Health Research Center
Date: 11/2003
Findings from site visits and interviews with six chronic disease management (DM) programs across the United States indicated DM programs were extremely important in the areas of patient healthcare and quality of care and resulted in positive clinical and financial outcomes.
Are There Geographic Disparities in Out-of-Pocket Spending by Medicare Beneficiaries?
University of Minnesota Rural Health Research Center
Date: 10/2003
This paper describes a study comparing out-of-pocket spending among rural and urban Medicare recipients. It includes data on differences based on supplemental insurance coverage.
Availability and Use of Health Plan Choices in Rural America: Medicare+Choice, Commercial HMO, and Federal Employees Health Benefit Program Plans
RUPRI Center for Rural Health Policy Analysis
Date: 10/2003
This report discusses the availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program insurance plans and the potential impact of M+C service delivery area changes on healthcare access in rural areas.
Medicare Physician Payment: Practice Expense
RUPRI Center for Rural Health Policy Analysis
Date: 10/2003
This rural policy brief examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment warrants careful validation to demonstrate that the index measures actual geographic cost differences.
Health Insurance Coverage of The Rural and Urban Near Elderly
Maine Rural Health Research Center
Date: 10/2003
This paper reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey to address two principal research questions related to health insurance coverage for the rural near elderly.
Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
NORC Walsh Center for Rural Health Analysis
Date: 09/2003
This survey provides a description of emergency medical services providers in rural communities, particularly those with critical access hospitals.
Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Regulations: Case Studies of Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 08/2003
Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information and have made substantial progress in achieving compliance with HIPAA privacy standards. Each recognized that additional work will be required to effectively secure patient privacy.
The Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Underserved Areas of Washington State
Journal Article
WWAMI Rural Health Research Center
Date: 08/2003
This article uses productivity data from the non-physician clinician (NPC) and physician populations in Washington state to assess the contribution to generalist care made by NPCs, giving special attention to the role of NPCs in rural and underserved areas and the role of women NPCs in the female provider population.
Prevalence of Health Related Behavioral Risk Factors Among Non-Metro Minority Adults
Rural and Minority Health Research Center
Date: 08/2003
Data is shared on tobacco use, seat belt use, and alcohol consumption among rural minority adults. It includes recommendations and detailed data tables.
Medicare Issues
RUPRI Center for Rural Health Policy Analysis
Date: 08/2003
This document provides an overview of rural policy issues related to Medicare. The presentation was made August 26, 2003 in Casper, Wyoming.
Who Receives Inpatient Charity Care in California?
NORC Walsh Center for Rural Health Analysis
Date: 08/2003
This policy analysis brief examines the results of a study regarding how California hospitals determine charity care.
The Response of Local Health Care Systems in the Rural Midwest to a Growing Latino Population
University of Minnesota Rural Health Research Center
Date: 08/2003
This paper reports on the case studies of rural communities in Iowa, Kansas, and Nebraska, documenting successful strategies that could be adopted by other communities facing challenges to their rural healthcare system in meeting the needs of a growing Latino population.
Impact of the Medicaid Budgetary Crisis on Rural Communities
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2003
This paper provides an overview of the Medicaid program and options states have to reduce program costs. Steps states have proposed or taken to reduce Medicaid costs and the potential impact of these changes on rural areas are discussed. The potential impact on rural communities of federal proposals to redesign Medicaid is assessed.
Who Is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
Journal Article
WWAMI Rural Health Research Center
Date: 07/2003
This article compares the geographic distribution and patient populations of physician and nonphysician primary care clinicians. It includes the proportion of clinicians within each discipline practicing in rural areas, health professional shortage areas, and areas with vulnerable populations.
Metropolitan and Micropolitan Core Based Statistical Areas (CBSAs) Map
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2003
This map illustrates the June 2003 Office of Management and Budget's metropolitan and micropolitan Core Based Statistical Areas designations by county.
Classification Change, 1999 to 2003: Office of Management and Budget Metropolitan Areas and Core Based Statistical Areas (CBSAs) Map
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2003
This map shows the Office of Management and Budget's June 2003 Core Based Statistical Areas designations for counties that were nonmetropolitan in 1999.
A Primer on Interpreting Hospital Margins
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2003
This document explains the most commonly used measures of hospital profitability and how they are used to inform policy changes.
Emergency Department Use by Medically Indigent Rural Residents
Rural and Minority Health Research Center
Date: 07/2003
This report examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents.
Medicare Home Health Care in Rural America (Full Report)
NORC Walsh Center for Rural Health Analysis
Date: 06/2003
This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies.
Rural Health Networks: Evolving Organizational Forms and Functions
University of Minnesota Rural Health Research Center
Date: 06/2003
This report discusses results of a survey of rural health networks. It includes information about the location, membership, relationships, governance, management, process, and products of rural health networks.
Rural Beneficiaries' Projected Drug Coverage Under Three Medicare Prescription Drug Proposals
NORC Walsh Center for Rural Health Analysis
Date: 06/2003
This study estimates the expected increase in urban and rural Medicare beneficiaries eligible for drug coverage under three Medicare prescription drug proposals. It also gives an estimate of the urban and rural per capita federal payments for drug coverage under the proposals.
Enrollment in FEHBP Plans in Rural America: What Are the Implications for Medicare Reform?
RUPRI Center for Rural Health Policy Analysis
Date: 06/2003
This brief explains how the Federal Employees Health Benefits Program (FEHBP) is functioning in rural areas. Enrollment patterns into the various options available in the FEHBP, descriptions of choices typically available in rural areas, and location of primary care providers used by plans in a sample of rural communities is presented.
Hospitalization for Ambulatory Care Sensitive Conditions: Asthma, Diabetes, and Congestive Heart Failure in South Carolina
Rural and Minority Health Research Center
Date: 05/2003
Hospitalization rates for ambulatory care sensitive conditions, diseases for which primary care in the preceding six months could have reduced or eliminated the need for hospitalization, are a commonly used indicator of disparities in access to care.
Enrollment in the Federal Employees Health Benefit Program (FEHBP): State and County-Level Enrollment Analysis
RUPRI Center for Rural Health Policy Analysis
Date: 05/2003
This analysis details information on Federal Employees Health Benefit Program (FEHBP) enrollment in rural counties, including the number of health insurance plans available and number of enrollees. FEHBP is being considered as a model for involving private insurers in Medicare.
Enrollment in FEHBP Plans in Rural Areas
RUPRI Center for Rural Health Policy Analysis
Date: 05/2003
This study of health plan enrollment decisions made by rural retirees and federal workers examines how a Federal Employees Health Benefit Program plan may work when applied to Medicare.
Rural Hospital HIPAA Readiness and Resource Needs
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2003
This rural policy brief presents a survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement them.
Breast and Cervical Cancer Screening: Is It Reaching Rural and Rural Minority Women?
Southwest Rural Health Research Center
Date: 04/2003
This study examines whether the Texas Breast and Cervical Cancer Control Program is reaching rural women in general and rural minority women in particular.
Design of Enhanced Primary Care Case Management Programs Operating in Rural Communities: Lessons Learned from Three States
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2003
This findings brief discusses state programs that provide enhanced benefits to Medicaid beneficiaries, such as enhanced primary care case management.
Analysis of Availability of Medicare+Choice, Commercial HMO, and FEHBP Plans in Rural Areas: Implications for Medicare Reform
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2003
This rural policy brief examines the viability of introducing private competition into the Medicare program. It discusses the availability of Medicare+Choice1, commercial HMO, and Federal Employees Health Benefits Program plans in rural (nonmetropolitan) counties.
Rural Health Research in Progress in the Rural Health Research Centers Program, 7th edition
Maine Rural Health Research Center
Date: 03/2003
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current and proposed that affects rural health services and populations.
Environmental Context of Patient Safety and Medical Errors
University of Minnesota Rural Health Research Center
Date: 03/2003
This paper explores the environmental context of patient safety/medical errors with specific interest in rural areas. It reviews patient safety/medical error literature, identifies features of rural healthcare organizations and their environment relating to patient safety issues/medical errors, and discusses error reduction/prevention strategies.
Attitudes of Family Physicians in Washington State Toward Physician-Assisted Suicide
Journal Article
WWAMI Rural Health Research Center
Date: 02/2003
Physician-assisted suicide is difficult and controversial. With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified. This paper utilizes data from a 1997 survey of family physicians in Washington.
Rural Hospitals: New Millennium and New Challenges
University of Minnesota Rural Health Research Center
Date: 02/2003
This report discusses the changes in rural hospitals that took place in the decade of the 1990s and discusses some of the challenges that face rural hospitals in 2003. It includes discussion of rural hospitals' organizational structures, health service provision, payment/reimbursement, and financial performance.
Background Paper: Rural-Urban Differences in Nursing Home and Skilled Nursing Supply
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2003
This paper examines characteristics of nursing facilities and the supply of certified skilled nursing beds as the new PPS is being phased in, with particular reference to differences between urban and rural settings.
Diabetes and Cardiovascular Disease Among Rural African Americans
Rural and Minority Health Research Center
Date: 02/2003
This report investigates the association of race and rural residence on rates of diagnosis of diabetes and cardiovascular disease and indicators of good medical control among people with diabetes, hypertension, and cardiovascular disease.
Access to Care Among Rural Minorities: Working Age Adults (Appendix - Methods, Data, and Detailed Tables)
Rural and Minority Health Research Center
Date: 01/2003
This is an appendix of a report on health status and health services use among poor and minority working-age adults in non-metro areas.
The Financial Effects of Critical Access Hospital Conversion
University of Minnesota Rural Health Research Center
Date: 01/2003
This paper describes how the first wave of conversions to critical access hospital status affected rural hospitals' financial performances and organizational structures.
State of the Health Workforce in Rural America: Profiles and Comparisons
WWAMI Rural Health Research Center
Date: 01/2003
This publication provides an overview of rural healthcare workforce issues. National and state-by-state data on the healthcare workforce, with rural-urban comparisons and interstate comparisons, are included, along with data on rural healthcare facilities.
Medicare Physician Payment
RUPRI Center for Rural Health Policy Analysis
Date: 01/2003
This rural policy brief examines how the Resource-Based Relative Value Scale has replaced the 25-year-old Medicare CPR charge system.
An Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
RUPRI Center for Rural Health Policy Analysis
Date: 01/2003
This policy paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas.
Unstable Demand and Cost per Case in Low-Volume Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2003
This findings brief looks at the effects of year-to-year changes in annual inpatient discharges on costs per Medicare discharge.
Unpredictable Demand and Low-Volume Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2003
This findings brief assesses the degree to which the annual number of patient discharges varies from year to year for low-volume hospitals.
Rate of Return on Capital Investments at Small Rural Hospitals
University of Minnesota Rural Health Research Center
Date: 01/2003
This paper examines whether the aging of rural facilities is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment.
Innovative Primary Care Case Management Programs Operating in Rural Communities: Case Studies of Three States
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2003
This study examines three states that have implemented primary care case management and provides an overview of each program, including their strengths and weaknesses.
Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
NORC Walsh Center for Rural Health Analysis
Date: 01/2003
This study examines the relationship between various Medicare prescription drug benefit design characteristics and their impact on rural areas based on analysis of competing legislative proposals.
The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
Chartbook
Maine Rural Health Research Center
Date: 01/2003
This chartbook reports on a rural health clinics (RHCs) survey. Information was collected on many topics, including their characteristics/operations; their location relative to the underservice problems/rural access needs; their safety net functions; staffing, recruitment, and financial issues; and involvement in training healthcare professionals.
Access to Care Among Rural Minorities: Working Age Adults
Rural and Minority Health Research Center
Date: 01/2003
This report examines the prevalence of health insurance and the use of physician services in rural areas.
The Effects of the 1997 Balanced Budget Act on Family Practice Residency Training Programs
Journal Article
WWAMI Rural Health Research Center
Date: 2003
This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States.
Rural Minority Children
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet provides data on rural minority children's health insurance coverage, healthcare use, poverty, and education.
Rural Minority Elders
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet provides data on health status, health insurance coverage, education, and income of rural elders.
Hospitalization for Ambulatory Care Sensitive Conditions: Congestive Heart Failure, Diabetes and Asthma in South Carolina
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet gives a brief overview of findings from a study of hospitalizations in South Carolina for ambulatory care sensitive conditions.
Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers
Journal Article
WICHE Center for Rural Mental Health Research
Date: 2003
Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 2
Southwest Rural Health Research Center
Date: 2003
This report detailed literature reviews and associated references for the top rural health concerns addressed in Vol. 1 of Rural Healthy People 2010.
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 1
Southwest Rural Health Research Center
Date: 2003
This report offers brief overviews of the top rural health concerns and objectives associated with Healthy People 2010 focus areas. Also included are references to key literature about these concerns and descriptions of models for practice that rural communities can draw upon to achieve key Healthy People 2010 objectives.
Nursing Homes in Rural America
Southwest Rural Health Research Center
Date: 2003
This policy brief discusses the main findings of a 2000 survey of 17,000 nursing homes related to rural elderly.
Rural Minority Working Age Adults
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
Holding demographic considerations equal, rural residents are less likely to report having health insurance than urban residents. African Americans, Hispanics, and persons of other races are all less likely to be insured than whites. The factors placing rural minorities at risk for lacking insurance include low income and low education.
Diagnostic Risk Factors & Improvement Activities Among Rural Hispanics
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses disease management among rural Hispanics.
Diagnostic Risk Factors & Improvement Activities Among Rural African Americans
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses disease management among rural African Americans.
Diabetes and Cardiovascular Disease in Rural African Americans
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
Previous research has indicated that persons living in rural areas are more vulnerable to poor health than those living in urban areas. Minorities in particular are more vulnerable to poor health than non-minorities.
Demand for Medical Services Among Previously Uninsured Children: The Roles of Race and Rurality
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet examines the use of medical services over nearly two years among newly insured and continuously insured children, ages 6 through 12, in the CHIP and Medicaid programs in South Carolina and West Virginia.
Behavioral Risk Factors Among Rural Hispanics
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses seat belt use, tobacco use, and alcohol use among rural Hispanics.
Behavioral Risk Factors Among Rural African Americans
Fact Sheet
Rural and Minority Health Research Center
Date: 2003
This fact sheet discusses seat belt use, tobacco use, and alcohol use among rural African Americans.
2003 Index of Hospital Quality
NORC Walsh Center for Rural Health Analysis
Date: 2003
Published annually by U.S. News & World Report, this report describes a series of factors regarding ranking of measuring hospital quality.