Rural Health
Research Gateway

2004 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.

  • Reducing Mortality From Motor Vehicle Crashes for Children 0 through 14 Years of Age: Success in New York and North Dakota
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2004
    This report reviews effective interventions to reduce motor vehicle crash mortality among children. It explores what is happening in New York and North Dakota that contributes to their success in being among the best performing states in regard to this measure of child health.
  • Impact of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence on Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
    Rural and Minority Health Research Center
    Date: 12/2004
    This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications as an indicator of access.
  • North Dakota's Uninsured and Uncompensated Care: Costs and Coverage Options
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 11/2004
    This policy brief on health insurance coverage and the uninsured in North Dakota discusses the financial impact of uncompensated care on the healthcare system and describes several methods for expanding health insurance coverage.
  • Indian Health Care Improvement Act: Implications for North Dakota Tribes
    Upper Midwest Rural Health Research Center
    Date: 11/2004
    This policy brief provides an overview of healthcare issues facing American Indians in North Dakota, with discussion of the impact of the Indian Health Care Improvement Act.
  • Community Health Workers: Status of Certification and Training
    Southwest Rural Health Research Center
    Date: 11/2004
    A national overview of state policy and state involvement in the standardized training and certification of Community Health Workers is provided.
  • Sustaining Community Health Services Over Time: Models From the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 11/2004
    This paper discusses post-grant sustainability of services provided by recipients of Rural Health Outreach Grant Program projects.
  • Cesarean Section Patterns in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2004
    This paper examines childbirth delivery patterns in rural hospitals and compares the cesarean section rate in rural hospitals to that in urban hospitals.
  • Mujer y Corazon: Community Health Workers and Their Organizations in Colonias on the U.S.-Mexico Border
    Southwest Rural Health Research Center
    Date: 10/2004
    This report shares the results of a study analyzing the community health worker (CHW) organizations and practices to learn how they work and why they are key resources in colonias for improving the health of the communities. The study also examined the relationships of the CHW with and their impact on the communities they serve.
  • Rurality and Nursing Home Quality: Results From a National Sample of Nursing Home Admissions
    Journal Article
    Southwest Rural Health Research Center
    Date: 10/2004
    There are higher percentages of elderly population in and the utilization rates of nursing homes are higher in rural areas. Overall, problems in rural nursing homes are at a much higher risk for poor outcomes, but it is most apparent in extremely isolated rural areas.
  • Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    This paper describes quality improvement efforts in critical access hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. It includes data on the use of clinical guidelines and quality measures in CAHs and the role of Medicare Quality Improvement Organizations.
  • Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    This paper describes the patient safety results from a 2004 survey of critical access hospital administrators.
  • Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 09/2004
    This study assesses how the definition of rural affects the potential impact of the access standards in the Proposed Rule to implement Title I of the MMA and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
  • Assessment of Barriers to the Delivery of Medicare Reimbursed Diabetes Self-Management Education in Rural Areas
    Rural and Minority Health Research Center
    Date: 09/2004
    This report explores the barriers that rural practitioners face in providing diabetes education services to Medicare beneficiaries.
  • Access to Dental Care for Rural Low Income and Minority Populations
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Using data from the 1999 National Health Interview Survey, this study examines the relationships between rural residence, income, race/ethnicity, and access to dental care.
  • 2004 CAH Survey National Data
    University of Minnesota Rural Health Research Center
    Date: 08/2004
    The Flex Monitoring Team conducted a national survey of critical access hospital (CAH) administrators between January and April 2004. The survey's purpose was to document program-related experiences of CAHs during the last two years to help shape public policy to improve the effectiveness of the Flex Program and CAHs.
  • Mujer y Corazon: Community Health Workers and Their Organizations in Colonias on the US-Mexico Border: An Exploratory Study
    Southwest Rural Health Research Center
    Date: 08/2004
    Study results are reported that analyzed the Community Health Worker (CHW) organizations and practices to learn how they work and why they are key resources in colonias for improving the health of the communities. The study also examined the relationships of the CHW with and their impact on the communities they serve.
  • Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
    NORC Walsh Center for Rural Health Analysis, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    This policy paper provides, in chart form, sections of the MMA that were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policy makers.
  • Rural Physicians' Acceptance of New Medicare Patients
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Findings are presented regarding rural physicians' acceptance of new Medicare patients from an analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians.
  • Investigating Rural EMS Infrastructure: A Developmental Methodology for Measuring the Availability of EMS Resources
    Rural and Minority Health Research Center
    Date: 08/2004
    This report explores a potential indicator of emergency medical services availability, the Expected Annual Emergency Miles per Ambulance (EXAMB). The EXAMB measure calculates expected annual emergency miles per ambulance beginning with the number of ambulances, the land area of a county as a proxy for distance, and county population.
  • Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    Date: 07/2004
    This policy analysis brief describes a change in Medicare post-acute transfer payment policy and its impact on rural and urban hospitals. It includes data on the financial impact and hospital discharge behavior before and after the change.
  • Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2004
    This study examines the behavioral and financial impacts of the initial 10-DRG policy and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds.
  • Nursing Homes in Rural And Urban Areas, 2001
    Southwest Rural Health Research Center
    Date: 06/2004
    This chartbook provides descriptive data on the entire population of longer-stay nursing home residents in the country in 2001 and categorizes them according to the rurality of the nursing homes in which they receive care in an effort to address questions related to residents' characteristics and quality of care.are.
  • Access To Primary Care and Quality of Care in Rural America
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2004
    This report provides findings from a population-based study addressing the impact of the availability of healthcare resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.
  • Do Rural Elders Have Limited Access to Medicare Hospice Services?
    Journal Article
    University of Minnesota Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 05/2004
    Examines whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.
  • A Synthesis of State Flex Program Plans 2003-2004
    University of Minnesota Rural Health Research Center
    Date: 05/2004
    This paper highlights recent trends in the development and implementation of state Flex Programs, whose goal is to strengthen the rural healthcare infrastructure using critical access hospitals as the hub of organized, local systems of care.
  • Information Technology and Rural Health Networks: An Overview of Network Practices
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2004
    This paper focuses on the use of information technology in rural health networks, based on detailed interviews with representatives for 15 rural health networks that received funding from the federal Rural Health Network Development Grant program.
  • Expanding Residential Care and Assisted Living in Rural America
    Southwest Rural Health Research Center
    Date: 05/2004
    There is an undersupply of assisted living facilities in rural areas. This policy brief provides options for state policy makers and advocates to consider in expanding the availability and nature of assisted living and other types of housing with supportive services in rural areas.
  • Chronic Disease Management in Rural Areas
    Southwest Rural Health Research Center
    Date: 05/2004
    This article describes a study of six chronic disease management programs throughout the United States. It discusses issues related to chronic disease management in rural areas.
  • Characterizing the General Surgery Workforce in Rural America
    WWAMI Rural Health Research Center
    Date: 05/2004
    General surgeons form a crucial component of the medical workforce in rural areas of the United States. Analysis of the data suggests that the general surgical workforce has not kept pace with the rising population, and that the number of general surgeons in most rural areas of the United States will decline further.
  • Assisted Living: Is It an Option for Rural Areas?
    Southwest Rural Health Research Center
    Date: 05/2004
    The key findings of a national survey on assisted living are highlighted, including supply, services, and affordability of assisted living facilities in rural areas.
  • An Analysis of the Agreement of Financial Data Between the Medicare Cost Report and the Audited Hospital Financial Statement
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2004
    Few studies have examined the discrepancies between the Medicare Cost Report (MCR) and the audited hospital financial statement (FS). Findings from this study, which focused on the MCR and FS for rural hospitals, suggest that relying on a single source of financial data to assess the financial performance of rural hospitals may be inappropriate.
  • Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 3
    Southwest Rural Health Research Center
    Date: 04/2004
    This report includes the overview of research and accompanying models for practice on five new focus areas in Rural Healthy People 2010, along with the more detailed literature reviews for each.
  • Understanding the Role of the Rural Hospital Emergency Department in Responding to Bioterrorist Attacks and Other Emergencies: A Review of the Literature and Guide to the Issues
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2004
    This report reviews issues affecting rural hospitals' levels of readiness for a bioterrorist attack. Issues examined include physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Concerns about funding cut across all the issues of preparedness.
  • Perspectives of Rural Hospitals on Bioterrorism Preparedness Planning
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2004
    Representatives from several rural hospitals met to discuss various aspects of bioterrorist preparedness in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities.
  • Measuring Rural Hospital Quality
    University of Minnesota Rural Health Research Center
    Date: 04/2004
    This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and are sensitive to the rural hospital context.
  • Are Advanced Practice Nurses a Solution to Rural Mental Health Workforce Shortages?
    Maine Rural Health Research Center
    Date: 04/2004
    This paper summarizes the clinical skills and prescriptive authority of advanced practice psychiatric nurses and investigates current trends in their geographic distribution to determine what their future role may be in addressing rural mental health needs.
  • Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Requirements
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2004
    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.
  • An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/2004
    The Medicare Incentive Payment program provides a 10 percent bonus payment to physicians who treat patients in Health Professional Shortage Areas (HPSAs). Results show that physicians eligible for the bonus payments often did not claim them, and physicians who likely did not work in approved HPSA sites, claimed the bonus payments and received them.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 8th Edition
    Maine Rural Health Research Center
    Date: 02/2004
    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.
  • Development of a Methodology for Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
    Rural and Minority Health Research Center
    Date: 02/2004
    This pilot study successfully demonstrated that a retrospective, population-based, comparative design is a feasible method for evaluating the effectiveness of a community health worker program for women at risk for poor pregnancy and birth outcomes.
  • Core Based Statistical Areas and the Medicare Wage Index
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2004
    This document discusses the potential impact of the 2003 Office of Management and Budget statistical area standards on the hospital wage index and Medicare payments to rural providers. Additionally, three other options for defining labor markets using the 2003 classifications are presented.
  • American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
    WWAMI Rural Health Research Center
    Date: 01/2004
    This paper describes the findings of a study to understand the paths of American Indian and Alaska Native students who successfully entered medical school.
  • Quality Improvement Strategies and Best Practices in Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    This paper describes critical access hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. It includes lists of changes made to staffing, training, equipment, and other issues related to QI.
  • The Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    This paper discusses the impact of conversion to critical access hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
  • Medicare Home Health Care in Rural America
    Policy Brief
    NORC Walsh Center for Rural Health Analysis
    Date: 01/2004
    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-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Brief Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2004
    Hourly wage data from Medicare-participating nursing homes were used to examine urban/rural patterns in average hourly nursing home wages and wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
  • Obesity Prevalence in Rural Counties: A National Study
    WWAMI Rural Health Research Center
    Date: 01/2004
    Using a telephone survey of adults ages 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-01, researchers found that the prevalence of obesity was 23% for rural adults and 20.5% for urban adults.
  • Medicare Prescription Drug, Improvement, and Modernization Act of 2003, (P.L. 108-173): A Summary of Provisions Important to Rural Health Care Delivery
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2004
    This paper provides a wide audience of rural health policy makers, advocates, and researchers a consolidated summary of legislative provisions contained in Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) that have particular meaning to the delivery of services in rural areas.
  • Financially Distressed Rural Hospitals in Four States
    NORC Walsh Center for Rural Health Analysis
    Date: 01/2004
    The effect of the outpatient prospective payment system on the financial performance of rural hospitals was simulated in four states: Iowa, Texas, Washington, and West Virginia.
  • The Migration of Physicians From Sub-Saharan Africa to the United States of America: Measures of the African Brain Drain
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2004
    The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.
    Methods: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA.
    Results: More than 23% of America's 771 491 physicians received their medical training outside the USA, the majority (64%) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana. Furthermore, 79% were trained at only 10 medical schools.
    Conclusions: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
  • The Productivity of Washington State's Obstetrician-Gynecologist Workforce: Does Gender Make a Difference?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2004
    Objective: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State.
    Methods: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
    Results: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P <= .01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P <= .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group.
    Conclusion: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.
  • Diabetes & Hypertension Among Rural Hispanics
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2004
    This fact sheet describes rates of diabetes and hypertension among rural Hispanics.
  • Comparative Performance Data for Critical Access Hospitals
    Journal Article
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 2004
    Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
  • Chronic Disease Management in Rural Areas: A Research Update
    Southwest Rural Health Research Center
    Date: 2004
    Rural implementation of chronic disease management is discussed. Included are a list of benefits and barriers related to disease management.
  • Rural Minority Children's Access to and Timeliness of Immunizations
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2004
    This fact sheet examined whether rural children ages 3-71 months are keeping up with urban children in the receipt of needed vaccinations.
  • Rural Emergency Medical Service (EMS) Infrastructure
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2004
    Prehospital care has become an important element in the spectrum of health services. Approaches for comparing the availability of emergency medical services across communities are a first step in developing policies that ensure equitable access for rural and frontier communities.
  • Emergency Department Use by Medically Indigent Rural Residents (Fact Sheet)
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2004
    An estimated 211 million emergency department visits were made across the United States during 1999-2000, 37 visits per 100 persons per year. Just under a quarter of these, 43 million visits, were made to rural emergency departments.
  • Effects of Medicaid Managed Care and Medicaid Managed Care Penetration on Potentially Avoidable Maternity Complications
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2004
    The effects of Medicaid Managed Care on pregnancy-related complications affecting mothers during their delivery hospitalizations were examined using the Potentially Avoidable Maternity Complications indicator.
  • Diabetes & Hypertension Among Rural Hispanics: Disparities in Diagnostics and Disease Management
    Rural and Minority Health Research Center
    Date: 2004
    Modest health disparities were found among rural Hispanics when examining diabetes. Undiagnosed hypertension was higher for rural residents than for urban residents. A large proportion of persons diagnosed with either disease had poor control of their condition, as indicated by elevated glucose levels or high blood pressure.
  • Barriers to the Delivery of Medicare Reimbursed Diabetes Self-Management Education in Rural Areas
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2004
    Diabetes Self-Management Education programs help newly diagnosed and chronic patients with diabetes learn to manage their care. This project explored the barriers that rural practitioners face in providing diabetes education to Medicare beneficiaries.
  • Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
    Rural and Minority Health Research Center
    Date: 2004
    This study tested a retrospective data set approach for evaluating the effectiveness of a community health worker program to improve pregnancy and birth outcomes. The program uses lay health workers to provide health education, referral, and social support to rural, low income, Medicaid-insured pregnant African-American women and their infants.
  • Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2004
    Acute myocardial infarction (AMI) is a common and important cause of admission to rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. This study examines the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.