2005 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.

Dentist Vacancies in Federally Funded Health Centers
WWAMI Rural Health Research Center
Date: 12/2005
This project summary presents results for dentists from a study of staffing needs at Federally Qualified Health Centers (FQHCs). It provides information on dentist vacancy rates by rural and urban location and compares dentist vacancies to other healthcare provider vacancies at FQHCs.
Out-of-Pocket Health Care Spending and the Rural Underinsured
Maine Rural Health Research Center
Date: 12/2005
This paper reports the results of a study to identify whether and to what extent there are rural-urban differences in underinsured rates among the privately insured, and, where differences exist, to understand what characteristics of rural residents are related to their likelihood of being underinsured.
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
Upper Midwest Rural Health Research Center
Date: 12/2005
This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
Rural Diabetes Care Management Programs: An Inventory of Sample Programs in Six States
RUPRI Center for Rural Health Policy Analysis
Date: 12/2005
This report was developed to share key contact and program information with organizations that are interested in starting a chronic disease management program in their facility.
The Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 12/2005
This policy brief explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons during the period when the reform was phased in.
Family Physician Vacancies in Federally Funded Health Centers
WWAMI Rural Health Research Center
Date: 11/2005
This project summary presents results for family physicians from a study of staffing needs at Federally Qualified Health Centers (FQHCs). The summary provides information on family physician vacancy rates by rural and urban location and compares family physician vacancies to other physician vacancies at FQHCs.
Barriers Associated With the Delivery of Medicare Reimbursed Diabetes Self-Management Education
Journal Article
University of South Carolina Rural Health Research Center
Date: 11/2005
Explores the barriers that practitioners face in providing diabetes self-management education to Medicare beneficiaries. Barriers identified for rural providers include costs, the shortage of designated specialists, fewer resources, amount of Medicare reimbursement, transportation and more.
Why Are Health Care Expenditures Increasing and Is There a Rural Differential?
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2005
Rising healthcare expenditures have disproportionately affected rural areas and in recent years seen higher increases in some expenditure categories, such as physician office-based visits and prescription drugs. Differences suggest strategies to contain health expenditure increases may be different in rural areas and determined on a local basis.
Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2005
This policy brief explores how predictions of changes in hospital financial performance differ when comparing results using data from the Medicare Cost Report (MCR) to data from the audited hospital financial statement (FS). Results indicate that using the MCR rather than FS data is more valid.
Washington State Hospitals: Results of the 2005 Workforce Survey
WWAMI Rural Health Research Center
Date: 10/2005
A survey of nonfederal acute care hospitals found growth in Washington's hospital sector is keeping demand for healthcare occupations high, even when vacancy rates for some jobs appear to be lower than in the past. This growth, and the shift away from contracting employees, should be considered in future workforce supply and demand projections.
Community-Level Risk Factors for Depression Hospitalizations
Policy Brief
WICHE Center for Rural Mental Health Research
Date: 09/2005
This policy brief examines the association between depression hospitalization rates and community-level socio-demographic, economic, and healthcare system characteristics.
Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
WICHE Center for Rural Mental Health Research
Date: 09/2005
This paper explored whether a depression disease management program has a comparable impact on clinical outcomes over two years in patients treated in rural and urban primary care practices.
Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
Maine Rural Health Research Center
Date: 09/2005
This survey investigates the extent and types of cases that present with mental health problems in critical access hospital emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to these patients.
Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
NORC Walsh Center for Rural Health Analysis
Date: 09/2005
This report investigates the impact of possible changes to the Medicare disproportionate share payment policy, designed to incorporate information on the hospital's uncompensated care burden as well as to improve the payment formulae.
Pathways to Rural Practice: A Chartbook of Family Medicine Residency Training Locations and Characteristics
WWAMI Rural Health Research Center
Date: 08/2005
This chartbook discusses the characteristics and geography of family medicine residency programs' rural locations, types of rural family medicine training by location, and rural mission of family medicine residencies.
Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
NORC Walsh Center for Rural Health Analysis
Date: 08/2005
This report describes a study conducted on the rural effects of the PPS, including whether the PPS contributed to changes in the demographic and clinical characteristics of home care users, the likelihood of using each of six home care disciplines, and the intensity of services.
Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2005
Keeping with their organizational missions to improve and promote the health of rural Americans, state offices of rural health and state rural health associations have an inherent interest in helping beneficiaries access necessary healthcare services, including prescription medications.
Rural Definitions for Health Policy and Research
Journal Article
WWAMI Rural Health Research Center
Date: 07/2005
Defining "rural" for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of "rural" is required for effectively targeting policy and research aimed at improving the health of rural Americans.
WWAMI Physician Workforce 2005
WWAMI Rural Health Research Center
Date: 05/2005
This report responds to a request by the University of Washington School of Medicine Primary Care Steering Committee to examine the current supply and distribution of physicians in the WWAMI region.
More Culturally Sensitive Neuropsychological Tests (and Normative Data) Needed
Journal Article
Upper Midwest Rural Health Research Center
Date: 04/2005
Discusses the need for culturally sensitive tests and normative data regarding the Native elder population.
Geographic Access to Health Care for Rural Medicare Beneficiaries
WWAMI Rural Health Research Center
Date: 04/2005
This study looked at where Medicare beneficiaries from five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care.
Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
Maine Rural Health Research Center
Date: 03/2005
Three years of data were used to examine services offered by critical access hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in the changes, and the reasons administrators gave for reported service expansions. They also looked at how services in CAHs have changed over time.
Patterns of Post-Acute Utilization in Rural and Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
NORC Walsh Center for Rural Health Analysis
Date: 03/2005
This report describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities.
Home Health Payment Reform: Trends in the Supply of Rural Agencies and Availability of Home-Based Skilled Services
NORC Walsh Center for Rural Health Analysis
Date: 03/2005
Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place.
Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
Maine Rural Health Research Center
Date: 02/2005
This book provides policymakers 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 that affects rural health services and populations.
The Flight of Physicians From West Africa: Views of African Physicians and Implications for Policy
Journal Article
WWAMI Rural Health Research Center
Date: 2005
West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes, and consequences of the migration.
Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders
Journal Article
Upper Midwest Rural Health Research Center
Date: 2005
Reports the results of an analysis of chronic disease's effect on functional limitation from a survey of 7,107 Native elders representing 143 tribes from 77 sites.
One Size Fits Some: The Impact of Patient Treatment Attitudes on the Cost-Effectiveness of a Depression Primary Care Intervention
Journal Article
WICHE Center for Rural Mental Health Research
Date: 2005
This study reports the estimated impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.
Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000
Journal Article
WWAMI Rural Health Research Center
Date: 2005

The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow healthcare professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity.
A National Study of Obesity Prevalence and Trends by Type of Rural County
Journal Article
WWAMI Rural Health Research Center
Date: 2005
Analyzes data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001 to estimate the recent trends in obesity among U.S. adults residing in rural locations. In 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for urban, representing increases of 4.8% and 5.5%, respectively, since 1994-1996.
Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services?
Journal Article
WICHE Center for Rural Mental Health Research
Date: 2005
Analyses show primary care service use increases were associated with increases in all specialty outpatient services and inpatient services, as well as increases in inpatient/outpatient costs. Results show that health systems can implement strategies encouraging members to use more primary care services without driving up physical health costs.
Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?
Journal Article
WICHE Center for Rural Mental Health Research
Date: 2005
This article examines whether the establishment of community-based outpatient clinics has affected access, use, and costs for the Department of Veterans Affairs.
Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
Journal Article
NORC Walsh Center for Rural Health Analysis
Date: 2005
Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy.
Factors Associated With Incidence of Inappropriate Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children
Journal Article
Upper Midwest Rural Health Research Center
Date: 2005
An analysis was conducted to identify a set of significant predictors of cases of inappropriate deliveries to acute care facilities with no trauma-center designation of any level. Greater distance to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving corresponded to higher probabilities of mistriage.
Chronic Disease in American Indian/Alaska Native Elders
Journal Article
Upper Midwest Rural Health Research Center
Date: 2005
This journal article describes the prevalence of chronic diseases among Native American elders.
Recruitment and Retention of EMTs: A Qualitative Study
Journal Article
University of South Carolina Rural Health Research Center
Date: 2005
Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics.
More May Be Better: Evidence of a Negative Relationship Between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
Journal Article
University of South Carolina Rural Health Research Center
Date: 2005
The authors conducted an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions.
The Federal Employees Health Benefits Program: A Model for Competition in Rural America?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 2005
Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas.
The Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2005
Are self-reports of unmet need a biased measure of access to healthcare? We examined the relationship between rural residence and perceived need for physician services and the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs.
How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Preimplementation Prescription Volume and Payment Sources in Rural and Urban Areas
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2005
Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the Medicare Prescription Drug, Improvement, and Modernization Act may affect the financial viability of rural independent pharmacies.
Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
Journal Article
Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
Date: 2005
The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.
Comparing Patient Safety in Rural Hospitals by Bed Count
Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
Date: 2005
This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.