Rural Health
Research Gateway

2006 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.

  • Registered Nurse Vacancies in Federally Funded Health Centers
    WWAMI Rural Health Research Center
    Date: 12/2006
    This project summary discusses the registered nurse vacancy rate in federally funded health centers, which varies by degree of rurality.
  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Journal Article
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 12/2006
    Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • Results of the 2004 Health Center Expansion and Recruitment Survey for Health Centers: Analyses for Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI States)
    WWAMI Rural Health Research Center
    Date: 11/2006
    This report presents a subset of the findings from the larger national study of Federally Qualified Health Center (FQHC) staffing needs of FQHCs located in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) overall and by urban and rural geography.
  • Wyoming Physicians Are Significant Providers of Safety Net Care
    Journal Article
    WWAMI Rural Health Research Center
    Date: 11/2006
    Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.
  • Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 11/2006
    This paper provides an overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration project.
  • Out-of-Pocket Health Spending and the Rural Underinsured
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2006
    This article estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
  • Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2006
    This policy brief analyzes financial ratios associated with critical access hospitals' profitability, liquidity, and capital structure.
  • The Experience of Sole Community Rural Independent Pharmacies With Medicare Part D: Reports From the Field
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 11/2006
    This case study describes firsthand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans in the first seven months of 2006.
  • Rural-Urban Differences in Depression Prevalence: Implications for Family Medicine
    Journal Article
    Rural and Minority Health Research Center
    Date: 10/2006
    Examined the prevalence of depression in rural vs. urban areas. An estimated 2.6 million rural adults suffer from depression. The unadjusted prevalence of depression was significantly higher among rural than urban populations. After adjusting for rural/urban population characteristics, the odds of depression did not differ by residence.
  • Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
    Upper Midwest Rural Health Research Center
    Date: 10/2006
    This report analyzes critical access hospital inpatient hospitalizations and transfers and assesses the implications for national quality measurement and reporting.
  • A Rural Healthcare Quality Agenda
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 09/2006
    An editorial that highlights aspects of the Institute of Medicines' report "Quality Through Collaboration: The Future of Rural Health," known as the "rural report." The editorial serves as an introduction to the journal's special issue on healthcare quality in rural health.
  • Implementation of Pay-for-Performance in Rural Hospitals: Lessons From the Hospital Quality Incentive Demonstration Project (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 09/2006
    This report shares the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
  • Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
    Journal Article
    WICHE Center for Rural Mental Health Research
    Date: 09/2006
    Is there a differential impact of enhanced depression care on patient outcomes in rural vs. urban primary care settings? Differences may be mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that care for depression improved mental health for urban populations, but not rural patients.
  • A Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2006
    This paper focuses on the occupational mix adjustment (OMA) to the labor-related share in the hospital inpatient prospective payment system. The primer explains what the OMA is, why it is needed, and how it has been calculated. In addition, reasons why the effect of the OMA has been less than some rural advocates anticipated are discussed.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2006
    This policy brief provides an overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on physician payment rates in rural areas. The brief discusses the effects of the Medicare incentive payment for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Quality and Performance Improvement Grant Activities Under the Flex Program
    Maine Rural Health Research Center
    Date: 08/2006
    This paper describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program.
  • Roadmap for the Adoption of Health Information Technology in Rural Communities
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2006
    This report assists rural providers who are just beginning their investigations into using health information technology and its applicability to their organizations.
  • Attention From the Top: Roles of State Offices of Rural Health Policy in Preparing for Bioterrorism and Other Health System Emergencies
    NORC Walsh Center for Rural Health Analysis
    Date: 07/2006
    This report presents results from a follow-up survey of directors of state offices of rural health on emergency preparedness in rural communities.
  • Elements of Successful Rural Diabetes Management Programs
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2006
    This report shares findings from a study about local innovations implemented by rural chronic disease management programs. Using diabetes as a proxy for all chronic diseases, the authors explored how local innovations overcame challenges of the rural setting to provide effective and efficient disease management.
  • Mode of Travel and Actual Distance Traveled For Medical or Dental Care By Rural and Urban Residents
    Rural and Minority Health Research Center
    Date: 05/2006
    This report discusses the cost and difficulty associated with travel for medical or dental care, which may serve as a barrier for rural populations.
  • Defining the Term "Frontier Area" for Programs Implemented Through the Office for the Advancement of Telehealth
    Upper Midwest Rural Health Research Center
    Date: 05/2006
    This report provides an overview of current frontier definitions and describes the process used to develop a new frontier area definition that could be applied to telehealth programs.
  • Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
    NORC Walsh Center for Rural Health Analysis
    Date: 05/2006
    This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes and to ascertain whether there are agency characteristics that are associated with better or worse outcomes.
  • The Current Status of Health Information Technology Use in CAHs
    University of Minnesota Rural Health Research Center
    Date: 05/2006
    The purpose of this briefing paper is to assess the current status of health information technology use in critical access hospitals nationally.
  • Chronic Disease Management Systems (Registries) in Rural Health Care
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2006
    A Chronic Disease Management System (CDMS) is a tool that helps providers collect and analyze patient information to promote quality care. This study shows that CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology.
  • Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources
    Journal Article
    Rural and Minority Health Research Center
    Date: 04/2006
    Proposes a county-level indicator of emergency medical services (EMS) resource availability that takes into consideration existing EMS resources, population health and demographics, and geographic factors. The indicator, the expected annual emergency miles per ambulance, provides a basis for comparing ambulance availability across counties.
  • The Effect of Rural Hospital Closures on Community Economic Health
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2006
    This article describes the effect of hospital closures on the local economies based on a study of county-level economic data for 1990-2000 in rural counties experiencing hospital closures.
  • Creating Program Logic Models: A Toolkit for State Flex Programs
    Maine Rural Health Research Center
    Date: 04/2006
    This is a tool for planning, managing, reporting on, and assessing Flex Program goals, activities, and accomplishments; assistance in identifying/defining measurable outcomes; information linking state-level Flex Program strategies to measurable outcomes; and a consistent program-reporting framework to share results internally and externally.
  • Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2006
    This policy brief provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program.
  • Rural Dental Practice: A Tale of Four States (Project Summary)
    WWAMI Rural Health Research Center
    Date: 03/2006
    This project summary provides an overview of survey results of rural dentists in Alabama, California, Maine, and Missouri. It provides charts and statistics on dentist demographics, dental hygienist and dental assistant vacancy rates, and dentist participation in Medicaid.
  • Rural Dental Practice: A Tale of Four States (Full Report)
    WWAMI Rural Health Research Center
    Date: 03/2006
    This paper reports the findings of a study investigating rural dentist issues, such as demography, training, practice characteristics, staff, and job satisfaction, in Alabama, California, Maine, and Missouri.
  • Local Public Health at the Crossroads: The Structure of Health Departments in Rural Areas (Issue Brief)
    FORHP-funded Individual Grantees
    Date: 03/2006
    This issue brief provides an overview of findings from a study of the structure of rural local public health departments. It includes policy recommendations.
  • Local Public Health at the Crossroads: The Structure of Health Departments in Rural Areas (Report)
    FORHP-funded Individual Grantees
    Date: 03/2006
    This report shares the results of a study on the structure of local health departments in rural areas. It includes case studies describing the structure of local health departments in rural areas in six geographically disparate states: Arizona, Georgia, Kansas, Louisiana, Pennsylvania, and Washington.
  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    This paper examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. It highlights recent trends in state Flex Program planning, development, and implementation.
  • Problem Drinking: Rural and Urban Trends in America, 1995/1997 to 2003
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/2006
    Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents.
  • The Changing Geography of Americans Graduating From Foreign Medical Schools
    Journal Article
    WWAMI Rural Health Research Center
    Date: 02/2006
    Reports the results of a study of U.S.-born international medical graduates, analyzing changes in their numbers and countries of training from the 1960s and before until the early 2000s.
  • CAH Participation in Hospital Compare and Initial Results
    University of Minnesota Rural Health Research Center
    Date: 02/2006
    This paper examines 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 presents the initial results for CAHs and comparisons with other hospital groups on quality measures for various conditions.
  • Differences Between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample
    Journal Article
    Southwest Rural Health Research Center
    Date: 02/2006
    This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care.
  • Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2006
    This paper describes the emergency medical services-related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-05.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
    Maine Rural Health Research Center
    Date: 02/2006
    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 and provides a context for legislation that affects rural health services and populations.
  • Trends Over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2006
    This findings brief examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals.
  • Rural Public Health Infrastructure: Case Studies to Assess the Impact of Structure on Service Delivery
    NORC Walsh Center for Rural Health Analysis
    Date: 01/2006
    The purpose of this study is to contribute to a more thorough understanding of how public health governance affects how states structure and organize the delivery of public health services and how this influences the strategies adopted for meeting community public health needs in rural areas.
  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 01/2006
    This study's results indicate that many small rural hospitals have limited hours of onsite pharmacist coverage and many either don't have a pharmacy computer or don't use it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
  • Premium Assistance Programs for Low Income Families: How Well Does It Work in Rural Areas?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2006
    This paper reports the results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals.
  • Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Objective: To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives).
    Methods: All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
    Results: Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers' most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
    Conclusion: Liability insurance premiums rose dramatically from 2002 to 2004 for Washington's obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study's results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.
  • Mental Health and Rural America: 1994-2005
    WICHE Center for Rural Mental Health Research
    Date: 2006
    This report provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades.
  • Will Rural Family Medicine Residency Training Survive?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    This report shares the results of a study examining the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability.
  • Health Risks Factors Among American Indians and Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2006
    Chronic disease rates are higher among American Indian and Alaska Native elders although they exercise more and have higher rates of participation in multiple exercise activities. Research concerning the relationship between chronic disease and health risk factors is limited for American Indian and Alaska Native elder populations. This paper indicated results of an analysis of the effect of risk factors on chronic disease from a survey of 9,296 Native elders, representing 171 tribes from 88 sites. The sampling design employed systematic random sampling for larger tribes, with smaller tribes (fewer than 200) interviewing all or the majority of their elders. The data suggest that smokers, drinkers, and non-exercisers are at increase risk for chronic disease.
  • Rural Residence and Hispanic Ethnicity: Doubly Disadvantaged for Diabetes?
    Journal Article
    Rural and Minority Health Research Center
    Date: 2006
    Determines whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes.
  • Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2006
    Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
  • Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
    Maine Rural Health Research Center
    Date: 2006
    This report discusses barriers to mental and behavioral health service delivery in rural America. It includes model programs and model policy strategies for rural mental and behavioral healthcare delivery and discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.
  • Mental Healthcare in Rural Communities: The Once and Future Role of Primary Care
    Journal Article
    Maine Rural Health Research Center
    Date: 2006
    Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.
  • Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
    Maine Rural Health Research Center
    Date: 2006
    There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
  • Stakeholder Benefit From Depression Disease Management: Differences by Rurality?
    WICHE Center for Rural Mental Health Research
    Date: 2006
    Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two stakeholder groups economically benefit from improved depression.
  • PTSD and Substance Use: Unrecognized Sequelae of Bioterrorism in Primary Care Providers
    Journal Article
    FORHP-funded Individual Grantees
    Date: 2006
    Study looks at rural primary care providers' knowledge of likely mental disorders, their risk factors, and preferred treatment options following a public health emergency.
  • Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism
    Journal Article
    FORHP-funded Individual Grantees
    Date: 2006
    Describes the need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental healthcare in rural communities.
  • Shortages of Medical Personnel At Community Health Centers: Implications for Planned Expansion
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Examines the status of workforce shortages that may limit Community Health Center (CHC) expansion by surveying all 846 federally-funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia.
  • Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Identifies mental health shortage areas using existing licensing and survey data. Shortages of mental health providers exist throughout the state, especially in rural areas. Urban areas had 3x the psychiatrist full-time equivalents (FTEs) per 100,000 and more than 1.5x the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas.
  • Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
    Journal Article
    Rural and Minority Health Research Center
    Date: 2006
    Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Potentially avoidable maternity complications in rural hospitals, African Americans had higher risk for complications than did non-Hispanic whites.
  • Care Across the Continuum: Access to Health Care Services in Rural America (2006)
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 2006
    The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
  • The Effect of Rural Residence On Dental Unmet Need for Children With Special Health Care Needs
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2006
    Unmet need for dental care is the most prevalent unmet healthcare need among children with special healthcare needs (CSHCN). The combination of rural residence and special healthcare needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs.
  • Emergency Medical Services and the Federal Government's Evolving Role: What Rural and Frontier Emergency Medical Services Advocates Should Know
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2006
    Examines the debate around recent recommendations for an expanded federal role in supporting Emergency Medical Services (EMS). If federal expansion were to occur, the author recommends that responsibility for EMS be placed in the Department of Health and Human Services.
  • Smallest Rural Hospitals Treat Mental Health Emergencies
    Maine Rural Health Research Center
    Date: 2006
    This research and policy brief discusses the extent to which rural emergency rooms encounter and treat mental health patients.
  • Rural Residents More Likely to Be Underinsured
    Maine Rural Health Research Center
    Date: 2006
    Studies have shown that rural residents have high uninsured rates. However, even those with private health insurance coverage can be at risk of having high out-of-pocket healthcare costs. Understanding the degree to which rural residents are underinsured has important implications for rural health policy and practice.
  • Prevalence and Trends in Smoking: A National Rural Study
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Using data from the Behavioral Risk Factor Surveillance System, the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states. However, it increased by 2 percent or more in ten states.