2009 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.

Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
Maine Rural Health Research Center
Date: 12/2009
This policy brief finds that few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100-mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
Availability, Characteristics, and Role of Detoxification Services in Rural Areas
Maine Rural Health Research Center
Date: 12/2009
Few detox providers (n=235) serve rural America; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve patients across a 100-mile radius, making travel distances a barrier to outpatient care. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
Rural Primary Care Physician Payment 2006-2009: What a Difference Three Years Doesn't Make
RUPRI Center for Rural Health Policy Analysis
Date: 11/2009
The analysis in this brief shows the impact of Medicare's Evaluation and Management (E&M) service valuation adjustment (implemented January 1, 2007) on two prototypical primary care practices—one providing only E&M services and the other providing a mix of procedures and E&M services.
Rural-Urban Differences in Depression Care (Working Paper)
WICHE Center for Rural Mental Health Research
Date: 10/2009
This paper assesses the association between rurality and depression care. It reports that rural individuals are more reliant on pharmacotherapy than psychotherapy.
Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents Between Rural and Urban Prescribers
WICHE Center for Rural Mental Health Research
Date: 10/2009
This study reports that prescriptions of all psychotropic drug categories increased for urban and rural populations during the 10-year study period. Urban youth were more likely to be prescribed psychotropic medications by psychiatrists. In contrast, rural youth were more likely to have psychotropics prescribed by generalists or other prescribers.
Implementing Patient Safety Initiatives in Rural Hospitals
Journal Article
University of Minnesota Rural Health Research Center
Date: 09/2009
This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in eight small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of three patient safety interventions.
Mental Health Services in Rural Jails (Policy Brief)
Policy Brief
Maine Rural Health Research Center
Date: 09/2009
The prevalence of mental illness among prison and jail inmates has attracted increasing attention in both mental health and criminal justice circles.
Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America
Policy Brief
WWAMI Rural Health Research Center
Date: 09/2009
This policy brief finds that resources are needed to increase and sustain the number of primary care providers and reduce financial barriers to care in all rural primary care health professional shortage areas.
Distance Education Training in Behavioral Health: A Rural Primary Care Needs Assessment and Pilot Webcast
WICHE Center for Rural Mental Health Research
Date: 08/2009
Primary care providers (PCPs) are often the only resource for rural/frontier residents needing mental healthcare. Mental health training is not easily accessible for PCPs working in rural settings. Distance education offers a low-cost, convenient way for PCPs to obtain the information necessary to treat the mental health needs of their patients.
Addressing Suicide Potential and Prevention in Rural and Frontier Areas: Suicide Prevention Toolkit for Rural Primary Care Providers
WICHE Center for Rural Mental Health Research
Date: 08/2009
Suicide rates in rural areas are significantly higher than they are in urban areas for men of all ages and for young women. Research shows that many people visit their primary care physician instead of a mental health provider for mental health problems. A Suicide Prevention Toolkit for rural primary care providers is provided.
Profile of Sole Community Pharmacists' Prescription Sales and Overall Financial Position
Rapid Response to Requests for Rural Data Analysis
Date: 08/2009
We conducted a survey of community pharmacists who owned the only retail outlets in their communities. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine their reliance on prescription sales and to understand their stores' current financial positions.
Potentially Preventable Readmissions in Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 08/2009
Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals and discusses the rural implications of policy initiatives to reduce readmission rates.
A Case Study of Developments in Rural Health in Difficult Economic Times: Nemaha County, Nebraska
RUPRI Center for Rural Health Policy Analysis
Date: 08/2009
The U.S. healthcare crisis is especially strong in rural communities. The experience of Nemaha County, a small county located in southeastern Nebraska, illustrates the reach of these problems into counties that are somewhat stable during times of economic turbulence.
A Case Study of Developments in Rural Health in Difficult Economic Times: Walthall County, Mississippi
RUPRI Center for Rural Health Policy Analysis
Date: 08/2009
The U.S. healthcare crisis is especially strong in rural communities. The experience of Walthall County, a small county located in southwestern Mississippi, exemplifies these problems.
A Case Study of Developments in Rural Health in Difficult Economic Times: Leake County, Mississippi
RUPRI Center for Rural Health Policy Analysis
Date: 08/2009
The U.S. healthcare crisis is especially strong in rural communities. The experience of Leake County, a rural Mississippi county, embodies these problems.
July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
RUPRI Center for Rural Health Policy Analysis
Date: 08/2009
Rural enrollment in Medicare Advantage continues to increase, with growth in the last 18 months led by the growth of preferred provider organization (PPO) plans. Despite the growth in PPO plans, private fee-for-service plans continue to dominate enrollment in rural areas and have accounted for much of the program's growth since 2005.
Community Health Center and Rural Health Clinic Presence Associated With Lower County-Level Hospitalization Rates for Ambulatory Care Sensitive Conditions (Fact Sheet)
Rural and Minority Health Research Center
Date: 08/2009
This study examines the contribution that community health centers and rural health clinics make to access to healthcare, as measured by rates of ambulatory care sensitive hospitalizations.
Community Health Center and Rural Health Clinic Presence Associated With Lower County-Level Hospitalization Rates for Ambulatory Care Sensitive Conditions (Full Report)
Rural and Minority Health Research Center
Date: 08/2009
Using data from eight states, this report examines the effect of the presence of a federally qualified community health center or rural health clinic within a county on population rates of hospitalization for ambulatory care sensitive conditions.
Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
Maine Rural Health Research Center
Date: 07/2009
This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
Workforce Issues Among Sole Community Pharmacies
North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
Date: 07/2009
This brief explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacies' futures.
Medicaid & CHIP Participation Among Rural & Urban Children
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2009
This policy brief describes the characteristics of rural and urban children who qualify for Medicaid or CHIP but are uninsured.
Characteristics of Rural & Urban Children Who Qualify for Medicaid or CHIP but Are Not Enrolled
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2009
About three-quarters of children who qualify for Medicaid or CHIP are enrolled, with slightly higher rates in rural areas than in urban areas. This leaves one in four qualified children without insurance coverage.
A Case Study of Rural Health Care in the Economic Downturn
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2009
This report describes the economic and healthcare environment in Ashe County, a rural community in the mountains of western North Carolina. The experience in Ashe County exemplifies the healthcare challenges faced in many rural areas across the country.
Rural Residents Lag in Preventive Services Use; Lag Increases With Service Complexity
Rural and Minority Health Research Center
Date: 06/2009
This research brief describes the receipt of preventive services among rural adults and explores the factors that are related to disparities in utilization.
Rural-Urban Differences in Health Care Access Vary Across Measures
Maine Rural Health Research Center
Date: 06/2009
Higher uninsured rates and workforce shortages in rural areas suggest that rural residents face greater barriers to accessing healthcare than their urban counterparts. Analysis of the 2006 Medical Expenditure Panel Survey found mixed results.
Rural Issues Related to Bundled Payments for Acute Care Episodes
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2009
Bundling Medicare payments has been proposed as a way of encouraging providers to find innovative, cost-reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address the challenges.
Health Information Technology Policy and Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2009
This brief summarizes the implementation status of key health information technology (HIT) applications in critical access hospitals and other rural hospitals and discusses policies for encouraging HIT adoption in rural hospitals.
Rural Issues Related to Comparative Effectiveness Research and Dissemination
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2009
This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.
The Future of Family Medicine and Implications for Rural Primary Care Physicians
Policy Brief
WWAMI Rural Health Research Center
Date: 06/2009
The shortage of providers in rural areas is being worsened by the decline in student interest in family medicine. This study examines the rural physician shortage based on an analysis of a cohort of recent medical school graduates, the effect of trends in specialty selection on provider supply, and major trends impacting healthcare delivery.
The Availability of Family Medicine Residency Training in Rural Locations of the United States
Policy Brief
WWAMI Rural Health Research Center
Date: 06/2009
Family physicians constitute the largest proportion of the rural primary care physician workforce, yet declining student interest in rural family medicine may worsen rural primary care shortages.
The Aging of the Primary Care Physician Workforce: Are Rural Locations Vulnerable?
Policy Brief
WWAMI Rural Health Research Center
Date: 06/2009
Large numbers of primary care physicians are nearing retirement as fewer new U.S. medical graduates are choosing primary care careers. This policy brief describes the rural areas of the U.S. where impending retirements threaten access to primary care and offers potential solutions to the problem.
Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
RUPRI Center for Rural Health Policy Analysis
Date: 06/2009
This brief presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas during the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas.
A Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2009
This brief uses a RUPRI health insurance model to compare the effects of a building blocks approach on health insurance coverage and health spending, focusing on the geographic differences (by metropolitan and non-metropolitan) of this approach.
Profile of Rural Health Insurance Coverage: A Chartbook
Maine Rural Health Research Center
Date: 06/2009
Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural vs. urban residents who are uninsured or covered through public sources. Uninsured rates are highest among adults over age 50 in the most remote rural places.
May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
RUPRI Center for Rural Health Policy Analysis
Date: 06/2009
Rural Medicare Advantage (MA) enrollment had rapid growth in preferred provider organization (PPO) plans and a decline in the growth rate of private fee-for-service (PFFS) plans. MA enrollment has continued to climb, but it has been impacted by the slowed rate of growth in PFFS plans, which cover more than half of MA enrollees in rural areas.
The Association Between Rural Residence and the Use, Type, and Quality of Depression Care
Policy Brief
WICHE Center for Rural Mental Health Research
Date: 05/2009
The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression.
Satisfaction With Practice and Decision to Relocate: An Examination of Rural Physicians
NORC Walsh Center for Rural Health Analysis
Date: 05/2009
The goal of this project was to improve our understanding of the dynamics of physician practice location decision making.
April 2009 Rural Enrollment in Medicare Advantage: Growth in PPOs Outpacing Growth in PFFS
RUPRI Center for Rural Health Policy Analysis
Date: 05/2009
Private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
Trends in Perinatal and Infant Health Disparities Between Rural American Indians and Alaska Natives and Rural Whites
Journal Article
WWAMI Rural Health Research Center
Date: 04/2009
Examines perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time. Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close health gaps for this group.
Private Health Insurance in Rural Areas: Challenges and Opportunities
Policy Brief
Maine Rural Health Research Center
Date: 04/2009
This brief discusses the challenges of expanding private coverage in rural areas and describes policy options to address them.
The Crisis in Rural Dentistry
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2009
Reports from the surgeon general and the Institute of Medicine call for more dentists in rural locations. Federal and state programs have focused on expanding the rural dentist supply, but efforts may need to intensify to meet the needs of rural communities.
Threats to the Future Supply of Rural Registered Nurses
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2009
Shortages of registered nurses (RNs) in rural areas of the United States may grow even greater in the coming years as the "baby boom" generation retires and as RNs commute to larger towns and urban areas for work.
The Crisis in Rural General Surgery
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2009
The decline in the number of rural general surgeons has caused a crisis. General surgeons are vital to the rural healthcare system, performing emergency operations, underpinning the trauma care system, backing up primary care providers, reducing drive time for rural residents, and contributing to the financial viability of small hospitals.
The Crisis in Rural Primary Care
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2009
The number of students choosing primary care careers has declined precipitously. Low compensation, rising malpractice premiums, professional isolation, limited time off, and scarcity of jobs for spouses discourage the recruitment/retention of rural primary care providers.
Loss of Community Pharmacies Since 2006: State Experiences
RUPRI Center for Rural Health Policy Analysis
Date: 04/2009
This brief presents the latest data from a continuous monitoring of the status of rural pharmacies by the RUPRI Center. The brief includes a table showing the data by state.
The Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2009
This brief presents findings from a survey of 401 community pharmacists who are the only retail providers in their communities. It documents their extended relationships with other healthcare providers and the additional healthcare services these pharmacists provide to their patients.
Rural Enrollment in Medicare Advantage: Growth Slows in 2008
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2009
The rate of growth of enrollment in the Medicare Advantage program decreased significantly in 2008, compared to previous years. The growth rate in preferred provider organization plans in rural areas now exceeds that in private fee-for-service plans. This updates earlier findings from analysis of the MA program reported by the RUPRI Center.
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2009
This policy brief describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2009
This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used prescription drug plans available in their state.
Rural Coverage Gaps Decline Following Public Health Insurance Expansions
Policy Brief
Maine Rural Health Research Center
Date: 02/2009
This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural/urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss characteristics of the rural uninsured and the implications for health insurance reform.
Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 02/2009
This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality-improvement initiatives.
Rural Children Don't Receive the Mental Health Care They Need
Policy Brief
Maine Rural Health Research Center
Date: 01/2009
Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children. Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas.
A Rural-Urban Comparison of Allied Health Average Hourly Wages
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2009
This report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for 11 allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates.
Medicare Beneficiaries' Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies With Part D Plans
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2009
This report describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
Rural Public Health Policy Models to Address an Evolving Environmental Asbestos Disaster
Journal Article
FORHP-funded Individual Grantees
Date: 2009
Describes the history and outcomes of asbestos exposure in the Libby, Montana community and discusses 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.
Do International Medical Graduates (IMGs) "Fill the Gap" in Rural Primary Care in the United States? A National Study
Journal Article
WWAMI Rural Health Research Center
Date: 2009
Compares the practice locations of international medical graduates (IMGs) and U.S. medical graduates (USMGs) in primary care specialties.