2010 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.

Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 12/2010
The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
Nurse Staffing and Rural Hospital Performance
Policy Brief
Upper Midwest Rural Health Research Center
Date: 12/2010
This policy brief examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Rural Hospital Support for Emergency Medical Services (Final Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2010
This report shares information on rural hospitals related to these questions: what proportion support/operate emergency medical services (EMS) units; has this changed; what are the characteristics of the hospitals that support/operate EMS; what investments were made in EMS; and what describes the communities where the hospitals are located?
Rural Hospital Support for Emergency Medical Services (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2010
This study looked at rural hospitals to answer these questions: what proportion support/operate emergency medical services (EMS) units; has this changed; what are the characteristics of the hospitals that support/operate EMS; what financial investments were made in EMS; and what describes the communities where the hospitals are located?
Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 11/2010
Potentially preventable readmissions (PPRs) among Medicare patients are examples of inefficiencies in the healthcare system. This study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS), rural PPS, and Critical Access Hospitals.
September 2010: Rural Medicare Advantage Enrollment Update
RUPRI Center for Rural Health Policy Analysis
Date: 11/2010
Rural enrollment in Medicare Advantage (MA) plans grew to nearly 1.5 million enrollees in September 2010 (15% of eligible Medicare beneficiaries), while national MA enrollment grew to more than 11.5 million (25%). Rural Medicare beneficiaries will find fewer options for MA health insurance coverage in 2011.
Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison (Final Report)
Rural and Minority Health Research Center
Date: 11/2010
Nearly 20% of the U.S. population resides in non-metropolitan areas, yet our knowledge about the prevalence of obesity in rural America is limited. Previous research found that rural children, paradoxically, were more likely to be overweight or obese and more likely to be physically active than urban children.
Many Urban and Rural Workers Lose Health Insurance During Job Transitions
Policy Brief
Maine Rural Health Research Center
Date: 10/2010
This policy brief explores the impact of changes in employment status on insurance coverage for rural and urban workers and the factors behind any differences.
Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
Maine Rural Health Research Center
Date: 10/2010
This study explores the impact of changes in employment status on insurance coverage for rural and urban workers.
The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
Upper Midwest Rural Health Research Center
Date: 10/2010
This policy brief describes the impact of ambulatory surgery centers on rural hospital markets.
The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006
Policy Brief
Upper Midwest Rural Health Research Center
Date: 10/2010
This policy brief uses a retrospective analysis of data on rural hospital, ambulatory surgery center (ASC), and market characteristics for the years 1997 through 2006 to assess the impact of freestanding ASCs on rural hospital performance.
Mental Health Problems Have Considerable Impact on Rural Children and Their Families
Policy Brief
Maine Rural Health Research Center
Date: 10/2010
This policy brief provides information on the prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs.
Access to Mental Health Services and Family Impact of Rural Children With Mental Health Problems
Maine Rural Health Research Center
Date: 10/2010
Rural children are more likely to have mental health problems, to have behavioral difficulties, and to be usually or always affected by their conditions than urban children. Rural children also are more likely to go without access to all parent-reported needed mental health services, and their families spend more time coordinating their care.
The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 09/2010
This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
Rural Volunteer EMS: Reports From the Field (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2010
This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals With Special Medicare Payment Provisions (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2010
This study compares the profitability of urban/rural hospitals paid under PPS (U-PPS and R-PPS, respectively) to rural hospitals with special Medicare payment provisions between 2007 and 2009.
Are Rural Health Clinics Part of the Rural Safety Net?
Policy Brief
Maine Rural Health Research Center
Date: 09/2010
This policy brief examines whether rural health clinics are part of the rural safety net.
Safety Net Activities of Independent Rural Health Clinics
Maine Rural Health Research Center
Date: 09/2010
Rural Health Clinics (RHCs) provide primary care services to rural residents of 45 states. Since RHCs are in underserved rural areas and serve vulnerable populations, many consider them safety net providers. In this paper, we explore whether, and to what extent, independent RHCs are serving a safety net role or have the capacity to do so.
Toxics Release Inventory Discharges and Population Health Outcomes in Rural and Urban Areas of the United States (Final Report)
West Virginia Rural Health Research Center
Date: 08/2010
This report examined if chemical releases from facilities monitored in the Toxics Release Inventory (TRI) program were associated with population mortality rates and birth outcomes for rural/urban populations. It also examined whether rural/urban areas with poor socioeconomic status or higher percentages of minorities had greater TRI releases.
Rural Health Snapshot 2010
Rapid Response to Requests for Rural Data Analysis
Date: 08/2010
The Rural Health Snapshot displays selected indicators of access to healthcare, health behavior/risk factors, and mortality rates, comparing rural to urban residents.
Mental Health Services in Rural Jails (Working Paper)
Maine Rural Health Research Center
Date: 08/2010
This study explored the role of rural jails in the mental health systems in rural communities, investigating how rural jails manage mental health and substance abuse problems among inmates, determining barriers to providing mental health services faced by rural jails, and identifying promising practices for service delivery.
Rural Volunteer EMS: Reports From the Field (Final Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2010
This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
A Comparison of Rural Hospitals With Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment (Final Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2010
This final report compares the financial performance and condition of rural hospitals with special Medicare payment provisions to urban and rural hospitals paid under prospective payment (UPPS and R-PPS hospitals, respectively). Nine ratios from the three most common categories of ratios used in financial statement analysis (profitability, liquidity, and capital structure) as well as four other ratios that are commonly used to evaluate rural hospital financial performance are assessed.
The Future of Family Medicine and Implications for Rural Primary Care Physician Supply (Final Report)
WWAMI Rural Health Research Center
Date: 08/2010
This report examines the rural physician shortage, the effect of recent trends in specialty choice on provider supply, and major trends that are changing the dynamics that shape the delivery of healthcare.
The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Policy Brief)
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 08/2010
Rural practices may be at a disadvantage with respect to participating in the Physician Quality Reporting Initiative, not necessarily because of their geographic location, but because they tend to be smaller and have fewer resources and a less developed quality measurement infrastructure.
The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 08/2010
This report discusses the impact of rurality on office-based physicians' participation in the 2007 Physician Quality Reporting Initiative (PQRI). PQRI offers a financial incentive to physicians and other eligible professionals who successfully report quality measures related to services provided under the Medicare Physician Fee Schedule.
Use of Emergency Departments for Conditions Related to Poor Oral Health Care
NORC Walsh Center for Rural Health Analysis
Date: 08/2010
Persistent and worsening shortages of oral healthcare providers in rural areas, combined with limited acceptance of Medicaid and the Children's Health Insurance Program, have left many patients without adequate access to dental care.
Rural Medicare Advantage: Modest Enrollment Growth in 2010
RUPRI Center for Rural Health Policy Analysis
Date: 08/2010
Despite a slight drop in enrollment and a dramatic shift in the landscape of the rural Medicare Advantage (MA) market in early 2010, MA plans have experienced modest growth in enrollment in rural areas during the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans.
Increases in Primary Care Physician Income Due to the Patient Protection and Affordable Care Act of 2010--Continued Tweaking of Physician Payment
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2010
In this brief, the Affordable Care Act-authorized primary care payment adjustments are modeled in a prototypical rural primary care practice to assess both the potential impact on physician personal income and the likelihood that the changes will achieve the desired policy outcome.
Current Practices and State Regulations Regarding Telepharmacy in Rural Hospitals
Journal Article
University of Minnesota Rural Health Research Center
Date: 07/2010
Telepharmacy practices in rural hospitals in several states were examined, and relevant policies and state laws and regulations were analyzed, along with issues to be addressed as the use of telepharmacy expands.
Family Medicine Residency Training in Rural Locations (Final Report)
WWAMI Rural Health Research Center
Date: 07/2010
This survey of family medicine residency programs found 33 rural programs accounted for more than 80% of family medicine training in rural sites. Expansion of rural family medicine training is limited by Medicare graduate medical education funding caps, financial hardships facing rural hospitals, and the challenges of creating programs.
Is Your Hospital's Board Prepared to Govern? Rural Acute Care Hospital Boards Of Directors: Education and Development Needed
Rural and Minority Health Research Center
Date: 06/2010
This report examines the structural, leadership, and educational needs of rural hospital boards as viewed by rural hospital board chairs and CEOs.
Patient Assessments and Quality of Care in Rural Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 06/2010
This report analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences. It assesses whether rural patients' perspectives of quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
Patient Assessments and Quality of Care in Rural Hospitals
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2010
This policy brief analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
The Patient Protection and Affordable Care Act: A Summary of Provisions Important to Rural Health Care Delivery
RUPRI Center for Rural Health Policy Analysis
Date: 06/2010
This paper provides a summary of legislative provisions contained in the Patient Protection and Affordability Act of 2010 (PPACA) that have particular meaning to rural residents and to the delivery of services in rural areas.
Key Environmental Health Competencies for Rural Primary Care Providers
Policy Brief
West Virginia Rural Health Research Center
Date: 05/2010
Providing healthcare that considers environmental determinants of health, environmental impact on health, and outcomes attributed to environmental issues is complex because of the need for providers to be competent not only in social and health sciences, but also in environmental health concepts.
The Provision of Mental Health Services by Rural Health Clinics
Maine Rural Health Research Center
Date: 05/2010
This study examined changes in the delivery of mental health services by rural health clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services.
Encouraging Rural Health Clinics to Provide Mental Health Services: What Are the Options?
Maine Rural Health Research Center
Date: 05/2010
This study examined changes in the delivery of mental health services by rural health clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services.
Pediatric Care in Rural Hospital Emergency Departments (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 05/2010
This brief analyzes data from the Emergency Pediatric Services and Equipment Supplement to the National Hospital Ambulatory Medical Care Survey. Rural/urban hospitals' responses on pediatric emergency department (ED) care were compared. Rural ED directors also were surveyed to further explore rural pediatric ED care in more detail.
Pediatric Care in Rural Hospital Emergency Departments (Final Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 05/2010
This report analyzes data from the Emergency Pediatric Services and Equipment Supplement to the National Hospital Ambulatory Medicare Care Survey to compare rural and urban hospitals' responses on various dimensions of pediatric emergency department care.
The Effect of Health Information Technology on Quality in U.S. Hospitals
Journal Article
University of Minnesota Rural Health Research Center
Date: 04/2010
This study examines changes in quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures; larger effects in academic than nonacademic hospitals.
A Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2010
This brief compares the profitability of hospitals in the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (critical access, Medicare-dependent, and sole community hospitals and rural referral centers) to urban and rural hospitals paid under prospective payment during a recent three-year period.
States' Use of Cost-Based Reimbursement for Medicaid Services at Critical Access Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2010
This brief documents which states utilize a cost-based reimbursement methodology for Medicaid.
Alternatives to the Outpatient Prospective Payment System: Assessing the Impact on Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 04/2010
The purpose of this policy brief is to explore alternatives to the outpatient prospective system and how these options would affect rural hospitals.
The Effect of Medicare Part D Plan Switching and Formulary Changes on Sole Community Pharmacies and the Patients They Serve
North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
Date: 03/2010
This brief presents findings from a 2008 survey of 401 pharmacist-owners of sole community independent pharmacies.
Key Environmental Health Competencies for Rural Primary Care Providers (Final Report)
West Virginia Rural Health Research Center
Date: 03/2010
The purpose of this study was to develop a set of basic environmental health competencies that are needed by all rural primary care providers to direct healthcare and education policy.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals With Serious Mental Illness (Findings Brief)
WICHE Center for Rural Mental Health Research
Date: 03/2010
This study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in payment sources vary for the seriously mentally ill relative to all other mental health conditions.
Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
Policy Brief
WWAMI Rural Health Research Center
Date: 03/2010
Overall, there has been improvement in acute myocardial infarction quality measures and persistent rural-urban disparities in only a few. Particularly in small/remote small rural locations, developing strategies to increase use of beneficial discharge medications is important.
Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing? (Final Report)
WWAMI Rural Health Research Center
Date: 03/2010
In the mid-1990s, quality of care for acute myocardial infarction (AMI) lagged in rural hospitals, with patients in the smallest and remotest hospitals at greatest risk. Overall quality of AMI care has improved in the United States since that time. Whether these improvements have been consistent across rural and urban hospitals is unknown.
Community Benefit Activities of Critical Access Hospitals, Non-Metropolitan Hospitals and Metropolitan Hospitals: National and State Data (State reports)
Maine Rural Health Research Center
Date: 03/2010
Quality, financial, and community benefit indicators of critical access hospital (CAH) performance are being analyzed by the Flex Monitoring Team. Here, state-level data on performance of CAHs in each state are summarized.
Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
Policy Brief
Maine Rural Health Research Center
Date: 03/2010
This brief examines the community benefit activities of critical access hospitals (CAHs) using data from the Flex Monitoring Team's (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service's (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.
Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper)
Maine Rural Health Research Center
Date: 03/2010
There is a growing national interest in the benefits provided by nonprofit and public hospitals to their communities in exchange for the tax benefits or public funding that they receive.
February 2010: A Dramatic Shift Away From Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
RUPRI Center for Rural Health Policy Analysis
Date: 03/2010
Private fee-for-service (PFFS) enrollment fell in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas fell. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to growth in total MA enrollment.
Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper)
WICHE Center for Rural Mental Health Research
Date: 02/2010
Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental healthcare.
Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States
Policy Brief
West Virginia Rural Health Research Center
Date: 02/2010
Rural counties contain more than 65,000 EPA-recognized point pollution sources. A greater density of water and air pollution sources in rural counties is associated with higher cancer mortality rates, adjusting for other risks. Rural areas also experience mortality risks in association with coal mining activity.
Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States (Final Report)
West Virginia Rural Health Research Center
Date: 02/2010
Rural counties contain more than 65,000 EPA-recognized point pollution sources. A greater density of water and air pollution sources in rural counties is associated with higher cancer mortality rates, adjusting for other risks. Rural areas also experience mortality risks in association with coal mining activity.
December 2009: Rural Medicare Advantage Enrollment Grows 15% in 2009
RUPRI Center for Rural Health Policy Analysis
Date: 01/2010
Rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service plans continued to dominate the market with over 50% of enrollment.
Toxics Release Inventory Discharges and Population Health Outcomes in Rural and Urban Areas of the United States
Policy Brief
West Virginia Rural Health Research Center
Date: 2010

Examined whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program were associated with population mortality rates for both rural and urban populations.
Rural Acute Care Hospital Boards Of Directors: CAHs Lag in Oversight (Fact Sheet)
Rural and Minority Health Research Center
Date: 2010
As small and rural hospitals face changes in finance, reimbursement, quality of care, and workforce shortages, strong governance is essential. Our study explored the structural, leadership, and educational needs of rural hospital boards through a survey of board chairs and CEOs at critical access and prospective payment system hospitals.
Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Childhood Obesity: An Urban and Rural Comparison (Fact Sheet)
Rural and Minority Health Research Center
Date: 2010
This fact sheet reports that the prevalence of those who are overweight and obese is higher among rural children than their urban counterparts.
Quality of Care for Myocardial Infarction in Rural and Urban Hospitals
Journal Article
WWAMI Rural Health Research Center
Date: 2010
In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.