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Rural Health
Research Gateway

2015 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.

  • Rural Bypass for Elective Surgeries
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2015
    Describes the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among Critical Access Hospitals (CAHs) that offer elective surgical services, and factors predictive of bypass.
  • Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2015
    Examines characteristics of rural hospitals that have merged or were acquired during 2005 and 2012. Also compares the change is rural hospital finances, staffing, or services after the merger or acquisition.
  • Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2015
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    Most beneficiaries seek added coverage to close the gap between the care they need and the costs covered by Medicare. This study evaluated rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service.
  • Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study provides detailed information about rural-urban differences among adults younger than age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act.
  • Access to Health Information Technology Training Programs at the Community College Level
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 11/2015
    Successful implementation of health information technology (HIT) in rural areas depends on a well-trained HIT workforce, and community colleges are key in producing this workforce. This study examined HIT workforce development programs in community colleges to find their strengths and needs.
  • Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study finds rural mothers are more likely than urban mothers to smoke. The authors suggest policymakers consider extending insurance for smoking cessation programs through the Affordable Care Act and Medicaid. Programs at the local, state, and national levels also could help reduce disparities in smoking-related morbidity and mortality.
  • Obesity and Obesity-Related Behaviors Among Rural and Urban Adults in the United States
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 10/2015
    Examines the differences in obesity-related behaviors across rural and urban adult populations in the United States. Data from the 1999 - 2006 National health and Nutrition Examination Survey was used.
  • Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2015
    Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013.
  • Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Care Sensitive Conditions
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 10/2015
    Evaluates inpatient hospitalizations among children in nine states to determine the effect of rurality and social/economic advantage on health outcomes and health disparities.
  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015
    This brief compares cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas by state and the percentages of potential market participants enrolled. Non-metropolitan enrollment rates were higher in several states. The analysis shows how well outreach/enrollment efforts targeting rural areas work.
  • Rural Medicare Beneficiaries Have Fewer Follow-Up Visits and Greater Emergency Department Use Post-Discharge
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2015
    Compares rates of post hospital discharge care among Medicare beneficiaries in rural and urban settings. Discusses the effect on policies for follow-up care and readmission penalties.
  • Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey
    Policy Brief
    Maine Rural Health Research Center
    Date: 09/2015
    This study reports the extent of electronic health record implementation and use in a randomly selected sample of 1,497 rural health clinics surveyed in 2013.
  • Thirty-Day Readmission Rates Among Dual-Eligible Beneficiaries
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 08/2015
    Examines readmission rates and factors affecting readmission of patients eligible for both Medicare and Medicaid (dual-eligibility).
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study compared estimates of nurse practitioner supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier data.
  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results From a Survey in Nine States
    Report
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.
  • The Rising Rate of Rural Hospital Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2015
    Discusses the increase in rural hospital closure rates, including the causes of closures and its impact on rural communities.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015
    This brief analyzes Health Insurance Marketplace enrollment outcomes for 2015 at rating area/county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, census region, and metropolitan status of the county. Rural/urban rates are often similar, but areas of concern exist.
  • Recruitment of Non-U.S. Citizen Physicians to Rural and Underserved Areas Through Conrad State 30 J-1 Visa Waiver Programs
    Report
    WWAMI Rural Health Research Center
    Date: 07/2015
    Conrad 30 programs allow international medical graduates (IMGs) on J-1 visas to remain in the U.S. after their residencies to provide healthcare for medically underserved populations. Information from state health department personnel was used to characterize national trends in waivers and factors related to states' successful recruitment of IMGs.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 06/2015
    This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.
  • Graduate Medical Education Financing: Sustaining Medical Education in Rural Places
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2015
    Rural Training Track (RTT) graduate medical education programs have shown success at preparing family physicians for rural practice, but financial difficulties have contributed to program closures. This policy brief reports on a survey of RTT directors and administrators across the U.S. to understand their finances.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents
    Report
    WWAMI Rural Health Research Center
    Date: 05/2015
    Residents of non-metropolitan counties were less likely than those in metropolitan counties to report having dental visits or teeth cleanings in the last year and more likely to report undergoing tooth extractions. These findings persisted even when controlling for demographic factors, income, insurance, and health/smoking status.
  • Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs With Rural Presence
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    In this policy brief, we present the findings of a survey of 27 rural accountable care organizations, focusing on characteristics important to their formation and operation.
  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    Analysis of national county-level Health Insurance Marketplace (HIM) plan data for 2014 and 2015 shows there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.
  • Characteristics of Rural Communities With a Sole, Independently Owned Pharmacy
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    This brief describes the populations of rural communities with single independently owned pharmacies. About 2.7 million people, more than 25% of whom live below the poverty level, live in 663 rural communities with sole independently owned pharmacies. For about 70% of these rural communities, the next closest pharmacy is more than 10 miles away.
  • A Rural Taxonomy of Population and Health-Resource Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015
    This brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics and discusses how this classification tool can be utilized by policymakers and rural communities.
  • Hospital Views of Factors Affecting Telemedicine Use
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015
    This brief expands upon previous research by examining hospital-based use of telemedicine by determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke, and then identifying factors from the hospitals' perspectives that affect use.
  • Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
    Report
    WWAMI Rural Health Research Center
    Date: 03/2015
    This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015
    Rural hospice care is under pressure by a variety of factors that are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2015
    This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
  • Surgical Services in Critical Access Hospitals, 2011
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.
  • Financially Fragile Hospitals: Mergers and Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2015
    Evaluates the causes of financial stress in rural hospitals, and describes the impact rural hospitals have on their communities. Also discusses the ways in which rural hospitals and communities have responded to this financial stress.
  • Geographic and Specialty Distribution of U.S. Physicians Trained to Treat Opioid Use Disorder
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2015
    Examines the distribution of physicians authorized to treat opioid use disorder in the United States, and proposes increasing access to office-based treatment as a promising strategy to address rising rates of opioid use disorder in rural areas.
  • 2014: Rural Medicare Advantage Enrollment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2015
    Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was about 1.95 million, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million in October 2014. Rural and urban enrollment increased despite reductions in payment and the conclusion of the MA bonus payment demonstration at 2014's end.
  • The Effect of Surgery on the Profitability of Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2015
    Presents research on the effect of providing surgery in rural hospitals. Examines the availability of surgery's effect on trauma outcomes and economies in rural communities.