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Rural Health
Research Gateway

2016 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.

  • How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act's Medicare Low-Volume Hospital Adjustment?
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2016
    Using data from the Hospital Market Service Area File, the Hospital Cost Report Information System, and Nielsen-Claritas Pop-Facts, this study examined the effect the low-volume hospital payment adjustment has on a hospital's finances. It also looked at the effects of losing the payment adjustment.
  • To What Extent Do Community Characteristics Explain Differences in Closure Among Financially Distressed Rural Hospitals?
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2016
    This study examined the differences between rural hospitals at high risk of financial distress that stayed open and those that closed.
  • What Is the Potential of Community Paramedicine to Fill Rural Healthcare Gaps?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 11/2016
    This study collected information on rural community paramedicine in the U.S. programs to describe their goals, target populations, services offered, connections with local community providers and resources, outcomes measured, and results, where available.
  • Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2016
    Provides an analysis of the differences in Accountable Care Organization (ACO) performance on the quality measures among the Medicare Shared Saving Program ACOs with varying levels of rural presence. Findings suggest that ACOs with significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
  • Health-Related Quality of Life Among Adults 65 Years and Older in the United States, 2011-2012: A Multilevel Small Area Estimation Approach
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 10/2016
    This study compiled estimates, at the county level, of poor health-related quality of life among those ages 65 and older. The study examined physical and mental health and found significant differences in health across the United States.
  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Spread of Accountable Care Organizations in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2016
    This brief updates a RUPRI Center analysis of the presence of Medicare Accountable Care Organizations (ACOs) in rural areas of the US in 2013. Using participation data through 2015, the current brief finds that there has been broad growth in the number of places where ACO participating providers can be found, including rural locations.
  • Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
    Policy Brief
    Maine Rural Health Research Center
    Date: 10/2016
    We describe regional distribution and market prevalence of Consumer Operated and Oriented Plan (CO-OP) products in rural and urban counties, and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015.
  • Do Residencies That Aim to Produce Rural Family Physicians Offer Relevant Training?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 09/2016
    Examines the rural-centric family medicine residencies, their training locations, and rurally relevant skills training provided. Rural training can promote rural practice, but the number of family medicine residencies with a rural focus, geographic distribution of training, and training content are poorly understood.
  • Current State of Child Health in Rural America: How Context Shapes Children's Health
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 09/2016
    Provides an essay on the status of children in rural America that focuses on the rural environment that may affect health.
  • Medicare Advantage Enrollment Update 2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2016
    This annual brief examines Medicare Advantage (MA) enrollment data from March 2015 and March 2016. It shows that enrollment in MA and other prepaid plans increased, both nationally and in non-metropolitan areas, but the rate of growth has slowed compared to previous years.
  • Supply and Distribution of the Behavioral Health Workforce in Rural America
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2016
    This brief uses National Provider Identifier (NPI) data to report on the variability of the supply and provider to population ratios of five types of behavioral health workforce providers (psychiatrists, psychologists, social workers, psychiatric nurse practitioners, counselors) in Metropolitan, Micropolitan and Non-core rural areas across the U.S.
  • Telemedicine Penetration and Consultation Among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota
    Policy Brief
    Rural Telehealth Research Center
    Date: 09/2016
    This study describes the penetration of ED-based telemedicine in North Dakota critical access hospitals and its use for rural trauma patients. Investigators showed that telemedicine subscription increased to 81 percent of rural North Dakota hospitals, and 11 percent of patients in a telemedicine-capable ED used telemedicine as part of their care.
  • Financial Performance of Rural Medicare ACOs
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2016
    Assesses the financial performances of rural accountable care organizations (ACOs) based on different levels of rural presence.
  • Understanding the Business Case for Telemental Health in Rural Communities
    Journal Article
    Maine Rural Health Research Center
    Date: 07/2016
    This article describes the current landscape and characteristics of rural telemental health programs and then examines their business case.
  • Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2016
    There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
  • Graduates of Rural-centric Family Medicine Residencies: Determinants of Rural and Urban Practice
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 07/2016
    This study of graduates of family medicine residencies seeking to produce rural physicians identified influences on rural practice choice, including significant others, residency, and practice communities. Findings point to the need to sustain the preferences of physicians interested in rural practice and encourage this interest in others.
  • Ambulatory Care-Sensitive Condition Hospitalizations Among Medicare Beneficiaries
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 06/2016
    Examines the relationship between the distribution of primary care physicians and Medicare beneficiaries' ambulatory care-sensitive condition hospitalizations using statistical and spatial analyses.
  • Geographic Disparities in Mortality Among the End Stage Renal Disease Patients: An Analysis of the United States Renal Data System, 2007-08.
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 06/2016
    Explores the association between morality, rurality, and distance from the treatment facility of patients with end-stage renal disease (ESRD). Rural patients were found to have a mortality advantage.
  • Medicare Accountable Care Organizations: Beneficiary Assignment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services Accountable Care Organization regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Understanding ACO beneficiary assignment policies is dire in managing ACO providers and beneficiaries.
  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • Are Rural Older Adults Benefiting From Increased State Spending on Medicaid Home and Community-Based Services?
    Policy Brief
    Maine Rural Health Research Center
    Date: 06/2016
    Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
  • Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program
    Maine Rural Health Research Center
    Date: 05/2016
    This paper reports on the design and implementation of a first-in-the-nation project to expand rural veterans' access to healthcare by establishing a bi-directional connection between Maine's statewide health information exchange (HIE) and Veterans Administration facilities and centers.
  • Adverse Childhood Experiences in Rural and Urban Contexts
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2016
    This study was designed to address the gap in the literature examining rural-urban differences in adults' exposure to adverse childhood experiences (ACEs) and to inform health system initiatives geared toward mitigating the impacts of ACEs on rural populations.
  • Variation in Primary Care Service Patterns by Rural-Urban Location
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2016
    Examines primary care physician service patterns by rural-urban location and discusses effect on recruitment strategies for primary care providers in rural communities.
  • How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2016
    New (2014) rural enrollees in the insurance plans on federal and state exchanges are expected to generate about 1.39 million primary care visits per year. At a national level, it would require 345 full-time equivalent physicians to provide those visits. This study examines how different mixes of physicians, PAs, and NPs might meet the increase.
  • Conrad 30 Waivers for Physicians on J-1 Visas: State Policies, Practices, and Perspectives
    Report
    WWAMI Rural Health Research Center
    Date: 03/2016
    States rely on international medical graduates (IMGs) to fill workforce gaps in rural and urban underserved areas. This study collected quantitative and qualitative information from states to assess how state policies and practices shape IMG recruitment and practice in underserved areas.
  • Outcomes of Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2016
    Among those with eight or more weeks of rural training, no single program characteristic or model offered sustained advantages over any other type in producing high yields to rural practice.
  • Exploring Rural and Urban Mortality Differences
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2016
    Contains visual aids which display indicators of mortality rates by cause of death, age group, rural-urban status, region, and sex for populations 15 years of age and older cross-referenced to tables and statistical results.
  • Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2016
    Examines how Critical Access Hospitals perform compared to Prospective Payment System hospitals on measures of quality.
  • Family Medicine Rural Training Track Residencies: 2008-2015 Graduate Outcomes
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2016
    This policy brief is the latest in a series tracking the rural practice outcomes of family physicians who have completed graduate medical education in Rural Training Track (RTT) residency programs.
  • Access to Rural Home Health Services: Views From the Field
    Report
    WWAMI Rural Health Research Center
    Date: 02/2016
    Access to home health care can be challenging for rural Medicare clients. Key informants for this study detailed obstacles, including financial, regulatory, workforce, and geographic issues. Rural communities will likely benefit from payment reforms that reward quality services while providing incentives to use best practices in home health care.
  • Rural Opioid Abuse: Prevalence and User Characteristics
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socioeconomic characteristics associated with their use and other risky behavior.
  • Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
  • Which Physician Assistant Training Programs Produce Rural PAs? A National Study
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2016
    The proportion of physician assistant (PA) graduates who enter practice in rural settings has dropped over the last two decades, though PAs still continue to enter rural practice at a higher rate than primary care physicians. This identifies the PA training programs that produced high numbers of rural PAs and the programs associated.
  • Mental Health First Aid in Rural Communities: Appropriateness and Outcomes
    Journal Article
    Maine Rural Health Research Center
    Date: 01/2016
    Mental Health First Aid (MHFA), an early intervention training program for general audiences, has been promoted as a means for improving population-level behavioral health in rural communities by encouraging treatment-seeking. This study examined MHFA's appropriateness and impacts in rural contexts.
  • Nurse Practitioner Autonomy and Satisfaction in Rural Settings
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2016
    Compares urban and rural primary care nurse practitioners (NPs) by practice location in urban, large rural, small rural, or isolated small rural areas by using analysis of the 2012 National Sample Survey of NPs.
  • Disparities in Home Health Service Providers Among Medicare Beneficiaries with Stroke
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 01/2016
    Examines the intensity of home health services, by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiates with stroke. There were no significant rural-urban differences in the number of home health visits, but rural residents were less likely to receive services from rehabilitation specialists.
  • Rural Medicare Advantage Plan Payment in 2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2016
    Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA). This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant.