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Rural Health
Research Gateway

2017 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-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2017
    As of June 2017, the percentage of rural enrollment in Part D plans, which include stand-alone prescription drug plans (PDPs) and Medicare Advantage with Prescription Drug (MA-PD) plans, lags urban enrollment despite significant growth overall in the number of Medicare beneficiaries with prescription drug coverage through Medicare Part D plans.
  • Who Performs Colonoscopy? Workforce Trends Over Space and Time
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 11/2017
    Using data from South Carolina from 2001-2010, this study looked at changes in the types of facilities doing colonoscopies as well as the any changes in who is performing them.
  • Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2017
    This policy brief provides information about the potential impact of scheduled changes in Medicaid Disproportionate Share Hospital (DSH) payment on hospitals in 47 states. We expect variation across states, because of differences in state policies allocating DSH payments, as well as geographic variation by census region.
  • Supply-Side Differences Only Modestly Associated With Inpatient Hospitalizations Among Medicare Beneficiaries in the Last Six Months of Life
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 11/2017
    This study examined rural and urban Medicare beneficiaries and inpatient hospitalizations during their last six months of life. The study concluded that care at the end of life is much the same for rural and urban Medicare decedents.
  • Rural Long-Term Services and Supports: A Primer
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2017
    This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.
  • Identifying Variability in Patient Characteristics and Prevalence of Emergency Department Utilization for Mental Health Diagnoses in Rural and Urban Communities
    Journal Article
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2017
    Patients needing behavioral healthcare can get more appropriate, cost-effective treatment if they are redirected from emergency departments (EDs). This study examined whether a larger proportion of rural versus urban patients went to went to EDs.
  • Rural-Urban Variations in Medicare Live Discharge Patterns From Hospice, 2012-2013
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2017
    This brief 1) provides an overview of the geographic distribution of "freestanding" (i.e., rather than those co-located in a hospital, home health agency, or skilled nursing facility) rural and urban hospices and, 2) explores live discharge rates for hospices operating in rural versus urban areas.
  • Medicare Advantage Enrollment Update 2017
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans and other prepaid enrollment plans. Compares national and rural MA enrollment, and variability by state.
  • Rural/Urban Analysis on Individual Insurance Market Topics
    Fact Sheet
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers.
  • Financial Issues Challenging Sustainability of Rural Pharmacies
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Findings from a survey of rural lone community retail pharmacies about issues perceived as a threat to their sustainability. Reimbursement issues were cited as being most immediate and of highest magnitude.
  • Improving Access to High Quality Sepsis Care in a South Dakota Emergency Telemedicine Network
    Policy Brief
    Rural Telehealth Research Center
    Date: 08/2017
    This brief describes an implementation initiative designed to increase use of emergency department-based telemedicine consultation for patients with severe sepsis or septic shock. This initiative is the first step of an analysis to estimate the effect of telemedicine on sepsis care and outcomes.
  • Home Is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 08/2017
    Access to home health in rural areas is an important public policy concern, particularly with the growing number of older adults residing in rural America. This qualitative study seeks to better understand how home health services are provided in rural areas, and identifies facilitators and barriers to providing care.
  • A Positive Association Between Hospice Profit Margin and the Rate at Which Patients Are Discharged Before Death
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2017
    The links between the increasing live discharge rate from hospice and the quality of care is examined.
  • Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
    Journal Article
    Rural Telehealth Research Center
    Date: 07/2017
    This article examines the use of telemedicine to help improve care for trauma patients and to try to close the gap between rural and urban outcomes for these patients. The study involved patients treated in critical access hospitals and emergency departments.
  • Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder
    Journal Article
    WWAMI Rural Health Research Center
    Date: 07/2017
    Opioid use disorder is a serious public health problem. Management with buprenorphine is an effective medication-assisted treatment, but 60.1% of rural counties lack a physician with a Drug Enforcement Agency waiver to prescribe buprenorphine. This national study surveyed all rural physicians who have received a waiver in the United States.
  • Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
    Policy Brief
    Maine Rural Health Research Center
    Date: 07/2017
    Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services. This study examined rural-urban differences in knowledge and/or use of the Affordable Care Act Marketplaces; subsidies; the health insurance mandate; and health insurance terms and concepts.
  • The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2017
    Uses 2007-2010 Medicare data to examine the relationship between Rural Health Clinic (RHC) use and potentially preventable hospitalizations and emergency department (ED) visits. RHC use was associated with an increase in both preventable hospitalizations and ED visits among all Medicare enrollees, regardless of their reason for eligibility.
  • Use of the Emergency Department for Mental Health and Substance Abuse Among Women
    Fact Sheet
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 07/2017
    This study identifies trends among women in rural and urban communities who utilize the emergency department for mental health and substance abuse. The information can be used to help communities provide more relevant, appropriate, and less costly care.
  • CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 06/2017
    The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.
  • Rural and Urban Utilization of the Emergency Department for Mental Health and Substance Abuse
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 06/2017
    Utilizes data from the Healthcare Cost and Utilization Project's (HCUP's) State Emergency Department Databases (SEDD) for seven states. Researchers explore, and describe in this brief, the use of the Emergency Department for mental health and substance abuse among Urban, Large Rural, Small Rural, and Isolated Small Rural residents.
  • After Hospital Closure: Pursuing High Performance Rural Health Systems Without Inpatient Care
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 06/2017
    A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
  • Predicting Financial Distress and Closure in Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 06/2017
    Examines the financial distress of rural hospitals to better predict closures within two years.
  • Changes in the Supply of Physicians With a DEA DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2017
    This project mapped the location of physicians with a DEA DATA 2000 waiver to prescribe buprenorphine for opioid use disorder in July 2012 and April 2016. The number of counties without a waivered physician and the ratio of waivered physicians per 100,000 population is reported by the rural/urban status of the county.
  • Telepharmacy Rules and Statutes: A 50-State Survey
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2017
    This is summary analysis reviews administrative rules and legislative statutes governing the practice of telepharmacy in all 50 states. Telepharmacy is specifically authorized in 23 states and 16 states have no rules or legislation authorizing telepharmacy. Other states have pilot programs or waivers that would enable telepharmacy.
  • Rural Opioid Prevention and Treatment Strategies: The Experience in Four States
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2017
    Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.
  • Issues Confronting Rural Pharmacies After a Decade of Medicare Part D
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2017
    This brief reports on a survey of very rural independent pharmacies designed to assess threats to their sustainability. Major, immediate issues included delays in updates to maximum allowable costs (MACS), charges for remuneration fees, competition from mail order pharmacies; and, status as a "non-preferred pharmacy" for Medicare Part D plans.
  • Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study
    Journal Article
    Rural Telehealth Research Center
    Date: 02/2017
    Traumatic injury is a leading cause of death in the U.S. Rural residents have limited access to trauma care, and telemedicine has been proposed to improve trauma care locally. This study describes patient-level factors associated with telemedicine and measures the association between telemedicine consultation and interhospital transfer.
  • The Role of Public Versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2017
    Medicaid and CHIP have played a critical role in ensuring access to health coverage among children –particularly rural children. This study examines rural-urban differences in children's access to care, and their families' perceived affordability of that care among those enrolled in Medicaid or CHIP, and those with private insurance plans.
  • Changing Rural and Urban Enrollment in State Medicaid Programs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-Affordable Care Act (ACA). Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas.
  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of "potential market" participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.