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.

  • Barriers to Nursing Home Care for Nonelderly Rural Residents
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 12/2017
    This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes.
  • 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.
  • Characteristics of Communities Served by Hospitals at High Risk of Financial Distress
    Report
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2017
    This brief compares the characteristics of communities served by rural hospitals at high risk of financial distress to those served by rural hospitals that are not at high risk of financial distress.
  • Who Performs Colonoscopy? Workforce Trends Over Space and Time
    Journal Article
    Rural and Minority 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.
  • Gender and Geographic Differences in Medicare Service Utilization During the Last Six Months of Life
    Journal Article
    Rural and Minority Health Research Center
    Date: 11/2017
    End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality.
  • 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.
  • ESRD Facility Characteristics by Rurality and Risk of Closure
    Report
    Rural and Minority Health Research Center
    Date: 11/2017
    This study's purpose was to profile rural end stage renal disease (ESRD) facilities, focusing on those at greatest risk for closure. We examined the characteristics of these facilities, the quality of care provided, and the distance patients in rural areas would have to travel if the facilities closed.
  • Supply-Side Differences Only Modestly Associated With Inpatient Hospitalizations Among Medicare Beneficiaries in the Last Six Months of Life
    Journal Article
    Rural and Minority 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 Transportation: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2017
    This policy brief uses survey data from 113 key informants across all 50 states to describe challenges and opportunities related to rural transportation.
  • 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.
  • Differences in Community Characteristics of Sole Community Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2017
    The purpose of this brief is to present a snapshot of Sole Community Hospitals (SCHs) and the communities served by them in 2015 (cross-sectional analysis), and identify some trends in selected SCH and community characteristics between 2006 and 2015 (longitudinal analysis).
  • 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.
  • Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 10/2017
    Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries' use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.
  • Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 09/2017
    Patient sociodemographic characteristics, such as age, race, gender, income, and education, can affect health outcomes and healthcare providers' performance on quality measures. The discussion about how to tackle these issues around quality measurement haven't included rurality, but this study examines it.
  • Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 09/2017
    This study examined the differences in quality of care outcomes between rural and urban Medicare beneficiaries. It concluded that rurality should be considered when discussing risk-adjustment procedures.
  • Access to Obstetric Services in Rural Counties Still Declining, With 9 Percent Losing Services, 2004-14
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 09/2017
    Providing access to obstetric care in rural areas is a growing concern. By 2014, about 54% of rural counties in the United States did not have hospital obstetric services.
  • 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.
  • Diabetes Mortality in Rural America: 1999-2015
    Policy Brief
    Southwest Rural Health Research Center
    Date: 08/2017
    This brief is the second in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The primary aim of this study was to understand the scope of diabetes-related mortality in urban and rural America. We analyzed mortality caused by diabetes over a 16-year period and explored the roles played by rurality and race.
  • Diabetes and Forgone Medical Care Due to Cost in the U.S. (2011-2015): Individual-level and Place-Based Disparities
    Policy Brief
    Southwest Rural Health Research Center
    Date: 08/2017
    This brief is the first in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The two aims of this study were to identify trends in diabetes rates and forgone medical care among persons with diabetes in the U.S. and to identify geographic determinants and other social determinants of health disparities.
  • 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.
  • Differences in Medicare Service Use in the Last Six Months of Life Among Rural and Urban Dual – Eligible Beneficiaries
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    In this brief, we compare rural and urban dual-eligible beneficiaries to Medicare-only beneficiaries in their service utilization in the last six months of life. Within rural beneficiaries, we further explore differences associated with race/ethnicity.
  • Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    This brief focuses on the current status of healthcare use during the last six months of life among Medicare beneficiaries. We used data from a sample of Medicare beneficiary claims to assess whether service utilization differed between rural and urban decedents and across decedents of different race/ethnicity categories.
  • Transitions in Care Among Rural Residents With Congestive Heart Failure, Acute Myocardial Infarction, and Pneumonia
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    Rural and urban hospitals vary with regard to the levels of care they are able to provide, requiring that a subset of patients be transferred from the first point of encounter to a second facility. The degree to which inter-hospital transfers occur, and the outcomes for transfer patients, have not been studied across rural and urban institutions.
  • 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.
  • Regional Differences in Rural and Urban Mortality Trends
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2017
    This brief explores the differences in mortality rates over time by (1) urban and rural location, (2) census division, and (3) urban and rural location within each census division.
  • Chartbook: Trends in Rural Children's Oral Health and Access to Care
    Chartbook
    Rural and Minority Health Research Center
    Date: 08/2017
    Assessing progress at improving children's oral health requires examining trends to see whether rural disparities, if present, are being reduced. Our report uses data from the National Survey of Children's Health (2003, 2007, and 2011- 2012) to assess progress in access to oral health care, and perceived status of teeth among rural children.
  • Improving Rural Oral Health: Six States' Response to the United States Department of Health and Human Services Oral Health Strategic Framework
    Policy Brief
    Rural and Minority Health Research Center
    Date: 08/2017
    The U.S. Public Health Service Oral Health Coordinating Committee published the Oral Health Strategic Framework 2014-2017. The framework includes 5 goals for advancing oral health in America. We explore how 6 states have responded to the Strategic Framework; specifically, how they address oral health inter-professional practice, and access to care.
  • Regulating Network Adequacy for Rural Populations: Perspectives of Five States
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2017
    The purpose of this study was to examine how five geographically-diverse states with significant rural populations define "network adequacy" and the degree to which they consider rural issues when regulating networks.
  • 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.
  • The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2017
    This brief describes Medicare post-acute and hospice care provided by hospitals in rural areas by characterizing the variation in the number of rural hospitals that provide PAC and hospice care, the average amount of Medicare revenue rural hospitals receive for these services, and the financial importance of PAC and hospice care to rural hospitals.
  • 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.
  • The Maternity Care Nurse Workforce in Rural U.S. Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    Findings are shared from a study examining the maternity care nursing workforce in rural hospital in the United States.
  • Resources to Reduce Adverse Drug Events in Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief provides resources that could be used to decrease Adverse Drug Events (ADEs) in rural hospitals.
  • Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    Analyzes the prevalence of Adverse Drug Events (ADEs) in rural hospitals, including both CAHs and rural PPS hospitals, related to four categories of drugs: steroids, antibiotics, opiates / narcotics, and anticoagulants in 2013 for eight states. It also examines whether or not these hospitals' ADE rates varied based on hospital characteristics.
  • 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.
  • Medical Barriers to Nursing Home Care for Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.
  • Rural Health Snapshot (2017)
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 05/2017
    The Rural Health Snapshot (2017) updates the 2010 Rural Health Snapshot. The document is a data sheet that compares a selection of health and healthcare access indicators for populations in rural and urban areas.
  • Assessing Diabetes and Factors Associated With Foregoing Medical Care Among Persons With Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011-2015)
    Journal Article
    Southwest Rural Health Research Center
    Date: 04/2017
    The purpose of this project was to identify individual- and place-based factors associated with diagnosed diabetes and foregone medical care among those diagnosed with diabetes. Diabetes prevalence and foregone medical care were found to be higher for those with lower incomes, for several racial/ethnic groups, and in the South versus other regions.
  • 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.
  • State Variability in Access to Hospital-Based Obstetric Services in Rural U.S. Counties
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2017
    This policy brief describes state-level variations in 1) the availability of hospital-based obstetric services, and 2) the scope of obstetric unit and hospital closures resulting in the loss of obstetric services in rural U.S. counties from 2004 to 2014.
  • Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2017
    This policy brief describes the scope of obstetric unit and hospital closures resulting in loss of obstetric services in rural U.S. counties from 2004 to 2014.
  • 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.
  • Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2017
    Findings are shared from a study that discovered the types of doctors employed at rural hospitals may make a difference in the rates of cesarean births.
  • 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.
  • Trends in Rural Children's Health and Access to Care
    Chartbook
    Rural and Minority Health Research Center
    Date: 01/2017
    The past ten years have seen positive trends in the availability of health insurance coverage for children. This project examines data from three iterations of the National Survey of Children's Health to see if rural children have benefited equally from any improvements in health insurance, healthcare use, and health status.
  • 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.