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Rural Health
Research Gateway

2019 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.

  • Congestive Heart Failure-Related Hospital Deaths Across the Urban-Rural Continuum in the United States
    Journal Article
    Southwest Rural Health Research Center
    Date: 12/2019
    This study examines congestive heart failure (CHF)-related, in-hospital mortality across six levels of rurality and four census regions. Results indicated CHF-related hospital admissions in small metropolitan, micropolitan, and noncore areas, compared to large central metropolitan areas, were more likely to result in death.
  • Healthy People 2020: Rural Areas Lag in Achieving Targets for Major Causes of Death
    Journal Article
    Southwest Rural Health Research Center
    Date: 12/2019
    For the period 2007-2017 rural death rates were higher than urban rates for the seven major causes of death analyzed, and disparities widened for five of the seven. In 2017 urban areas had met national targets for three of the seven causes, while rural areas had met none of the targets.
  • Strategic Choice in Developing Telemedicine - Observations From Three Organizations
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2019
    Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing those services or for patients has not been firmly established. This paper explores organizational motivations of three large health systems for incorporating telemedicine patient care services.
  • The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States
    Journal Article
    Rural and Underserved Health Research Center
    Date: 12/2019
    This paper compares the prevalence and odds of chronic diseases among ex-miners and current miners, adjusting for certain variables that might influence health outcomes. The analysis found that the prevalence of chronic disease is significantly higher among ex-miners.
  • Impact of the Medicare Disproportionate Share Hospital Payment Cap on Urban and Rural Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2019
    The Medicare Disproportionate Share Hospital payment adjustment is intended to compensate hospitals serving a disproportionate number of low-income patients. This policy brief describes the number and location of urban and rural hospitals affected by a 12% payment cap established by the Medicare Modernization Act of 2003.
  • Rural-Urban Differences in Financial Burden Among Cancer Survivors: An Analysis of a Nationally Representative Survey
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 12/2019
    Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey.
  • Hospital Closures and Short-Run Change in Ambulance Call Times
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2019
    Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
  • Geographic Disparities in Residential Proximity to Colorectal and Cervical Cancer Care Providers
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 11/2019
    Persistent rural‐urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural‐urban differences in residential proximity to cancer specialists.
  • Financial Hardship Among Rural Cancer Survivors: An Analysis of the Medical Expenditure Panel Survey
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 11/2019
    This study examined contrasts in financial hardship among 1,419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement the Effects of Cancer and Its Treatment on Finances.
  • Tele-Emergency Behavioral Health in Rural and Underserved Areas
    Journal Article
    Rural Telehealth Research Center
    Date: 11/2019
    This paper describes how two distinct tele-emergency department (ED) behavioral health models address challenges in access and placement for patients in rural and underserved areas presenting to EDs. The notable difference in disposition rates between cases and controls shows the impact each model is having on care practices and processes.
  • Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
    Journal Article
    Rural Telehealth Research Center
    Date: 11/2019
    This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care.
  • Rural Health Clinic Costs and Medicare Reimbursement
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2019
    We used cost report data to examine Rural Health Clinic (RHC) services costs. The findings support the National Advisory Committee on Rural Health & Human Service's conclusion that the cost-based methodology used to determine Medicare reimbursement for RHCs is outdated and RHCs subject to the reimbursement cap are paid less than their costs.
  • Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs
    Journal Article
    WWAMI Rural Health Research Center
    Date: 10/2019
    This study surveyed physician residency programs in anesthesiology, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry to describe training locations and rural-specific content of rural-centric residency programs (those requiring at least eight weeks of rurally located training).
  • Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine
    Journal Article
    WWAMI Rural Health Research Center
    Date: 10/2019
    This study surveyed rural and urban nurse practitioners (NPs) and physician assistants (PAs) with Drug Enforcement Agency waivers to provide medication treatment for opioid use disorder by prescribing buprenorphine. Rural NPs and PAs reported facing many of the same barriers to providing buprenorphine as rural physicians have reported.
  • Multilevel Analysis in Rural Cancer Control: A Conceptual Framework and Methodological Implications
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 09/2019
    Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research.
  • Challenges of Using Nationally Representative, Population-Based Surveys to Assess Rural Cancer Disparities
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 08/2019
    Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice.
  • Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry
    Journal Article
    WWAMI Rural Health Research Center
    Date: 08/2019
    Access to recommended cancer screening is more difficult for rural than urban residents. As a result, rural patients may present at later stages than urban patients due to delays in detection. This study compared the adjusted rates of and late colorectal cancer staging at diagnosis between patients residing in urban and rural counties.
  • Effects of the Patient Protection and Affordable Care Act on Coverage and Access to Care in Metropolitan vs. Nonmetropolitan Areas Through 2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2019
    The Patient Protection and Affordable Care Act as a whole led to notable increases in coverage rate and better access to care in both metropolitan and nonmetropolitan areas, and the Medicaid expansion was the key driver of coverage gains in nonmetropolitan areas.
  • Declining Endoscopic Care by Family Physicians in Both Rural and Urban Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 07/2019
    This paper explores the decline in the percentage of family physicians providing endoscopic services overall and in urban and rural areas. This has implications on the availability of colonoscopies, endoscopies, and flexible sigmoidoscopies in areas that lack specialists who perform such services.
  • Insurer Participation in Rural Health Insurance Marketplaces: Are Some Markets Intrinsically More Competitive Than Others?
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2019
    We examine insurer participation changes in three health insurance (Federal Employees Health Benefits Program, Medicare Advantage, and Health Insurance Marketplaces) markets over time in rural counties.
  • Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 05/2019
    This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
  • 2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 05/2019
    This brief characterizes rural/urban disparities in the 2019 Centers for Medicare & Medicaid Services hospital wage index by describing and comparing the wage indices of rural and urban hospitals by the number of beds, the amount of net patient revenue, and Medicare payment classification.
  • Pediatric Tele-Emergency Care: A Study of Two Delivery Models
    Journal Article
    Rural Telehealth Research Center
    Date: 04/2019
    This study describes two tele-emergency programs that provide care to pediatric populations. Qualitative descriptions of the two tele-emergency department (ED) models and key characteristics of the patient populations served by tele-ED are presented. The study informs others about evaluative measures and how tele-ED works in practice.
  • Geographic Variation in the 2019 Risk of Financial Distress Among Rural Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 04/2019
    This brief investigates 2019 geographic variation in risk of financial distress among rural hospitals.
  • Trends in Risk of Financial Distress Among Rural Hospitals, 2015 to 2019
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 04/2019
    This brief investigates 2015 to 2019 trends in risk of financial distress among rural hospitals by census region and Medicare payment classification.
  • Preventive Health Service Use Among Rural Women
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2019
    This study used the National Health Interview Survey to examine differences in receipt of preventive health services among rural and urban women. It found that rural women are less likely to receive HPV vaccines and mammograms, even controlling for rural-urban sociodemographic and resource differences.
  • Differences in Care Processes Between Community-Entry Versus Post-Acute Home Health for Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2019
    This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).
  • Primary Care Clinician Participation in the CMS Quality Payment
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2019
    Approximately 10% of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30% of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than nonmetropolitan primary care clinicians.
  • Medicare Advantage Enrollment Update 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2019
    This annual report on Medicare Advantage (MA) enrollment shows growth in the program in nonmetropolitan and metropolitan areas. The rate of metro enrollment is higher than in nonmetro areas, but the growth rate in the nonmetropolitan population is higher. There are also significant differences in metro/nonmetro MA enrollment by plan type.
  • Rural-Urban Differences in the Decline of Adolescent Cigarette Smoking
    Journal Article
    Maine Rural Health Research Center
    Date: 03/2019
    Comparing survey data from 2008-2010 with 2014-2016, we examined change over time in cigarette smoking among rural and urban adolescents. We found that both rural and urban rates declined, but the decrease was smaller in rural counties, which widened the rural-urban gap in adolescent smoking rates.
  • Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2019
    This brief reports few rural and urban differences in observed demographic characteristics among enrollees in the Medicare Advantage program. Issuers often exclude rural counties from their service areas, but we find no evidence that this is due to such demographics, suggesting that other reasons relating to population size may be more likely.
  • Diabetes-Related Hospital Mortality in the U.S.: A Pooled Cross-Sectional Study of the National Inpatient Sample
    Journal Article
    Southwest Rural Health Research Center
    Date: 02/2019
    This study examined place-based and individual-level variations in diabetes-related hospital deaths using the 2009-2015 National Inpatient Sample. Results show that place-based disparities exist. Targeted focus should be placed on the control of diabetic complications in the South, West, and Midwest census regions and among rural residents.
  • The Changing Landscape of Diabetes Mortality in the United States Across Region and Rurality, 1999-2016
    Journal Article
    Southwest Rural Health Research Center
    Date: 02/2019
    This brief report examines place-based differences in diabetes mortality to understand whether disparities in diabetes mortality have changed across U.S. Census regions and levels of rurality over time. Reductions in diabetes mortality are lagging in rural areas, and the rural South in particular, relative to other areas of the country.
  • The Market Mechanism and Health Insurance in Rural Places: Lessons Learned From an Economics and Policy Perspective
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2019
    This paper focuses on unique challenges in health insurance markets facing rural people, providers, and places, identifying their origins in what economists call "market failures," defined narrowly or broadly. We conclude with observations about the current landscape of rural insurance markets and identify issues policy makers should consider.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Journal Article
    Maine Rural Health Research Center
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.