2021 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.

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment
Journal Article
Rural Telehealth Research Center
Date: 11/2021
This study explores facilitators and barriers to implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. Researchers conducted semi-structured interviews with 50 key personnel involved in the School-Based Telehealth Network Grant Program.
Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
Policy Brief
Rural Telehealth Research Center
Date: 11/2021
This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables.
Community Health Worker Roles and Their Evolving Interprofessional Relationships in the United States
Journal Article
Southwest Rural Health Research Center
Date: 10/2021
This project analyzes the evolving integration of Community Health Workers (CHWs) into the United States healthcare system. CHWs can aid patients in navigating the complex nature of medical services. Through focus groups with CHWs, three stages in the interprofessional relationships between CHWs and other care providers were identified.
The Association of Rurality and Breast Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry
Policy Brief
WWAMI Rural Health Research Center
Date: 10/2021
Patients from rural areas have lower breast cancer screening rates and poorer cancer outcomes than urban patients and received initial breast cancer diagnosis at a later stage compared with urban patients. Being uninsured was also associated with late stage at diagnosis. Patterns have persisted and suggest areas for policy change.
Medicare Advantage Enrollment Update 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 09/2021
The RUPRI Center's annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, between 2020 and 2021 the rate of growth in nonmetropolitan counties was more than twice as large as that in metropolitan counties.
COVID-19 Cases and Vaccination Rates
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 09/2021
This data brief examines the relationship between vaccination rates, COVID-19 one-week incidence and metropolitan/nonmetropolitan location. Additional information is provided for Census regions and individual states.
Suicide Mortality Rates in Farm-Related Occupations and the Agriculture Industry in the United States
Journal Article
Rural and Underserved Health Research Center
Date: 09/2021
This article examines suicide mortality among agricultural workers comparing rural and urban residents using pooled data from the Mortality‐Linked National Health Interview Survey, 1986–2014.
Geographic Access to Health Care for Rural Medicare Beneficiaries: A National Study
Policy Brief
WWAMI Rural Health Research Center
Date: 09/2021
Using national data from 2014, this policy brief describes geographic variation in the mix of providers caring for rural versus urban Medicare beneficiaries, the quantity of visits received by beneficiaries across Census Divisions and types of rural areas, and the distance traveled for care for several serious conditions.
Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care
Journal Article
Maine Rural Health Research Center
Date: 09/2021
This study compares the performance of rural and urban primary care providers in adhering to evidence-based smoking-related standards of care and assesses the degree to which electronic health record use was related to improved adherence to these standards in the practice of rural versus urban providers.
Higher Electronic Health Record (EHR) Functionality Lowers Urban Hospital Costs but Rural Impacts Are Minimal
Policy Brief
Center for Economic Analysis of Rural Health
Date: 09/2021
Increases in Electronic Health Records (EHRs) functionality are associated with reductions in total hospital costs, driven mainly by lower outpatient costs. However, improvements in EHR functionality do not seem to significantly reduce costs for rural hospitals.
Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
Journal Article
University of South Carolina Rural Health Research Center
Date: 08/2021
This study investigated trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs). Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time.
COVID-19 Cases and Deaths, Metropolitan and Nonmetropolitan Counties Over Time (Update)
Report
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
This data brief compares seven-day moving average COVID-19 incidence and mortality rates between metropolitan, micropolitan, and noncore counties in the U.S. The brief is updated twice a month.
County-Level 14-Day COVID-19 Case Trajectories
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
Many locations in the U.S. are relaxing their community-level COVID-19 mitigation measures. But one of the key "gating" indicators for doing this is a downward trajectory of new cases during a 14-day period. The rural data brief examines county-level 14-day trajectories for new confirmed COVID-19 cases.
Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
This data brief shows the spread of COVID-19 confirmed cases across the U.S., highlighting metropolitan and nonmetropolitan counties with confirmed cases of, and deaths from, COVID-19.
Trends in Spatial Access to Colonoscopy in South Carolina, 2000-2014
Journal Article
University of South Carolina Rural Health Research Center
Date: 06/2021
This study looks at the availability of colonoscopy screenings in South Carolina between 2000 and 2014 with a focus on changes in spatial access for these preventive services.
Estimates of Childhood Overweight and Obesity at the Region, State, and County Levels: A Multilevel Small Area Estimation Approach
Journal Article
University of South Carolina Rural Health Research Center
Date: 06/2021
The goal of this study is to create a map of county-level obesity rates at the regional, county, and state levels.
Voices From the Field: A Qualitative Study of the Challenges and Promising Practices of Rural Public Health in Addressing HIV and Hepatitis C
Journal Article
Maine Rural Health Research Center
Date: 05/2021
Interviewing public health professionals from six rural states, researchers examined the challenges involving HIV, HCV, and serving rural people who inject drugs and determined strategies to address those challenges.
Medicare Advantage Enrollment Update 2020
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 05/2021
This annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. The percent of nonmetropolitan MA enrollees in Health Maintenance Organization (HMO) plans has increased every year since 2017. Metropolitan HMO enrollment has decreased every year since 2016.
Community Health Worker Sustainability: Funding, Payment, and Reimbursement Laws in the United States
Journal Article
Southwest Rural Health Research Center
Date: 04/2021
Recent changes have been made to community health worker (CHW) funding at the federal level, but payment structures vary from state to state. This paper aims to identify funding mechanisms that would enable CHW programs to sustain a robust workforce.
Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States
Journal Article
University of South Carolina Rural Health Research Center
Date: 04/2021
The US Preventive Services Task Force provides recommendations for breast, cervical, and colorectal cancer screening. This manuscript examines the sociodemographic characteristics associated with women meeting these recommendations.
Geographic Access to Health Care for Rural Beneficiaries in Five States: An Update
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2021
Using data from five states, this study describes the mix of providers caring for rural Medicare beneficiaries, the quantity of care received, and how far rural beneficiaries traveled for care for several selected conditions in 2014. Results are also compared with a similar study of the same states that used data from 1998.
Tracking the Geographic Distribution and Growth of Clinicians With a DEA Waiver to Prescribe Buprenorphine to Treat Opioid Use Disorder
Journal Article
WWAMI Rural Health Research Center
Date: 03/2021
The increase in clinicians who can prescribe buprenorphine improves access to treatment for opioid use disorder. Small remote rural communities continue to experience access challenges. 63.1% of all rural counties had at least one clinician with a Drug Enforcement Administration waiver, but more than half of small remote rural counties did not.
Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned Versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies
Policy Brief
WWAMI Rural Health Research Center
Date: 03/2021
This policy brief describes trajectories for rural Medicare beneficiaries following hospital discharge, including differences between planned and actual discharge to skilled nursing facilities and home health agencies. More than 40% of beneficiaries for whom home health care was indicated did not receive care from a home health agency.
The Distribution of the General Surgery Workforce in Rural and Urban America in 2019
Policy Brief
WWAMI Rural Health Research Center
Date: 03/2021
Researchers examined the 2019 per capita supply of general surgeons in rural and urban areas of the U.S. and compared those results to a similar study of general surgeon supply conducted in 2001. Researchers also examined change in the regional distribution and age and sex characteristics of general surgeons since 2001.
Sources of Insurance Coverage in Nonmetropolitan Areas: The Role of Public and Private Insurance Since 2009
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2021
This brief uses 2009-13 and 2013-17 American Community Survey five-year estimates to compare types of health insurance coverage for the nonelderly in metropolitan and nonmetropolitan areas. The significant growth in public insurance rates due to Medicaid expansion was larger for those living in nonmetropolitan areas compared to metropolitan areas.
Geographic Expansion of Medicaid Managed Care Organizations: Assessing Access to Primary Care in Nonmetropolitan Counties
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2021
This brief evaluates the degree to which Medicaid beneficiaries in nonmetropolitan counties that were newly served by managed care organizations in 2012-2018 are able to access primary care, as determined by travel time. The study also examined the association between their primary care access and the strength of network adequacy state policies.
Rural-Urban Residence and Maternal Hepatitis C Infection, U.S.: 2010-2018
Journal Article
Maine Rural Health Research Center
Date: 02/2021
This study uses data from the U.S. natality files to examine rural-urban differences in county-level rates of maternal infection with hepatitis C virus (HCV) during 2010-2018. Findings can help inform implementation of community-level interventions to reduce maternal HCV infection and narrow rural-urban disparities.
Availability of Supplemental Benefits in Medicare Advantage Plans in Rural and Urban Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
This brief identifies differences in Medicare Advantage (MA) plans that include supplemental benefits available to rural and urban enrollees. By better understanding the variation in MA plan offerings across the country, policymakers can take appropriate action to improve the value of plans available in rural regions.
Rural HIV Prevalence and Service Availability in the United States: A Chartbook
Chartbook
Maine Rural Health Research Center
Date: 02/2021
This chartbook examines 2016 HIV prevalence and the availability of HIV prevention, testing, and treatment services across the rural-urban continuum and by U.S. census region.
Capacity of Rural Counties to Address an HIV or Hepatitis C Outbreak
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
This study examines rural-urban differences in state and local health department capacity to prevent, prepare for, and respond to an HIV or hepatitis C outbreak.
High-Functioning Rural Medicare ACOs – A Qualitative Review
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
This brief identifies common success factors among four high-performing rural Medicare Accountable Care Organizations.
Opioid-Related Visits to Rural Emergency Departments
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.
Trends in Nursing Home Closures in Metropolitan and Nonmetropolitan Counties in the United States, 2008-2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
Nursing home closures have raised concerns about access to long-term services and supports in rural areas. This study examines trends in closures and characteristics of open and closed nursing homes in metropolitan and nonmetropolitan counties. Furthermore, this study identifies metropolitan and nonmetropolitan counties without any nursing homes.
Pharmacy Vaccination Service Availability in Nonmetropolitan Counties
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 02/2021
Pharmacies will play a role in administering the COVID-19 vaccination to the general public. But there are many rural locations in the U.S. where pharmacy resources are limited. This rural data brief examines the availability of pharmacies capable of delivering COVID-19 vaccinations in nonmetropolitan areas.
Characteristics and Challenges of Rural Ambulance Agencies – A Brief Review and Policy Considerations
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2021
There are 23,272 ambulance agencies in the U.S., and 73% of those agencies report serving rural areas. This paper examines current rural ambulance agency characteristics and challenges and identifies public policy considerations designed to stabilize rural ambulance agencies.
Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2021
This paper advances policy discussion of population health in rural places, focusing on the role of rural healthcare organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and infrastructure development, flexibility in covered benefits, and further expansion of telehealth.
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Journal Article
Rural Telehealth Research Center
Date: 01/2021
The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.