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Rural Health
Research Gateway

2022 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.

  • Community Sociodemographics and Rural Hospital Survival
    Journal Article
    Center for Economic Analysis of Rural Health
    Date: 12/2022
    This study examines whether community sociodemographic factors are associated with the survival or closure of rural hospitals at risk of financial distress between 2010 and 2019.
  • The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
    Report
    RUPRI Center for Rural Health Policy Analysis, RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2022
    Medicare hospital payment policies affecting rural hospitals play a significant role in the financial viability of rural hospitals. This report provides an overview of historic and current Medicare rural hospital payment policies and alternative payment models to understand their impact on rural hospitals and the communities they serve.
  • Medicaid Expansion and Access to Naloxone in Metropolitan and Nonmetropolitan Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2022
    This study evaluated the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid. Increasing the percentage of Medicaid-paid naloxone prescriptions improved access in metro areas.
  • Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2022
    This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
  • Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 11/2022
    Using data from the Inpatient Psychiatric Facility Quality Reporting program 2015-2019, this study examined differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.
  • The Impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2022
    This study evaluated the extent to which Medicare Shared Savings Program participation affected hospital financial outcomes, including patient revenue, operating margin, different revenue source shares, and allowance and discount rate.
  • Changes in the Supply and Rural-Urban Distribution of Social Workers in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of social workers by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychologists in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychologists by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatric Nurse Practitioners in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatric nurse practitioners by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatrists in the U.S., 1995-2019
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatrists by rural-urban status and Census Division.
  • Changes in the Supply and Rural-Urban Distribution of Counselors in the U.S., 2014-2021
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of counselors by rural-urban status and Census Division.
  • Availability of Hospital-Based Cancer Services Before and After Rural Hospital Closure, 2008-2017
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 09/2022
    Using American Hospital Association survey data from 2008 to 2017, the changes in access to cancer-related screening and treatment services were examined to determine the impact of hospital closures across hospital service areas.
  • Review of Rural U.S. Economic and Health Care Trends
    Report
    Center for Economic Analysis of Rural Health
    Date: 09/2022
    This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.
  • Predictors of Hospital Bypass for Rural Residents Seeking Common Elective Surgery
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 08/2022
    This article used Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates and predictors for patients bypassing rural hospitals for common procedures.
  • Examining the Association Between Rurality and Positive Childhood Experiences Among a National Sample
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 08/2022
    Using the full National Survey of Children's Health with all 50 states and the District of Columbia, this study examined rural-urban differences in positive childhood experiences.
  • Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 08/2022
    Since the 2014 implementation of Health Insurance Marketplaces (HIMs), considerable changes have been observed in the number of insurance companies offering plans across the United States. This policy brief describes changes in HIM plan issuers over the 2014-2022 period with an emphasis on variation across metropolitan and non-metropolitan places.
  • Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 08/2022
    Independently owned retail pharmacies in rural areas experienced a higher rate of closure than micropolitan and metropolitan areas. Closures have raised concerns about access to prescription medications as well as pharmacist-provided primary care services, which are often the sole source in rural areas for obtaining health services.
  • Medicare Beneficiary Access to Prescription Drugs in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2022
    Declines in the number of retail pharmacies in rural areas have raised concerns about beneficiary access to prescription medications when their local pharmacy closes. The purpose of this policy brief is to identify the types of pharmacies used by beneficiaries in rural areas with limited or no access to local pharmacies.
  • Rural and Urban Pharmacy Presence – Pharmacy Deserts
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2022
    This policy brief continues the RUPRI Center's ongoing examination of the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e. pharmacy deserts) based on metropolitan/nonmetropolitan locations.
  • Higher Electronic Health Record Functionality Is Associated With Lower Operating Costs in Urban—but Not Rural—Hospitals
    Journal Article
    Center for Economic Analysis of Rural Health
    Date: 07/2022
    This study examines the relationship between electronic health record use/functionality and hospital operating costs and compares the results across rural and urban facilities.
  • Changes in Access to Community Health Services Among Rural Areas Affected and Unaffected by Hospital Closures Between 2006 and 2018: A Comparative Interrupted Time Series Study
    Journal Article
    University of South Carolina Rural Health Research Center
    Date: 07/2022
    In this article, investigators compared access to Federally Qualified Health Centers and Rural Health Clinics by those in rural areas affected versus those in rural areas unaffected by hospital closures.
  • County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care
    Policy Brief
    Center for Economic Analysis of Rural Health
    Date: 07/2022
    This policy brief draws out demographic and economic differences between counties with obstetric care facilities and those without. It provides descriptive data on the economic changes underway in counties that lost obstetric care facilities between 2012 and 2019.
  • Nursing Homes in Rural America: A Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2022
    Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.
  • Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2022
    This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues and will be useful to policymakers and others interested in the performance of RHCs nationally. It provides a discussion of the challenges related to collection and reporting of RHC quality data.
  • Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2022
    This policy brief examines the effects of emergency medical services (EMS) personnel level of experience and agency rurality on the provision of evidenced-based care. Compared with urban-serving EMS agencies, rural-serving agencies provided evidence-based care less often for stroke, hypoglycemia, and trauma but more often for seizures.
  • Medicare Accountable Care Organization Characteristics Associated With Participation in 2‐Sided Risk
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2022
    This study examined the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2-sided risk tracks in the Medicare Shared Savings Program. Small and rural ACOs were found to be less prepared to transition into 2-sided risk tracks than their urban counterparts.
  • The Northern Border Region: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • Vermont: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • New York: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • New Hampshire: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • Maine: A Health-Focused Landscape Analysis
    Chartbook
    Maine Rural Health Research Center
    Date: 04/2022
    These chartbooks present a comprehensive set of state- and county-level population health and health care access measures for Maine, New Hampshire, New York, and Vermont. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission.
  • The Economic Effects of Rural Hospital Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2022
    This study updates previous research (Holmes, et al. 2006) on the economic effects of rural hospital closures by measuring the economic changes over time among U.S. rural counties that had a hospital closure from 2001-2018.
  • Disparities in Prenatal Immunization Rates in Rural and Urban U.S. Areas by Indicators of Access to Care
    Journal Article
    Southwest Rural Health Research Center
    Date: 02/2022
    This study evaluates variations in immunization rates among pregnant women across the urban-rural continuum. Results indicate pregnant women in rural areas more commonly rely on Medicaid to fund prenatal care but are less likely to have full or expanded access to Medicaid. This finding may contribute to immunization uptake disparities.
  • Estimating Mortality From Coal Workers' Pneumoconiosis Among Medicare Beneficiaries With Pneumoconiosis Using Binary Regressions for Spatially Sparse Data
    Journal Article
    Rural and Underserved Health Research Center
    Date: 02/2022
    This study estimates mortality from coal workers' pneumoconiosis and other pneumoconioses among Medicare beneficiaries using the 5% Medicare Limited Claims Data Set, 2011-2014.
  • Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2022
    This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
  • Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2022
    This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.
  • Meeting the Behavioral Health Needs of Farm Families in Times of Economic Distress
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 02/2022
    Economic fluctuations and periods of distress in farming cannot be eliminated, however, their impact on communities and individuals can be mitigated. Strategies for meeting the behavioral health needs of farm families by supporting community-based services, and expanding behavioral health services in rural contexts are highlighted in this work.
  • High-Performing Rural Health System
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2022
    This document updates the RUPRI Health Panel's framework, for a high-performing rural health system, originally published in 2011. It offers a revised vision statement and updates the high-performing rural health system pillars (access, affordability, community health, and quality) and describes an underlying base of equity considerations.