2024 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.

Utilization of Inpatient and Emergency Services by Rural and Urban Medicaid Enrollees
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2024
In 2019, nearly 25 percent of rural residents under age 65 had Medicaid or CHIP health insurance coverage. Researchers used data from the 2019 T-MSIS Analytic Files to describe health care utilization among rural Medicaid beneficiaries at the national level and to compare these results to utilization among urban Medicaid beneficiaries.
Rural-Urban Medicaid and CHIP Enrollee Comparisons Using the 2019 T-MSIS Analytic File
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2024
In 2019, nearly 25 percent of rural residents under age 65 had Medicaid or CHIP health insurance coverage. Researchers used data from the 2019 T-MSIS Analytic Files to compare urban and rural residents enrolled in either fee for-service or managed care Medicaid. This brief provides descriptive data on enrollment and demographics.
Variation in Elder Abuse State Statutes by State Level of Rurality
Policy Brief
University of Minnesota Rural Health Research Center
Date: 12/2024
This policy brief examines elements of state-level elder abuse statutes' definitions and reporting requirements to investigate potential differences in these policies by state rurality that could influence one's understanding of elder abuse among rural and urban areas.
Obstetric Care Access at Rural and Urban Hospitals in the United States
Journal Article
University of Minnesota Rural Health Research Center
Date: 12/2024
Maternal mortality is on the rise in the U.S., while access to maternal health services continues to decline. This study examines the losses and gains of obstetric care at hospitals in the United States from 2010 to 2022.
Access to Maternity Care: Challenges and Solutions for Improving Equity Across U.S. Communities
Journal Article
University of Minnesota Rural Health Research Center
Date: 11/2024
This review summarizes the most up-to-date research on maternity care access and health outcomes associated with obstetric unit closures and traveling long distance to receive care. It also offers potential strategies to combat declining access and improve health outcomes.
Triad Program Perspectives on Preventing and Addressing Elder Abuse in Rural Communities
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2024
Elder abuse is a widespread issue and rural communities face unique risks to preventing, identifying, and addressing it. This brief shares results from key informant interviews with representatives of rural Triads (multi-sectoral community-based partnerships that address elder abuse) to illuminate rural-specific dimensions of this issue.
Understanding the Impact of Medical Debt in Rural Communities: Perspectives From Rural Hospital Administrators
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2024
This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states. Using content analysis of interview data, researchers share findings around hospital and community-level implications of medical debt, and policies that may help or hinder this issue.
Medical Debt in Collections Among Counties by Rural-Urban Location and Racial-Ethnic Composition
Policy Brief
University of Minnesota Rural Health Research Center
Date: 11/2024
This policy brief examines the differences in the proportion of people with medical debt in collections and median amount of medical debt by rural-urban location. The brief also examines additional differences within rural and urban communities of color.
Trends in the Health Workforce Supply in the Rural U.S.
Report
WWAMI Rural Health Research Center
Date: 10/2024
This report examines the availability of current and historical workforce data for a variety of health care professionals and provides estimates of the trends in the supply and distribution in the rural vs. urban U.S. workforce.
An Updated Model of Rural Hospital Financial Distress
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2024
In fall 2024, the North Carolina Rural Health Research Program completed a study modeling financial distress among rural hospitals, "An Updated Model of Rural Hospital Financial Distress." The model updates a 2016 version, by adding recent changes in the operating environment.
The First Year of Rural Emergency Hospitals: REHs Serve Relatively Disadvantaged Counties
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 10/2024
This brief looks at community characteristics (socio-economic, race and ethnicity, and health status and access characteristics) of communities with a hospital that converted to a Rural Emergency Hospital (REH) in 2023—the first year of the new rural hospital payment designation.
News Media Coverage of Rural Hospital Closures and the Causes
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 10/2024
This study augments previous research with findings from a structured framework of attributed causes of rural hospital closures through the analysis of news media reports.
Health Care Affordability and Medical Debt: Differences by Rurality, Region, and Socio-Demographic Characteristics
Policy Brief
University of Minnesota Rural Health Research Center
Date: 09/2024
This policy brief examines rural/urban differences in rates of health care (un)affordability, as well as among rural residents by key socio-demographic characteristics.
States and Rural Communities With and Without the Program of All-Inclusive Care for the Elderly (PACE)
Policy Brief
University of Minnesota Rural Health Research Center
Date: 09/2024
The purpose of this policy brief is to measure sociodemographic differences in areas with and without a Program of All-Inclusive Care for the Elderly (PACE) organization headquarters among rural communities and by state-level PACE availability and headquarters location.
Pediatric and Pregnancy-related Visits at Rural Health Clinics in 2018 Among Medicaid/CHIP Enrollees in 20 States
Policy Brief
Maine Rural Health Research Center
Date: 09/2024
This policy brief reports on the percentage of Medicaid-enrolled children and reproductive age women with pregnancy-related service use who visited a Rural Health Clinic in 2018 in 20 states.
Rural-Urban Differences in Self-Reported Participation in Diabetes Self-Management Education
Journal Article
Rural and Minority Health Research Center
Date: 09/2024
Using 2019 Behavioral Risk Factor Surveillance System data, this study examined the proportion of rural versus urban adults who reported receiving Diabetes Self-Management Education.
Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.
Palliative Care Challenges and Solutions in Rural U.S. Communities
Policy Brief
WWAMI Rural Health Research Center
Date: 09/2024
This study describes palliative care in rural communities.
Geographic Variations in Urban-Rural Particulate Matter (PM2.5) Concentrations in the United States, 2010–2019
Journal Article
Rural and Minority Health Research Center
Date: 09/2024
The purpose of this project was to compare fine particulate matter 2.5 across U.S. Census tracts, specifically focusing on rural vs. urban differences between 2010 and 2019.
Information for Rural Stakeholders About Access to Maternity and Obstetric Care: A Community-Relevant Synthesis of Research
University of Minnesota Rural Health Research Center
Date: 09/2024
This document aims to inform rural stakeholders about challenges related to access to and quality of hospital-based childbirth care in rural U.S. communities.
Profiling Social Needs Activities in Publicly Traded Medicare Advantage Organizations
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 08/2024
This article reviews how six major Medicare Advantage (MA) companies address social determinants of health (SDOH) through supplemental benefits. It analyzes public reports, highlighting MA growth, SDOH activities, and plan initiatives.
Changes in Rural Pharmacy Presence 2023
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2024
This data brief continues the RUPRI Center's series of reports exploring the availability of retail pharmacy services in rural areas of the U.S. It provides information on rural communities that have kept, lost, or gained a retail pharmacy between 2018 and 2023.
The Availability of Midwifery Care in Rural United States Communities
Journal Article
University of Minnesota Rural Health Research Center
Date: 07/2024
In this paper, researchers addressed the limited understanding of the current landscape of rural midwifery providers, describing the availability of local midwifery care in rural U.S. communities using a national survey of rural U.S. hospitals.
The Low-Volume Hospital Adjustment Before and During COVID-19
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2024
This brief uses current low-volume hospital adjustment qualifying criteria to compare low-volume hospitals to other rural hospitals and explores the effect of removing the adjustment before COVID-19 and during COVID.
Rural-Urban Differences in Midwifery Care During Childbirth in the U.S.
University of Minnesota Rural Health Research Center
Date: 07/2024
This infographic provides a snapshot of rural-urban differences in midwife-attended births, including changes over time as access to rural obstetric care declined and severe maternal morbidity and mortality rose across the United States.
Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022
University of Minnesota Rural Health Research Center
Date: 07/2024
The purpose of this infographic is to show the loss of hospital-based obstetric services in rural counties from 2010 to 2022, and how this differs by rural county type (micropolitan vs. noncore).
Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2024
This brief examines the estimated impact of three Medicare payment policy changes on home health agency (HHA) reimbursement by rural-serving status, geographic location, and select HHA characteristics.
Health Care Access Barriers Among Metropolitan and Nonmetropolitan Populations of Eight Geographically Diverse States, 2018
Journal Article
Rural and Minority Health Research Center
Date: 06/2024
This research focused on differences in barriers to health care access across metropolitan, micropolitan, and noncore populations. More access and cost related barriers are experienced by micropolitan respondents. These populations experience health care disparities and financial burdens that emphasize the need to mitigate these barriers.
2018-23 Profitability of Rural Hospitals by With and Without Rural Health Clinics and Long-Term Care
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 06/2024
This study compares the 2018-23 profitability of rural hospitals for hospitals that provide and do not provide long-term care, and that operate and do not operate rural health clinics.
2018‐23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 06/2024
This study compares profitability of three types of hospitals in both urban and rural locations: Critical Access Hospitals, Prospective Payment System-only (PPS) hospitals by number of acute beds, and PPS hospitals with special payment designations hospitals over a five-year period.
2018-23 Profitability of Rural Hospitals by Ownership and System Affiliation
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 06/2024
This study compares the 2018-23 profitability of rural hospitals based on ownership and system affiliation status. The purpose of this brief is to describe the profitability of rural hospitals over a five-year period consisting of two years before and three years after COVID-19.
Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022
Journal Article
Rural and Underserved Health Research Center
Date: 06/2024
This study examines the receipt of a Papanicolaou test in the past year among U.S. females overall and females residing in rural and urban areas in 2019, 2020, and 2022, using the Health Information National Trends Survey.
Understanding the Rise of Ransomware Attacks on Rural Hospitals
Policy Brief
University of Minnesota Rural Health Research Center
Date: 06/2024
This policy brief presents findings from a novel database of hospital ransomware attacks, focusing on the frequency and characteristics of ransomware attacks on rural hospitals.
Risk Factors for Poor Health Among U.S. Older Adults in Rural and Urban Areas: Injury, Food Insecurity, and Lack of Social and Emotional Support
Policy Brief
University of Minnesota Rural Health Research Center
Date: 06/2024
This policy brief examines three risk factors for poor health outcomes among older adults: injury, food insecurity, and lack of social and emotional support by rural-urban residence.
Health Insurance Coverage and Experiences of Intimate Partner Violence and Postpartum Abuse Screening Among Rural U.S. Residents Who Gave Birth 2016-2020
Journal Article
University of Minnesota Rural Health Research Center
Date: 05/2024
Rural residents are known to experience higher rates of intimate partner violence (IPV) than their urban counterparts, and IPV contributes to maternal injury and death. In this paper, researchers examine the relationship between perinatal health insurance, intimate partner violence, and postpartum abuse screening among rural U.S. residents.
Discussions of Cancer Survivorship Care Needs: Are There Rural Versus Urban Inequities?
Journal Article
Rural and Underserved Health Research Center
Date: 05/2024
This study used 2017 Medical Expenditure Panel Survey data to test for rural versus urban inequities and identify other correlates of discussions about cancer survivorship care with health care professionals.
Rural/Urban Differences in Housing Quality and Adequacy: Findings From the American Housing Survey, 2019
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2024
In this policy brief, researchers identify rural/urban differences in various measures of housing quality using a nationally representative survey.
Housing for Rural Residents Recovering from Substance Use Disorders
University of Minnesota Rural Health Research Center
Date: 05/2024
The purpose of this case series is to highlight organizations providing housing for individuals in recovery from substance use disorders in rural communities. These may serve as examples to others considering this work.
Differences in Measurement of Operating Margin: An Update
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 05/2024
This study uses recent Medicare Cost Report data to compare rural and urban hospitals using the three definitions for operating margin. Researchers assess the distribution and extent of extreme values of operating margin.
Medicare Advantage Plan Growth in Rural America: Availability of Supplemental Benefits
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2024
This policy brief compares availability of Medicare Advantage plans providing supplemental health-related benefits and special supplemental benefits for the chronically ill in metropolitan, micropolitan, and noncore counties.
Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2024
Using a recent revision of the Financial Distress Index (FDI) model, this study aimed to describe the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals.
Non-Urgent Use of Emergency Departments by Rural and Urban Adults
Policy Brief
Maine Rural Health Research Center
Date: 04/2024
This study provides updated information and addresses gaps in knowledge about rural non-urgent emergency department (ED) use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce inappropriate use of EDs in rural communities.
Satisfaction With Care Among Cancer Survivors With Medicare Coverage: Are There Rural vs. Urban Inequities?
Journal Article
Rural and Underserved Health Research Center
Date: 03/2024
This article examines satisfaction with health care among rural vs urban Medicare cancer survivors. Researchers looked at nine dimensions of health care and tested for rural/urban differences, adjusting for demographic factors, health insurance, and self-rated health.
What Happens to Rural Hospitals During a Ransomware Attack? Evidence From Medicare Data
Journal Article
University of Minnesota Rural Health Research Center
Date: 03/2024
To understand more about how ransomware attacks affect care at rural hospitals, researchers used data on hospital ransomware attacks from 2016 to 2021. This paper describes how ransomware attacks disrupted hospital operations at rural and urban areas, and the implications for these attacks especially in rural areas.
Identifying Rural Health Clinics Within the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files
Policy Brief
Maine Rural Health Research Center
Date: 03/2024
This brief describes a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.
Prevent or Treat: Availability of Diabetes Self-Management Education and Dialysis in High Need Rural Counties
Policy Brief
Rural and Minority Health Research Center
Date: 03/2024
In this brief, researchers assess the availability of in-county diabetes self-management education and dialysis across rural and urban counties.
Partnerships to Address Social Needs Across Metropolitan and Non-Metropolitan Prospective Payment System Hospitals and Critical Access Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2024
This policy brief used American Hospital Association survey data to examine partnerships between hospitals and external organizations to address social needs.
Intimate Partner Violence in Rural Communities: Perspectives from Key Informant Interviews
Policy Brief
University of Minnesota Rural Health Research Center
Date: 03/2024
This policy brief describes findings from interviews with key informants from intimate partner violence (IPV) victim support and advocacy organizations, shedding light on distinct challenges faced by rural victims and survivors. It also highlights targeted opportunities for better supporting the health and safety of rural IPV victims and survivors.
Use of the Area Deprivation Index and Rural Applications in the Peer-Reviewed Literature
Policy Brief
Rural Health Equity Research Center
Date: 03/2024
The Area Deprivation Index (ADI) was developed to capture area-level social deprivation for use in policy and research. In this literature review, researchers find that the use of the ADI in research is common.
COVID-19 Affected Rural and Urban Hospital Uncompensated Care
Fact Sheet
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2024
The purpose of this infographic is to illustrate the impact COVID-19 had on uncompensated care and operating margin among rural and urban hospitals.
Racial/Ethnic Differences in Experiences of Intimate Partner Violence and Postpartum Abuse Screening Among Rural U.S. Residents Who Gave Birth 2016-2020
Policy Brief
University of Minnesota Rural Health Research Center
Date: 03/2024
The goal of this analysis is to describe intimate partner violence among rural U.S. residents who gave birth 2016-2020, with a focus on differences by race/ethnicity. Researchers also describe the frequency by which different racial/ethnic groups are not screened for abuse postpartum.
Rural-Urban Differences in Housing Cost Burden Across the U.S.
Policy Brief
University of Minnesota Rural Health Research Center
Date: 03/2024
Housing is closely tied to health and well-being, but affordable housing is out of reach for many households. This policy brief examines the proportion of households who are housing cost burdened by rural-urban location across different U.S. geographic spaces in order to identify how housing affordability varies by location.
Nonmetropolitan Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces in 2022
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2024
This policy brief describes differences in unsubsidized and net-of-subsidy premiums between nonmetropolitan and metropolitan counties in Health Insurance Marketplace plan design and availability in 2022.
Availability and Quality of Dialysis Care in Rural Versus Urban U.S. Counties
Journal Article
Rural and Minority Health Research Center
Date: 02/2024
An examination of rural-urban differences in quality of dialysis care offered across the United States was conducted using data from Medicare certified dialysis facilities in 2020 from the Centers for Medicaid and Medicare.
Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 01/2024
Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. In this study, researchers estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.
Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey
Journal Article
Rural and Underserved Health Research Center
Date: 01/2024
Combining 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015, this study estimates suicide risks across industries in the U.S. working population.
A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2024
The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. Specifically, researchers investigate the association of uncompensated care with net patient revenue, system affiliation, and ownership.