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Rural Health
Research Gateway

Alana Knudson, PhD, EdM

Director, ETSU/NORC Rural Health Research Center

Phone: 301.908.0835
Email: Knudson@etsu.edu

East Tennessee State University
College of Public Health
PO Box 70623
Johnson City, TN 37614

Current Projects - (1)

Completed Projects - (7)

  • Examination of Rural and Frontier Home Health Services
    This mixed-method study is an in-depth examination of access to and utilization of home health services provided in rural and frontier areas. The study begins to explore how influential patient-centered decision-making is in determining the type of post-acute care services used by rural and frontier Medicare beneficiaries.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Frontier health, Home health, Post-acute care
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    This study described and compared the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. Researchers identified factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics, Medicare, Social determinants of health
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we were interested to learn if there are aspects of the model that could be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Hospitals and clinics
  • Exploring Rural and Urban Mortality Differences
    This project examines the impact of rurality on mortality and explores the regional differences in the primary and underlying causes of death. It also explores the role of the rural public health systems in addressing social determinants of health.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Public health, Social determinants of health
  • Hospitalizations of Rural Children for Ambulatory Care Sensitive Conditions
    This project uses state inpatient discharge data from six states, data from the Area Resource File and the AHRQ Pediatric Quality Indicators to examine Ambulatory Care Sensitive Condition admission rates for rural children.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Children and adolescents, Chronic diseases and conditions
  • Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural American Indian Elders
    This project examined the types of health insurance coverage of rural Native American elders ages 55 and older, and examine how different types of health insurance coverage and lack of health insurance coverage impact access to health care services among Native American elders by geographic location (rural frontier, rural non-frontier and urban).
    Research center: Upper Midwest Rural Health Research Center
    Topics: Aging, Frontier health, Healthcare access, Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  • Perspectives of Rural Hospice Directors
    Rural hospice care, as it is currently configured, is under pressure by a variety of factors (e.g., policy and regulation, economic and financial, and organizational and structural) which are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system (i.e., typically a small non-profit arrangement) and design (i.e., a delivery system reliant on community connections and personal relationships) of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states. Fifty-three directors or key staff members were interviewed during a three-month period in 2013.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality, Telehealth

Publications - (14)

2022

  • 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.

2021

  • 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.
  • 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.

2020

  • Considerations for Defining Rural Places in Health Policies and Programs
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 05/2020
    Rural definitions in statute and policy are used to direct resources to underserved people. But changes in population behavior and census processes have led to concern about historic methods of defining rural. This paper identifies key questions, reviews rural definitions, and discusses options for reconsidering rural definitions.

2017

2016

  • Exploring Rural and Urban Mortality Differences
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2016
    Contains visual aids which display indicators of mortality rates by cause of death, age group, rural-urban status, region, and sex for populations 15 years of age and older cross-referenced to tables and statistical results.

2015

  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015
    Rural hospice care is under pressure by a variety of factors that are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.

2014

  • Rural-Urban Disparities in Heart Disease
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014
    The Department of Health and Human Services' report Health, United States, 2001: With Urban and Rural Health Chartbook illustrated trends and highlighted priorities in urban/rural health. The Rural Health Reform Policy Research Center replicated the analyses using the most recent data available. This brief highlights key heart disease findings.

2010

2008

2007

2005