Rural Health
Research Gateway

Gary Hart, PhD

Contact information for this researcher is no longer available, but you can still access their previous work.

Completed Projects - (22)

  • Access to Physician Care for the Rural Medicare Elderly
    This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
  • Ambulatory Care and the Rural Elderly
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services
  • Chartbook of Family Practice Graduate Medical Education Programs in Rural America
    Little is known about the volume, location, and types of rural training for family physicians. This project will produce a chartbook that makes previously unreported information about family physician residency directors more fully available to medical educators and other policymakers.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
  • Comparisons of Rural Definitions
    This project will lead to the creation of a mega rural and frontier website. This website will emphasize the use of various rural definitions and datasets for healthcare policy, policy analysis, and research. Additionally, researchers will review Dartmouth's Primary Care Service Areas (PCSAs), other Rational Service Area (RSA) methodologies, and alternative methodologies related to their strengths, weaknesses, and spatial analytic criteria regarding their ability to serve in the process of developing useful primary care service areas.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topic: Frontier health
  • Evaluation of Washington State Shortage Designations
    Research center: WWAMI Rural Health Research Center
    Topic: Workforce
  • Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform
    The purpose of this project is to update and supplement the seminal Health, United States, 2001: Urban and Rural Health Chartbook. Resulting information can not only be compared to the 2001 Chartbook but provides a baseline from which to measure future change related to the Accountable Care Act implementation. Where appropriate additional charts are included wherein rural areas are subdivided by type.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Health disparities and health equity, Health services, Public 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
  • Frontier and Rural Definition Development and Dissemination Project
    The Frontier and Remote (FAR) codes are a new geographic definition that delineates frontier/remote areas in the U.S.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topic: Frontier health
  • Medicare Bonus Payments for Physician Care in Health Professional Shortage Areas
    Research center: WWAMI Rural Health Research Center
    Topics: Healthcare financing, Medicare, Physicians
  • National Rural General Surgeon Project
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Physicians, Workforce
  • National Rural Hospital Flexibility Program Tracking Project
    Research center: WWAMI Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Rural Hospital Flexibility Program
  • National Study of Rural-Urban Differences in Use of Home Oxygen for Chronic Obstructive Lung Disease: Are Rural Medicare Beneficiaries Disadvantaged?
    To understand disparities in care among rural and urban Medicare beneficiaries, data from Medicare's Durable Medical Equipment (DME) files were used to assess rural/urban variation in the home use of supplemental oxygen.
    Research center: WWAMI Rural Health Research Center
    Topics: Chronic diseases and conditions, Medicare
  • 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
  • Rural Health Center Expansion and Recruitment Survey
    This collaborative project between WWAMI and the South Carolina Rural Health Research Centers examined and described the current staffing needs of rural health centers (RHCs), ascertained the staffing, recruitment, and retention issues that RHC CEOs regard as most critical; distinguished how issues differ between CEOs contemplating development of expansion sites versus those who are not; and described how these findings correlate with the literature and current national supply projections for the categories of health professions needed by the RHCs.
    Research centers: Rural and Minority Health Research Center, WWAMI Rural Health Research Center
    Topics: Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Workforce
  • Rural Hospice Surveys Regarding Family Members & Health Workforce
    This project's two parts surveyed both hospice users' family members and hospice CEOs regarding their health workforce staffing and shortages. The family member survey involved a sample of hospices from a geographically disperse group of states and the CEO survey involving a national random sample of hospice CEOs.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Hospice and palliative care, Workforce
  • Rural Population Hospice Care
    Relatively little is known about rural hospice care. The objectives of this project are to review and describe what is already known about rural hospices and to perform initial quantitative analyses on available data to describe the: number of rural hospices and their use patterns (e.g., length of stay and utilization rates), rural residents to urban hospice utilization, and rural versus urban resident hospice utilization rates. For this project, rural is be subdivided into categories such as large rural, small rural, isolated small rural, and frontier. To supplement this information, qualitative information was obtained and integrated into the findings report.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Aging, Health services, Quality
  • Rural-Urban Commuting Area (RUCA) Development Project: Demographic Description and Frontier Enhancement
    This project augments the initial RUCA work by producing and describing the base 1998 demography of the RUCA code areas, creating quality state maps of the RUCA codes, and making this information and the codes easily available on the Web.
    Research center: WWAMI Rural Health Research Center
    Topic: Frontier health
  • State Rural Health Workforce Monograph
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
  • The Rural/Urban Practice Location Patterns of Women Medical School Graduates
    While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
  • Use and Performance Variations in Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    This project describes rural usage of rural emergency departments (EDs). It will examine the conditions that are treated in these EDs and describe those that are more and less appropriate for ED use. Rural ED use is described by community characteristics including rural level. The findings provide a baseline from which to measure the future influence of the Accountable Care Act implementation on the usage of rural EDs and the appropriateness and cost efficiency of changes.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Emergency medical services (EMS) and trauma, Quality
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Frontier health, Hospitals and clinics, Medicare
  • Validation of Commuting Area Designations for the Elderly
    Research center: WWAMI Rural Health Research Center
    Topic: Aging

Publications - (59)

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.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2010

2009

2008

2007

2006

2005

  • Pathways to Rural Practice: A Chartbook of Family Medicine Residency Training Locations and Characteristics
    WWAMI Rural Health Research Center
    Date: 08/2005
    This chartbook discusses the characteristics and geography of family medicine residency programs' rural locations, types of rural family medicine training by location, and rural mission of family medicine residencies.
  • Rural Definitions for Health Policy and Research
    Journal Article
    WWAMI Rural Health Research Center
    Date: 07/2005
    Defining "rural" for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of "rural" is required for effectively targeting policy and research aimed at improving the health of rural Americans.
  • WWAMI Physician Workforce 2005
    WWAMI Rural Health Research Center
    Date: 05/2005
    This report responds to a request by the University of Washington School of Medicine Primary Care Steering Committee to examine the current supply and distribution of physicians in the WWAMI region.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
    Date: 04/2005
    This study looked at where Medicare beneficiaries from five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care.
  • The Flight of Physicians From West Africa: Views of African Physicians and Implications for Policy
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2005
    West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes, and consequences of the migration.
  • A National Study of Obesity Prevalence and Trends by Type of Rural County
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2005
    Analyzes data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001 to estimate the recent trends in obesity among U.S. adults residing in rural locations. In 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for urban, representing increases of 4.8% and 5.5%, respectively, since 1994-1996.
  • Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2005

    The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow healthcare professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity.

2004

  • Characterizing the General Surgery Workforce in Rural America
    WWAMI Rural Health Research Center
    Date: 05/2004
    General surgeons form a crucial component of the medical workforce in rural areas of the United States. Analysis of the data suggests that the general surgical workforce has not kept pace with the rising population, and that the number of general surgeons in most rural areas of the United States will decline further.
  • An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/2004
    The Medicare Incentive Payment program provides a 10 percent bonus payment to physicians who treat patients in Health Professional Shortage Areas (HPSAs). Results show that physicians eligible for the bonus payments often did not claim them, and physicians who likely did not work in approved HPSA sites, claimed the bonus payments and received them.
  • Obesity Prevalence in Rural Counties: A National Study
    WWAMI Rural Health Research Center
    Date: 01/2004
    Using a telephone survey of adults ages 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-01, researchers found that the prevalence of obesity was 23% for rural adults and 20.5% for urban adults.

2003

2002

2001

2000

  • U.S. Medical Schools and the Rural Family Physician Gender Gap
    Journal Article
    WWAMI Rural Health Research Center
    Date: 05/2000
    Women comprise increasing proportions of med school graduates. They tend to choose primary care but are less likely than men to choose rural practice. This study identified the U.S. medical schools most successful at producing rural family physicians and general practitioners of both genders.
  • The Distribution of Rural Female Generalist Physicians in the United States
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States.
  • Educating Generalist Physicians for Rural Practice: How Are We Doing?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    About 20 percent of Americans live in rural areas, 9 percent of physicians practice there. Physicians consistently settle in metropolitan, suburban, and other nonrural areas. This report summarizes the successes/failures of medical education and government initiatives intended to prepare and place more generalist physicians in rural practice.
  • Emergency Department Use by the Rural Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.

1999

  • The Production of Rural Female Generalists by U.S. Medical Schools
    WWAMI Rural Health Research Center
    Date: 05/1999
    This paper compares the production of rural female generalists among medical schools. Data from the AMA Physician Masterfile for the 1988-1996 graduate cohort were used to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school.
  • Dimensions of Retention: A National Study of the Locational Histories of Physician Assistants
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice.
  • Metropolitan, Urban and Rural Commuting Areas: Toward a Better Depiction of the U.S. Settlement System
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    Analyzes 1990 census-defined urbanized areas and tract-to-tract commuter flows. Results include a modest shift of population from metropolitan to nonmetropolitan, as well as a significant reduction in the areal size of metropolitan areas, disaggregation of many areas, and frequent reconfiguration to a more realistic settlement form.
  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas.

1997