Rural Health
Research Gateway

Ira Moscovice, PhD

University of Minnesota Rural Health Research Center

Phone: 612.624.8618
Email: mosco001@umn.edu

University of Minnesota
Division of Health Policy and Management
2221 University Ave. SE, Suite 350
Minneapolis, MN 55414

Completed Projects - (48)

  • Access and Quality of Care for Rural Patients with Chronic Obstructive Pulmonary Disease
    Although rates of chronic obstructive pulmonary disease (COPD) are substantially higher in rural areas, there has been limited research on healthcare access and quality issues for individuals with COPD who live in rural communities. This project aimed to improve the accessibility and quality of care for rural COPD patients.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Cancer, Chronic diseases and conditions, Quality
  • Affordable Care Act Outreach and Enrollment: Case Studies of Rural Hospitals in Four States
    The purpose of this project is to identify best practices used by rural hospitals to educate uninsured rural patients and consumers about available health insurance coverage options and to assist them in enrolling in a Qualified Health Plan or Medicaid.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Medicaid and CHIP, Uninsured and underinsured
  • Analysis of Critical Access Hospital Inpatient Hospitalizations and Transfers from CAHs to Other Acute and Post-Acute Care Settings Using State Inpatient Databases
    The purpose of this project is to analyze Critical Access Hospital (CAH) inpatient hospitalizations and transfers from CAHs in order to help inform the development of quality indicators for CAHs, especially quality indicators focused on the transfer process.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Post-acute care, Quality
  • Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
    This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare financing, Networking and collaboration
  • Are Part D Plans Meeting the Needs of Rural Medicare Beneficiaries?
    The purpose of this project is to assess whether the Medicare Part D prescription drug plans available in rural counties are sufficient to meet the needs of rural Medicare beneficiaries.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  • Assessing Pent-Up Demand for Rural Medicare Beneficiaries
    The purpose of this project is to estimate the amount of pent-up demand of rural Medicare beneficiaries who enter risk plans.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Medicare
  • Assessing the Rural Relevance of Hospital Outpatient Quality Measures
    The purpose of this project is to: 1) determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and 2) to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Beyond Simple Ranking: Identifying and Empirically Testing Alternative Approaches for Recognizing Quality in Rural Hospitals
    The purpose of this project is to explore several alternative methods for assessing the relative quality of hospitals using data from the Hospital Quality Incentive Demonstration Project and Hospital Compare.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Critical Access Hospital Participation in the Hospital Quality Alliance and Initial Quality Measure Results
    This project examined the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presented the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Quality
  • Critical Access Hospital Readiness for CMS Value-Based Purchasing
    The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Quality
  • Developing a Quality Performance Measurement System for Critical Access Hospitals
    This project continues to support activities related to quality performance measurement relevant for Critical Access Hospitals. By the end of 2005, the technical expert panel had reviewed the findings of the initial field test of the small rural hospital quality measure set and made recommendations for revisions.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Quality
  • Developing Quality Measures and Communication Strategies for Rural Patient Transfers
    The purpose of this project is to quantify the complexity of the coordination of patient care in rural health care systems and to expand our work on developing quality measures for rural patients whose care is transferred between providers.
    Research center: Upper Midwest Rural Health Research Center
    Topic: Quality
  • Developing Relevant Quality Indicators for Rural Hospitals
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries
    The purpose of this project is to: 1) determine how location of hospitals used for initial admissions by rural patients affects readmission rates; 2) assess how the use of swing beds affects rural patients' readmissions; and 3) examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Medicare, Post-acute care
  • Federal Rural Health Outreach Grant Program: The Impact and Sustainability of Grantees
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health services, Networking and collaboration
  • Has the Medicare Part D Program Improved Medication Access and the Health Status of Rural Beneficiaries?
    This project will use Medicare Current Beneficiary Survey data to assess the impact of the Medicare Part D Program on medication access and the health status of rural Medicare beneficiaries.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Medicare Advantage (MA), Medicare Part D, Pharmacy and prescription drugs
  • Health Information Technology and Quality in Rural Hospitals
    The purpose of this project is to: 1) examine the adoption of health information technology (HIT) among rural hospitals and identify hospital and market characteristics that facilitate or impede HIT diffusion; 2) measure the effect of HIT on clinical quality in rural hospitals; and 3) identify technologies that may be promoted to improve quality of care in rural areas.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health information technology, Hospitals and clinics, Quality
  • High Quality Rural Hospitals and Post-Acute Care Providers
    This project will use several large longitudinal national databases to model alternative ways of identifying high quality rural hospitals, analyze factors related to quality in rural hospitals, and examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Post-acute care, Quality
  • 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
  • Identifying Adverse Drug Events and Improving Patient Safety in Rural Hospitals
    This study identifies rates of adverse drug events (ADEs) and opportunities to improve patient safety in Critical Access Hospitals (CAHs) and non‐CAH rural hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
    This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Healthcare financing
  • 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, American Indians and Alaska Natives, Frontier health, Healthcare access, Minority health, Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  • Impact of Hospitalists on Inpatient and Primary Care in Rural Communities
    This project will analyze primary data from a survey of rural hospitals about their use of hospitalists along with several sources of secondary data to examine why and how hospitalists are being used in rural hospitals and the impact of their use.
    Research center: Upper Midwest Rural Health Research Center
    Topic: Hospitals and clinics
  • Impact of Private Sector Quality Initiatives on Rural Providers and Patients
    The purpose of this project is to assess the impact of private sector quality reporting and quality improvement initiatives on rural providers and on the quality of care provided to rural patients.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Quality
  • Impact of the CMS Value-Based Purchasing and Readmission Reduction Programs on Rural Hospitals
    The purpose of this project is to assess the initial impacts of the Value-Based Purchasing (VBP) and Readmission Reduction Programs on rural Prospective Payment System (PPS) hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Hospitals and clinics
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Telehealth
  • Measuring Quality Performance in CAHs
    The purpose of the project is to update our previous analyses of Critical Access Hospital (CAH) participation in Hospital Compare, analyze trends over time, and explore additional sources of quality data for CAHs.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Quality
  • Measuring the Quality of Swing Bed Care in Critical Access Hospitals
    This project identified quality measures to be used by Critical Access Hospitals to assess the quality of care provided to their swing bed patients, and recommend appropriate uses of the measures.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Post-acute care, Quality
  • National Rural Hospital Flexibility Program Tracking Project: Analysis of CAH Quality Improvement (QI) Strategies
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Quality, Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Analysis of the Financial Impact of Conversion on Critical Access Hospitals (CAHs) and the Medicare Program
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Rural Hospital Flexibility Program
  • Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project
    The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the CMS/premier Inc. Hospital Quality Incentive Demonstration project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Quality, Workforce
  • Obstetric Care Practice Models and Quality in Rural Hospitals
    The project will examine current obstetric practice models in rural hospitals and assess the prospects for implementation of new policy recommendations for reducing primary cesarean rates and non-medically indicated inductions of labor in rural hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Maternal health, Quality
  • Patient Assessments and Quality of Care in Rural Hospitals
    This study will 1)analyze the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care; and 2) assess whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Quality
  • Pay-for-Performance and Quality Improvement in Rural Hospitals
    This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Healthcare financing, Hospitals and clinics, Quality
  • Preventing Errors in Rural Hospitals
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Quality
  • Progress Toward Meaningful Use of Health Information Technology Among Rural Physician Practices
    This project will assess progress toward the meaningful use of health information technology among rural physician practices, using several sources of data. This empirical analysis will be supplemented by a qualitative assessment of rural physician practices' experiences with the meaningful use of health IT, working with two quality improvement organizations (QIOs)/Regional Extension Centers (RECs).
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health information technology, Physicians
  • Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
    The purpose of this project is to continue to investigate the relationship between Critical Access Hospital financial performance and quality of care. The University of Minnesota and the University of North Carolina will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Quality, Rural Hospital Flexibility Program
  • Quality Measures and Sociodemographic Risk Factors: The Rural Environmental Context
    For three acute care conditions/diagnoses (potential examples include diabetes, congestive heart failure, COPD), this study will (1) identify the key socio-demographic variables that may affect quality adjustment for rural populations/providers; (2) identify data sources/strategies available for the above variables; and (3) identify the quality measures (e.g. readmission rates) that should be adjusted for socio-demographic variables for rural populations/providers and estimate the potential impact of those adjustments on quality measurement.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Diabetes, Quality, Rural statistics and demographics
  • Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
    This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Health services, Hospitals and clinics
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
    This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs' role as safety net providers.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Emergency medical services (EMS) and trauma, Hospitals and clinics, Quality, Workforce
  • Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008
    Under contract with the federal Office of Rural Health Policy, the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project will assess the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Rural Hospital Flexibility Program
  • Rural Hospital Obstetric Workforce, Procedure Utilization, and Quality of Care
    This study examines the relationships between key aspects of the obstetric workforce in rural hospitals and procedure intensity and quality of maternity care in those hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Maternal health, Quality, Women, Workforce
  • Rural Implications of Health Care Reform: Issues Related to Quality of Care, Health Information Technology and Care Coordination
    The purpose of this project is to provide support to the Office of Rural Health Policy on rural health care reform issues.
    Research center: Upper Midwest Rural Health Research Center
    Topic: Health services
  • Rural Implications of Quality-Based Physician Payment Reform
    The purpose of this project is to assess existing national data about the quality of care provided by rural physicians, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Physicians, Quality
  • Rural Women Giving Birth in Non-Local Hospitals: Implications for Obstetric Access and Quality
    The purpose of this project is to: 1) analyze recent data from nine geographically diverse states on delivery by rural women at non-local hospitals; 2) characterize the roles of medical vs. non-medical factors in delivery at a non-local hospital by identifying lower-risk and higher-risk women using established criteria; and 3) analyze the relationship between delivery at a non-local hospital and obstetric quality.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Quality, Women
  • Rural-Urban Differences in Insurer Participation, Premiums, Health Plan Provider Networks in Federal and State Marketplaces
    This two-year project will: 1) measure rural-urban differences in the size, scope, and composition of provider networks affiliated with Marketplace plans; 2) analyze the relationships between provider network size and composition, other benefit design attributes, geographic rating area designations, and premiums; and 3) examine how rural and urban Marketplace-based plan enrollment is affected by plan availability and provider network size and scope.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Private health insurance
  • Successful Implementation of Medication Safety Initiatives in Rural Hospitals: The Role of Pharmacists and Technology
    This project will assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, and will identify factors that facilitate successful implementation of medication safety practices in rural hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
  • What Constitutes An Adequate Provider Network For Rural Health Populations?
    The purpose of this study is to develop norms/standards for provider network adequacy for rural populations (which may vary across different rural environments) that will be useful to consumers, providers, and policymakers in the decisions they face with respect to health plan choices, participation, and policies.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Private health insurance

Publications - (87)

2020

  • Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    The increasing number of nurse practitioners (NPs) in the rural U.S. has the potential to help alleviate primary care shortages. Using a nationwide source of claims and Electronic Health Record data from 2017, this study constructs measures of NP clinical autonomy and complexity of care.

2019

  • Quality Measures for Critical Access Hospital Swing Bed Patients
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2019
    This study identified measures to be used to assess the quality of care provided to Critical Access Hospital (CAH) swing bed patients with the goal of having these measures endorsed by the National Quality Forum and used by policymakers to help assess the value of CAH swing beds.

2018

2017

2016

2015

  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
  • Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 07/2015
    This brief analyzes how the plan options available to rural and urban beneficiaries differ in terms of premiums, deductibles, and copayments, as well as differences in plan options within rural areas.
  • Rural and Urban Differences in Choice of and Satisfaction With Medicare Part D Plans
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 07/2015
    This brief examines whether rural Medicare beneficiaries are satisfied with their Medicare Part D drug plans and whether there is a difference in beneficiary satisfaction and plan selection experience by rurality.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2015
    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
  • Minimum Distance Requirements Could Harm High-Performing CAHs and Rural Communities
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2015
    Compares the effect of location on critical access hospitals' size, quality of care, and financial strength. Discusses implications of minimum distance requirements on critical access hospitals.
  • The Rural Obstetric Workforce in U.S. Hospitals: Challenges and Opportunities
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2015
    Describes the healthcare and clinician types who are delivering babies in rural hospitals, such as family physicians, general surgeons, obstetricians, and midwives. Discusses the relationship between hospital birth volume and staffing models.
  • Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2015
    This study's purpose was to examine the relationship between nurse staffing levels and care quality in rural nursing homes and to assess potential differences between hospital-based and freestanding rural nursing homes.

2014

2013

2012

  • Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 07/2012
    As a part of a larger project that examined alternative ways of identifying high quality rural hospitals, this report assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals.
  • The Use of Hospitalists in Small Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 04/2012
    This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants, or nurse practitioners who assume responsibility for patient care during inpatient hospital stays.

2011

  • Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 09/2011
    This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues.
  • Care Transitions: "Time to Come Home"
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2011
    This policy brief examines care coordination, with a focus on the transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.
  • Care Transitions: "Time to Come Home" (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 03/2011
    This report looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community, and suggests ways of measuring the quality of care coordination on discharge from the hospital.
  • Meaningful Use of Health Information Technology by Rural Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 01/2011
    This study examines the current status of meaningful use of health information technology in Critical Access Hospitals (CAHs) and other rural and urban U.S. hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use.

2010

2009

  • Implementing Patient Safety Initiatives in Rural Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 09/2009
    This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in eight small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of three patient safety interventions.
  • Potentially Preventable Readmissions in Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 08/2009
    Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals and discusses the rural implications of policy initiatives to reduce readmission rates.
  • Health Information Technology Policy and Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009
    This brief summarizes the implementation status of key health information technology (HIT) applications in critical access hospitals and other rural hospitals and discusses policies for encouraging HIT adoption in rural hospitals.
  • Rural Issues Related to Bundled Payments for Acute Care Episodes
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009
    Bundling Medicare payments has been proposed as a way of encouraging providers to find innovative, cost-reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address the challenges.
  • Rural Issues Related to Comparative Effectiveness Research and Dissemination
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009
    This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.

2008

2007

2006

2005

  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2005
    This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
  • Is Large Really Beautiful? Physician Practice in Small Versus Large Scale Communities
    University of Minnesota Rural Health Research Center
    Date: 09/2005
    This paper examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-99) of a national sample survey conducted as part of the Community Tracking Study. Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practices.
  • Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 2005

    Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.

2004

2003

  • Grantee Sustainability in the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 12/2003
    This paper describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients and focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
  • Rural Health Networks: Evolving Organizational Forms and Functions
    University of Minnesota Rural Health Research Center
    Date: 06/2003
    This report discusses results of a survey of rural health networks. It includes information about the location, membership, relationships, governance, management, process, and products of rural health networks.
  • Environmental Context of Patient Safety and Medical Errors
    University of Minnesota Rural Health Research Center
    Date: 03/2003
    This paper explores the environmental context of patient safety/medical errors with specific interest in rural areas. It reviews patient safety/medical error literature, identifies features of rural healthcare organizations and their environment relating to patient safety issues/medical errors, and discusses error reduction/prevention strategies.
  • Rural Hospitals: New Millennium and New Challenges
    University of Minnesota Rural Health Research Center
    Date: 02/2003
    This report discusses the changes in rural hospitals that took place in the decade of the 1990s and discusses some of the challenges that face rural hospitals in 2003. It includes discussion of rural hospitals' organizational structures, health service provision, payment/reimbursement, and financial performance.
  • The Financial Effects of Critical Access Hospital Conversion
    University of Minnesota Rural Health Research Center
    Date: 01/2003
    This paper describes how the first wave of conversions to critical access hospital status affected rural hospitals' financial performances and organizational structures.
  • Rate of Return on Capital Investments at Small Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2003
    This paper examines whether the aging of rural facilities is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment.

2002

  • Use of the Hospice Benefit by Rural Medicare Beneficiaries
    University of Minnesota Rural Health Research Center
    Date: 08/2002
    This publication identifies urban-rural differences in hospice use in rural service areas.
  • Rural Hospital Access to Capital: Issues and Recommendations
    University of Minnesota Rural Health Research Center
    Date: 07/2002
    This paper identifies programs that have assisted/could assist rural hospitals in meeting capital needs; assesses whether rural hospital borrowers have difficulty in meeting capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals.
  • Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with limited inpatient services.
  • Understanding Rural Hospital Bypass Behavior
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This study provides a descriptive analysis of rural hospital bypass behavior. It focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.

2001

2000

  • Financial Viability of Rural Hospitals in a Post-BBA Environment
    University of Minnesota Rural Health Research Center
    Date: 10/2000
    This paper evaluates the financial viability of rural hospitals under the Balanced Budget Act of 1997 and the Balanced Budget Refinement Act of 1999 Medicare payment policies. It estimates the number of hospitals that will become critical access hospitals and the number of beds at each hospital.
  • Why Do Rural Primary-Care Physicians Sell Their Practices?
    University of Minnesota Rural Health Research Center
    Date: 06/2000
    This study evaluates why rural primary care physicians sell their practices. It examines the factors that led independent physicians to sell their practices to either non-local buyers, local hospitals, or local physicians.