Marilyn Klug, PhD

North Dakota and NORC Rural Health Reform Policy Research Center

Phone: 701.787.0089
Email: marilyn.klug@med.und.edu

Center for Rural Health
University of North Dakota
1301 N. Columbia Road, Stop 9037
Grand Forks, ND 58202

Current Projects - (2)
Completed Projects - (2)
Publications - (6)

Current Projects - (2)

Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify 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: Rural Health Equity Research Center
Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Health disparities and health equity, Healthcare access, Hospitals and clinics, Medicare, Social determinants of health
Rural/Urban Differences in Forgoing Health Care during the COVID-19 Pandemic
Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
Research center: Rural Health Equity Research Center
Topics: Aging, Care management, Chronic diseases and conditions, Coronavirus Disease 2019 (COVID-19), Diabetes, Health disparities and health equity, Health promotion and disease prevention, Health services, Medicare, Mental and behavioral health, Minority health, Telehealth

Completed Projects - (2)

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
Potentially Preventable Rural Hospital Readmissions
This project focuses on the analysis of potentially preventable rural hospital readmissions, a potential quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and MedPAR inpatient claims data from 9 geographically representative states, this study will explore the relationship between readmission rates and geographic regions, categories of rural hospitals, discharge destination, clinical diagnoses and patient attributes.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Quality

Publications - (6)

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

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.

2012

Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2012
This brief explores the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban patients, and time to follow-up care. These factors were examined in a large population of Medicare patients with hospital stays for congestive heart failure or bacterial pneumonia.
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
Upper Midwest Rural Health Research Center
Date: 03/2012
This study explored the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban residence of the patient, and time to follow-up care.

2010

Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals (Final Report)
Upper Midwest Rural Health Research Center
Date: 11/2010
Potentially preventable readmissions (PPRs) among Medicare patients are examples of inefficiencies in the healthcare system. This study estimated PPRs in three types of acute care hospitals: urban prospective payment system (PPS), rural PPS, and Critical Access Hospitals.

2009

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.